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NASCSP Conference Charlene M. Flaherty Director, Southwest September 11, 2013 The Source for Housing Solutions Our Mission Advancing housing solutions that: Improve lives of vulnerable people Maximize public resources Build strong, healthy communities 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 4 A Small Number of Very High Risk Homeless Persons $7,000 Probation Sheriff mental health jail $6,000 Sheriff medical jail Sheriff general jail $5,000 • The most expensive 10% of homeless persons have average monthly costs $6,529 LAHSA homeless services GR Housing Vouchers $4,000 General Relief Food Stamps $3,000 Paramedics Public Health $2,000 Mental Health Private hospitals-ER $1,000 Health Srv - ER Highest Decile Ninth Decile Eighth Decile Seventh Decile Sixth Decile Fifth Decile Fourth Decile Third Decile Second Decile Lowest Decile $0 Health Srv outpatient clinic Private hospitalsinpatient Health Srv hospitalinpatient •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 5 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 Flaherty Director, Southwest 480-203.8131 [email protected]