nascsp conference
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NASCSP Conference . Charlene M. Flaherty Director, Southwest September 11, 2013. Our Mission. Advancing housing solutions that:. Building Strong, Healthy Communities. Locations where CSH has staff stationed. Locations where CSH has helped build strong communities. - PowerPoint PPT PresentationTRANSCRIPT
The Source forHousing Solutions
NASCSP Conference
Charlene M. FlahertyDirector, SouthwestSeptember 11, 2013
Our Mission
Improve lives of vulnerable
people
Maximize public
resources
Build strong, healthy
communities
Advancing housing solutions that:
Building Strong, Healthy Communities
Locations where CSH has staff stationed
Locations where CSH has helped build strong communities
High Utilization of Hospitals & EDs
A subset of individuals are caught on a revolving door of emergency department visits, inpatient hospitalizations, and use of other crisis health services
These individuals typically have complex needs, with multiple co-occurring chronic conditions and social challenges including extreme poverty, limited social supports, and homelessness
Failing to address the needs of these individuals not only contributes to their worsening health status, but also poor use of public and institutional resources
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A Small Number of Very High Risk Homeless Persons
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Probation
Sheriff mental healthjail
Sheriff medical jail
Sheriff general jail
LAHSA homelessservices
GR HousingVouchers
General Relief
Food Stamps
Paramedics
Public Health
Mental Health
Private hospitals-ER
Health Srv - ER
Health Srvoutpatient clinic
Private hospitals-inpatient
Health Srv hospital-inpatient
•The most expensive 10% of homeless persons have average monthly costs $6,529
•LA County linked service and cost records across county departments for a representative sample of recipients to produce this exceptionally valuable data
Source: 2,907 homeless recipients in LA County with DHS ER or inpatient records Deciles based on costs in all months
Housing Instability Contributes to Frequent ED Use
Growing understanding of role that homelessness and housing instability plays in contributing to frequent use
“The recognition of the complex care needs and fragile social circumstances of these especially high-need patients has stimulated fresh thinking about aggressive outreach, intense coordination of services by integrated care teams, and the need for nonmedical resources such as supportive housing, all of which could likely help curb the cost of health care.” – M. Raven and D. Gould
Housing Is Health Care
Impacts on Health Denver study found 50% of
tenants placed into SH experienced improved health, 43% had improved mental health outcomes, and 15% reduced substance use
Seattle study found 30% reduction in alcohol use among chronic alcohol users in supportive housing
SH in San Francisco and Chicago had higher survival rates for persons with HIV/AIDS compared to control groups
Impact on Health Costs
• 24% to 34% fewer emergency room visits
• 27% to 29% fewer inpatient admissions and hospital days
• 87% fewer days in detox and fewer psychiatric inpatient admissions
• 41% to 67% decrease in Medicaid costs
Supportive Housing Solution
Communities across the country are pursuing initiatives that use supportive housing to reduce ED and hospital use among frequent users Using data matches to identify homeless
frequent users Assertive outreach and recruitment in crisis
health settings Stronger links to coordinated, patient-centered
healthcare
What is Supportive Housing?
Supportive housing is permanent,
affordable housing combined with
a range of supportive services that help
people with special needs
live stable and independent lives
Characteristics of Supportive Housing
HOUSING PERMANENT: Not time limited,
not transitional AFFORDABLE: For people
coming out of homelessness INDEPENDENT: Tenant holds
lease with normal rights and responsibilities.
SERVICES FLEXIBLE: Designed to be
responsive to tenants’ needs VOLUNTARY: Participation is
not a condition of tenancy INDEPENDENT: Focus of
services is on maintaining housing stability.
Who Lives in Supportive Housing?
Long-term homeless Veterans Domestic violence
victims Unaccompanied Youth People with mental
illness and/or chemical dependency
People coming home from correctional facilities, treatment, jail, hospitals, detox
HUD Focus on Performance
HUD Continuum of Care on Homelessness/ HEARTH Outcomes Reduce new episodes of homelessness Reduce length of homeless episodes Reduce returns to homelessness(Note: CoC includes ALL homeless programs including those not funded by Continuum of Care)
Coordinated Assessment and Entry Rapid Rehousing Permanent Housing
Common Ground – Housing & Health
High Cost Health Care
Utilizers
High Cost At-Risk/
Homeless
Supportive Housing
SJHMC FUSE Pilot
15 Frequent and high cost utilizers of SJHMC ER
Chronically homeless individuals Long-term homeless Disability
Care Navigator/Case Manager Permanent Supportive Housing Evaluation
SJHMC FUSE Pilot
Dignity Health/St. Joseph’s Hospital and Medical Center
Corporation for Supportive Housing Circle the City Medical Respite Native American Connections Arizona Housing Inc. Arizona Behavioral Health Corporation Native American Community Health Center Valley of the Sun United Way St. Luke’s Health Initiative
Success Story – “Mr. 280”
280 visits to SJHMC ER Traumatic Brain Injury and seizures Chronically homeless Criminal history History of failed housing attempts
Success Story – “Mr. 280”
Seizures under control Housed at 209 W. Jackson Employed No additional ER visits Reconnected with family
Stakeholders & Community Partners
HUD Continuum of Care Hospitals Public Housing Authorities State Department of Housing Local Government Homeless Housing and Service
Providers United Way CAP Agencies
Considerations/Questions
What are my organization/clients needs? How do our goals align with the goals of the
ACA? Are we engaged in the discussion and
decision making processes in our community?
Are we open to realigning our priorities and resource allocation to participate in initiatives?
What resources do we have to bring to the table?
Charlene FlahertyDirector, [email protected]