Albuquerque Health Care for the Homeless UNM Hospitalist
Albuquerque Health Care for the Homeless UNM Hospitalist Best Practices Sam Tri, DO Staff Physician 04/24/2019
Learning Objectives • To define homelessness • To describe common health issues affecting persons experiencing homelessness • To gain a greater understanding of the barriers to providing healthcare to persons experiencing homelessness • To learn several basic tools to better address the health needs of persons experiencing homelessness • Describe primary care programs and services offered by AHCH and how to collaborate with AHCH when need arises • Identify contacts to help facilitate housing services for most vulnerable
Homelessness in Albuquerque • In the City of Albuquerque, a minimum of 1, 318 people reported experiencing homelessness (New Mexico Coalition to End Homelessness Point-In-Time Count, 2017). • Albuquerque Health Care for the Homeless (AHCH) and community best estimates, at least 16, 000 persons – approximately 2. 3% of Bernalillo County residents – will experience homelessness during the year.
Causes of Homelessnes s • Fading work opportunities, lack of living wage • Decline in public assistance • Lack of affordable housing • Average 1 bedroom apartment in Albuquerque is $700 • • Health care costs Substance use disorders Domestic Violence Inadequate access to mental health treatment
Homelessness and Healthcare Settings • AHCH serves over 7, 000 individuals per year with 4, 000 individuals accessing health services • UNMH? • Public hospitals have reports ~ 30% of medical inpatients were found to be experiencing homelessness • Compared to controls, rates of hospitalization higher among homeless males (8. 5 x), homeless single women (4. 6 x), and homeless families (3. 4 x)
Mc. Kinney Vento Homeless Act of 1987 • Lacks a fixed, regular and adequate nighttime residence and • Whose primary nighttime residence is: • Shelter designed to provide temporary living accommodations (inc. welfare hotels, congregate shelters, and transitional housing for the mentally ill) • Temporary residence for individuals intending to be institutionalized • Place not designated for regular sleeping accommodation for humans
The Faces of Homelessness
Screening for homelessness • Where are you currently staying? How long have you been there? • Do you feel that your housing situation is secure? • In the past month, have you slept in an emergency shelter, vehicle, or place not meant for sleeping? • Are you staying temporarily with friends or family because you don’t have a place of your own? • Have you had difficulty paying your rent, utility bills, or food expense in the past year? • Can you live in the place you are living for the next several months? If not, do you have a place to go?
Morbidity in the Homeless Higher prevalence of: • • • HIV, TB, Hepatitis C Hypertension (2 x) Poor dental health (31 x) Tobacco related illness Alcohol problems(6 -7 x) Severe, chronic mental illness Barrow et al. 1999; Hwang et al. 1997 and 2001; Wiersma et al. 2010; Raoult et al. 2001; Schanzer et al. 2007; Jones et al. 2009. US Dept. Health and Human Services 2011; Koegler et al. 1999; O’Toole et al.
Increased Mortality Average Life Expectancy 55 years
Homeless Healthcare 101: Practical Considerations • A SAFE DC: a conceptual framework for care of the homeless inpatient. • Best JA 1, Young A. • 1 Harborview Medical Center, Seattle, Washington 98104, USA. jabest@u. washington. edu • Abstract • Homeless patients suffer disproportionately from medical disease and from barriers to healthcare, affecting their likelihood of presentation, severity of disease, long-term outcomes, and mortality. In the hospital, homeless patients are frequently cared for by hospitalists. Homeless patients' unstable social situation may challenge usual systems of inpatient care and discharge. To provide more effective care for this group, it is important to recognize the demographics of the hospitalized homeless patient. We suggest a structured approach to the inpatient care of the unstably housed patient, represented by a simple mnemonic checklist "A SAFE DC, " describing evidence-based adaptations of care, where available, and discussing systems-based approaches to discharge.
A Conceptual Framework for the Care of the Homeless Inpatient • A SAFE DC: • • A= Assess Housing Status S= Screening and Prevention A= Address Primary Care Issues F= Follow-up Care E= End of Life Discussions D= Discharge Instructions, Simple and Realistic C= Communication Method After Discharge
Health Equity
Albuquerque Health Care for the Homeless • Mission • Our mission is to provide caring and comprehensive health and integrated supportive services, linking people experiencing homelessness to individual and collective solutions, and to be a leader in implementing innovative service models and a catalyst for solutions to homelessness and uphold a commitment to diversity and equity. • Vision • To live in a world that is just and without homelessness.
Established in 1985 as one of 19 original HCH project sites in the US • Robert Wood Johnson/Pew foundation demonstration • HCH program started by Mc. Kinney Homeless assistance act of 1987 • Tasked with providing innovative care to people experiencing homelessness • Recognized health care alone was neither sufficient nor effective in addressing underlying health problems • • Created integrated services to serve people experiencing homelessness Housing is health care.
National Health Care for the Homeless Requirements • Basic health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology; diagnostic laboratory and radiologic services; preventive health services; emergency medical services; and pharmaceutical services as may be appropriate for particular centers • Substance use disorder treatment and referrals to providers of specialty services including mental health services • Patient case management services • Services that enable individuals to use the services of the health center (including outreach, transportation, and interpretation services) • Assisting patients in proper use and navigation of health care services
• Federally Qualified Health Center with Health Care for the Homeless designation • Serves roughly 7, 000 patients/clients per year across all programs, 4, 000 accessing health services • Approximately 60% male, 37% women, 5% youth/children • Programs • Primary Care Services- Medical, Behavioral Health, Psychiatry, Dental • Social Services- Client Advocacy, Outreach and Enrollment Workers, Case Management • Harm Reduction Services • Art Street
Harm Reduction Services • Department of Health funded programs • Syringe Exchange program • NM 1 of 2 states in country with state wide syringe exchange program • Anonymous HIV/Hep C testing • STI education • Focus is on sex workers, IV drug users, women, Native Americans
Social Services • Resource Center • Client Advocacy • Medicaid Enrollers (OEWs) • Case Management – mainly HUD funded • • Showers Computer stations Housing assessments COFFEE!!!
Art Street • Low threshold entry • Building engagement
Primary Care Services • Dental • Cleanings, tooth extractions, root canals, dentures • Behavioral Health- LISW • Individual assessments/therapy • Group therapy • Psychiatric Nurse Practitioner providing assessments and gamut of psychiatric medications • Injectable, long term anti-psychotics • Outreach Services • Medical • Walk-in model • Addiction Medicine- buprenorphine, vivitrol • Hepatitis C treatment • Transgender Care • Pharmacy on site
Medical Program and Services • Patient population • #1 chief complaint- “I just got out of prison and need my psych meds. ” • Large population of recently released patients • Transient population • “Came to Albuquerque because I heard there were jobs. ” • Undocumented individuals • Majority with substance use disorder and/or psychiatric disorders
Struggles in providing care Medical Case Management Respite Care Continuity of Care Homeless substance use recovery programs
Medical Programs and Services • Respite Care • “Medical Bed”- AOC/Good Shepherd, males only; Barrett House for females • Motel Vouchers- acute conditions, city funded • Coalition to End Homelessness- Bee Chavez 263 -2085
THANK YOU! Sam Tri, DO samtri@abqhch. org 505 -209 -5102 Sara Doorley, MD Sara. Doorley@abqhch. org 937 -623 -3350 • Medical Records- Deb Harlow • 767 -1127 • Fax: 266 -3199
- Slides: 25