Hospital Discharge of Homeless Persons in Chicago 2000 - 2006

National Alliance to End Homelessness Annual Conference 2006 Arturo Valdivia Bendixen Associate Director AIDS Foundation of Chicago abendixen@aidschicago.org

Presentation The Interfaith House Experience Snapshot Study of Cook County Hospital – 2006 Integrating Systems of Care The CHHP Experience

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

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

Hospital Discharges Interfaith House Variety of Shelters Temporarily with family / friends Some discharged to the streets Some placed inappropriately at nursing homes

Prevalence of the Homeless at Cook County Hospital - 2006 Dr Prevalence of the Homeless at 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

THE FAILURE OF MULTIPLE SYSTEMS OF CARE Homelessness = THE FAILURE OF MULTIPLE SYSTEMS OF CARE

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

Organizational Partners 3 Key Medical Centers / Hospitals 11 Supportive Housing Providers 3 Respite/Interim Housing Providers 7+ Health Care Foundations HUD / HOPWA

Client Partners Adults who are homeless In-patient at 3 area hospitals At least 1 chronic medical illness Willingness to give consent

4-Year Demonstration & Research Project Sept. 2003 to Aug. 2007 First of Chicago’s Plan to End Homelessness

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

CHHP Project Design Hospital Respite Program Permanent Housing

Systems Integration Team Serving the Intervention Group Hospital: 2 case managers Interim/Respite Housing: 3 case managers Housing: 10 case managers Coordination: 1 coordinator

Project Design - Housing Supportive Housing – variety of models Intensive Case Management – 10:1 ratio “Housing First” approach “Harm Reduction” models Research Component

CHHP Participants June 30, 2006 – Final Enrollment Intervention: 216 Usual Care: 220 TOTAL: 436

CHHP “Intervention” Participants

Intervention Group Enrollment Began September 2003 Concluded May 2006

Intervention Group Top 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 Gastrointestinal / Liver 14 participants 6% Seizure Disorders 18 participants 8%

Intervention Group Gender – 216 Participants Male: 74% - 159 participants Female: 25% - 56 participants Transgender: 1% - 1 participant

Intervention Group Age – 216 Participants 21 - 40: 30% - 64 participants 41 - 60: 64% - 140 participants 61 - 82: 6% - 12 participants MEDIAN: 47 years

Intervention Group Race/Ethnicity – 216 Participants African A / Black: 77% - 166 participants Hispanic / Latino: 8% - 17 participants Caucasian / White: 10% - 22 participants Other: 5% - 11 participants

Long-Term Homelessness 216 Participants Long-Term Homelessness (HUD) 151 participants - 70% Short-Term Homelessness 65 participants - 30%

Substance Use History 216 Participants Assessed with Long Term History 153 participants - 71% Estimated with Long-Term History 186 participants - 86%

Mental Illness History 216 Participants Diagnosed with Long Term History 67 participants - 31% Estimated with Long-Term History 99 participants - 46%

Stably Housed

Reached Stable Housing Intervention Group – 11/03 to 6/06 75% are reaching permanent housing 60% are remaining housed for 1+ year

Housed Less Than 1 Year June 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

Reached Stable Housing Intervention 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

1+ Year Housed MISA Issues Substance Use History – 60% Mental Illness History – 10% MISA History - 20%

Not Achieved Stable Housing 25% 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

Preliminary Outcomes June 2006 Nursing Home Days Intervention Group: 2,146 days Usual Care Group: 6,553 days

Preliminary Outcomes June 2006 Emergency Room Visits Intervention Group 2.5 times less (mean: 1.6) Usual Care Group 2.5 times more (mean: 4.0)

Preliminary Outcomes June 2006 Hospitalizations Intervention Group: Mean: 1.5 Usual Care Group: Mean: 2.3