Health Care for the Homeless:the Basics

CHE/Trinity Homeless Champions Webinar #1

October 14, 2014

Introduction:Doreen Fadus, CBMO, Mercy Medical Center, Springfield MA

Presenters:John Lozier, Executive Director, National HCH Council, Nashville

TNHeidi Nelson, CEO, Duffy Health Center, Hyannis MA

Catholic Social TeachingA  basic moral test is how our most vulnerable members are faring. In a society  marred by deepening divisions between rich and poor, our tradition recalls the  story of the Last Judgment (Mt 25:31-46) and instructs us to put the needs of the poor and vulnerable first.

http://www.usccb.org/beliefs-and-teachings/what-we-believe/catholic-social-teaching/seven-themes-of-catholic-social-teaching.cfm

130 Organizational Members, including:•St. Joseph’s Mercy Care, Atlanta GA•Mercy Medical Center, Springfield MAHCH Clinicians’ NetworkNational Consumer Advisory BoardRespite Care Providers’ NetworkPractice-Based Research Network

Funding:•National Cooperative Agreement with HRSA to

provide training & TA to 255 HCH grantees and others•2 HCIA awards from CMS (studying Community Health

Workers and Medical Respite Care)•Additional public and private support

The mission of the National Health Care for the Homeless Council is to eliminate homelessness by ensuring comprehensive health care and secure housing for everyone.

The National Health Care for the Homeless Council was founded on the principles that•homelessness is unacceptable;•every person has the right to adequate food, housing, clothing, and health care;•all people have the right to participate in the decisions affecting their lives;•contemporary homelessness is the product of conscious social and economic policy decisions that have retreated from a commitment to insuring basic life necessities for all people; and•the struggle to end homelessness and alleviate its consequences takes many forms, including efforts to insure adequate housing, health care, and access to meaningful work.

Who is Homeless?A homeless person is an individual without

permanent housing who may live on the streets, stay in a shelter, mission, single room

occupancy facilities, abandoned building or vehicle, or in any other unstable or non-

permanent situation. A recognition of the instability of an individual's living arrangements is critical to the definition of homelessness.

*Bureau of Primary Health Care

Please Use These Diagnosis Codes for

HomelessnessICD-9-CM: v60.0 ICD-10-CM: Z59.0

REFERENCE TERMS:Hobo

Lack of housing, shelterSocial Migrant

NomadTramp

TransientVagabondVagrant

Causes of Homelessness

Housing Costs+

Insufficient incomes

=Homelessness

In the United States, the 2014 two-bedroom Housing Wage is $18.92. This national average is more than two-and-a-half times the federal minimum wage, and 52% higher than it was in 2000. In no state can a full-time minimum wage worker afford a one-bedroom or a two-bedroom rental unit at Fair Market Rent.

-National Low Income Housing CoalitionOut of Reach 2014 http://nlihc.org/oor/2014

Causes of Homelessness

Poor health causes homelessness–Financial impact (medical bankruptcy)–Personal Impact (behavioral health -> exclusion)–Effects of Trauma

A Second Relationship Between Homelessness &

HealthHomelessness causes poor health– Exposure to elements, communicable

disease, violence, parasites – Poor nutrition– Poor sleep/rest• Criminalization of homelessness

– Exacerbation of existing conditions– Self-medication & depression

A Third Relationship Between Homelessness & Health

Homelessness interferes with treatment– Competing priorities– Adherence difficulties– Transportation– Uninsurance

Institute of Medicine, Homelessness, Health, and Human Needs. Washington: National Academy Press, 1988.

CONSEQUENCES• Pervasive homelessness• High rates of illnesses (3-6 times)• Multiple complex morbidities• Premature mortality (30 years)• Deferred care/high costs• Inappropriate ER utilization• Discharge difficulties

Health Care for the Homeless Grantees

http://www.nhchc.org/resources/grantees/national-hch-grantee-directory/

Training & Technical Assistance

• National HCH Conference–Washington DC, May 7-9, 2015

• Eastern Regional Training– New York City, March 19-20, 2015

• Live and archived webinars– http://www.nhchc.org/cat/webinars/

• Technical Assistance

Community BenefitNeeds assessment resources

Toolkit: Assessing Your Community’s Health: A Needs Assessment Toolkit for HCH Grantees

http://www.nhchc.org/wp-content/uploads/2014/02/chna-toolkit_final_2-21-14.pdf

Webinar: HRSA Needs Assessment for HCH Grantees

http://www.nhchc.org/2013/09/homeless-persons-memorial-day-2014/

Community benefit examples

The HCH Approach to Care• PCMH – Patient-Centered Medical

Homes • Coordination of Care• Multidisciplinary Teams• Access– Street outreach– Accessible locations & hours– Elimination of financial barriers

• Patient Self-determination Goal Setting

Evidence-Based HCH Practices

• Motivational Interviewing• Trauma Informed Care• Harm Reduction• Cultural Competency

Promising Practice:• Medical Respite Care

http://www.nhchc.org/resources/clinical/medical-respite/

Adapted Clinical Guidelines• Asthma• Cardiovascular Diseases: Hypertension, Hyperlipidemi

a & Heart Failure• Chlamydial or Gonococcal Infections • Chronic Pain• Diabetes Mellitus • General Recommendations for the Care of Homeless

Patients• HIV/AIDS• Opioid Use Disorder• Otitis Media• Reproductive Health Care

http://www.nhchc.org/resources/clinical/adapted-clinical-guidelines/

Coming in this Champions Series

Nov. 13, 2014 Redirecting Frequent Users from Emergency Rooms to Primary Care

Dec. 11, 2014Medical Care on the Streets: Homeless Outreach

Jan. 13, 2015Care Transitions: Hospital Discharge and Medical Respite Care

Feb. 12, 2015Payment Challenges

Mar. 12, 2015 Housing & Health Care

All 3:00 – 4:00 pm Eastern