![Page 1: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/1.jpg)
Hospital Discharge of
Homeless Persons in Chicago
2000 - 2006
![Page 2: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/2.jpg)
National Alliance to End Homelessness Annual Conference
2006
Arturo Valdivia BendixenAssociate Director
AIDS Foundation of [email protected]
![Page 3: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/3.jpg)
Presentation• The Interfaith House Experience
• Snapshot Study of Cook County Hospital – 2006
• Integrating Systems of Care
• The CHHP Experience
![Page 4: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/4.jpg)
Interfaith House• 64 bed respite care facility
• Hospital referrals from hospital discharge social workers
• At capacity most of the time
• 3 largest referral sources:
- Cook County Hospital (Stroger)
- Mt. Sinai Hospital
- West Side VA Hospital
![Page 5: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/5.jpg)
Study of Discharges to Respite Care
Dr. David Buchanan
Service Respite Care Usual Group
• Inpatient Days: mean: 3.4 mean: 8.1
• ER Visits: mean: 1.4 mean: 2.2
• Outpatient Vts: mean: 6.7 mean: 6.0
![Page 6: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/6.jpg)
Hospital Discharges
• Interfaith House
• Variety of Shelters
• Temporarily with family / friends
• Some discharged to the streets
• Some placed inappropriately at nursing homes
![Page 7: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/7.jpg)
Prevalence of the Homelessat Cook County Hospital - 2006
Dr. David Buchanan
Snapshot of inpatients at hospital:• Homeless (HUD definition): 19.8%
• Doubled-up homeless: 12.6%
TOTAL: 32.4%
• Mean duration of homelessness: 15.6 months
![Page 8: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/8.jpg)
Homelessness =THE FAILURE OF
MULTIPLE SYSTEMS OF
CARE
![Page 9: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/9.jpg)
Chicago Area• No tracking of the homeless at hospitals• No designated social workers to serve the
homeless• Expedited hospital discharges often
result in poor referrals and placements• Poor integration of hospital social
services with shelter or housing systems
![Page 10: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/10.jpg)
![Page 11: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/11.jpg)
Organizational Partners
• 3 Key Medical Centers / Hospitals
• 11 Supportive Housing Providers
• 3 Respite/Interim Housing Providers
• 7+ Health Care Foundations
• HUD / HOPWA
![Page 12: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/12.jpg)
Client Partners
• Adults who are homeless
• In-patient at 3 area hospitals
• At least 1 chronic medical illness
• Willingness to give consent
![Page 13: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/13.jpg)
4-Year Demonstration & Research Project
Sept. 2003 to Aug. 2007
First of Chicago’s Plan to End Homelessness
![Page 14: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/14.jpg)
CHHP Project Design
• Systems Integration - Council of Executive Directors
- Oversight Committee of Directors
- Systems Integration Team of Social Workers and Case Managers
- Integrated Funding Opportunities
![Page 15: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/15.jpg)
CHHP Project Design
• Hospital
• Respite Program
• Permanent Housing
![Page 16: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/16.jpg)
Systems Integration Team
Serving the Intervention Group
• Hospital: 2 case managers• Interim/Respite Housing: 3 case managers• Housing: 10 case managers• Coordination: 1 coordinator
![Page 17: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/17.jpg)
Project Design - Housing
• Supportive Housing – variety of models
• Intensive Case Management – 10:1 ratio
• “Housing First” approach
• “Harm Reduction” models
• Research Component
![Page 18: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/18.jpg)
CHHP ParticipantsJune 30, 2006 – Final Enrollment
• Intervention: 216
• Usual Care: 220
• TOTAL: 436
![Page 19: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/19.jpg)
CHHP “Intervention”
Participants
![Page 20: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/20.jpg)
Intervention GroupEnrollment
Began September 2003
Concluded May 2006
![Page 21: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/21.jpg)
Intervention GroupTop Multiple Diagnoses - 216 Participants
HIV/AIDS 75 participants 34%
Hypertension 73 participants 33%
Cardiovascular Diseases 33 participants 14%
Pulmonary Diseases 39 participants 18%
Diabetes 32 participants 14%
Gastrointestinal / Liver 14 participants 6%
Seizure Disorders 18 participants 8%
![Page 22: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/22.jpg)
Intervention GroupGender – 216 Participants
0
10
20
30
40
50
60
70
80
Male TransG
Gender
• Male: 74%
- 159 participants• Female: 25%
- 56 participants• Transgender: 1%
- 1 participant
![Page 23: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/23.jpg)
Intervention GroupAge – 216 Participants
0
10
20
30
40
50
60
70
21+ 41+ 61+
Age
• 21 - 40: 30% - 64 participants
• 41 - 60: 64% - 140 participants
• 61 - 82: 6% - 12 participants
• MEDIAN: 47 years
![Page 24: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/24.jpg)
Intervention GroupRace/Ethnicity – 216 Participants
0
10
20
30
40
50
60
70
80
Race/Eth
• African A / Black: 77%
- 166 participants
• Hispanic / Latino: 8%
- 17 participants
• Caucasian / White: 10%
- 22 participants
• Other: 5%
- 11 participants
![Page 25: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/25.jpg)
Long-Term Homelessness216 Participants
• Long-Term Homelessness (HUD)
151 participants - 70%
• Short-Term Homelessness
65 participants - 30%
![Page 26: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/26.jpg)
Substance Use History216 Participants
• Assessed with Long Term History
153 participants - 71%• Estimated with Long-Term History
186 participants - 86%
![Page 27: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/27.jpg)
Mental Illness History216 Participants
• Diagnosed with Long Term History
67 participants - 31%
• Estimated with Long-Term History
99 participants - 46%
![Page 28: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/28.jpg)
Stably Housed
![Page 29: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/29.jpg)
Reached Stable HousingIntervention Group – 11/03 to 6/06
• 75% are reaching permanent housing
• 60% are remaining housed for 1+ year
![Page 30: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/30.jpg)
Housed Less Than 1 YearJune 2006
• 11 died in stable housing
• 2 went nursing home (terminal illness)
• 5 went to prison / jail
• 13 lost housing – eviction, illegal or violent behavior
![Page 31: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/31.jpg)
Reached Stable HousingIntervention Group – 11/03 to 6/06
Length of days to reach housing after hospital discharge-
• Average: 76 days
• Range: 70 – 90 days / {outliers: 0 – 371 days}
• Median: 62 days
![Page 32: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/32.jpg)
1+ Year HousedMISA Issues
• Substance Use History – 60% • Mental Illness History – 10% • MISA History - 20%
![Page 33: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/33.jpg)
Not Achieved Stable Housing25%
Common Challenges
• 50% disengaged after hospital discharge• Serious mental illness history with
neuropsychiatry issues for some• Serious MISA histories• Felony histories – esp. sex offenders• Chronic illness complications – in nursing
homes• Death before housing placement• Return to jail or prison
![Page 34: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/34.jpg)
Preliminary OutcomesJune 2006
Nursing Home Days
Intervention Group:
• 2,146 days
Usual Care Group:
• 6,553 days0
1000
2000
3000
4000
5000
6000
7000
Days
Intervention Usual Care
![Page 35: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/35.jpg)
Preliminary OutcomesJune 2006
0
0.5
1
1.5
2
2.5
3
3.5
4
Visits
Intervetion Usual Care
Emergency Room Visits
Intervention Group• 2.5 times less
(mean: 1.6)
Usual Care Group• 2.5 times more
(mean: 4.0)
![Page 36: Hospital Discharge of Homeless Persons in Chicago 2000 - 2006](https://reader036.vdocuments.net/reader036/viewer/2022062423/56649ea65503460f94ba938f/html5/thumbnails/36.jpg)
Preliminary OutcomesJune 2006
HospitalizationsIntervention Group:
• Mean: 1.5
Usual Care Group:
• Mean: 2.30
0.5
1
1.5
2
2.5
Hospitalizations
InterventionUsual Care