1. Edward Thomas House Enhanced Medical Respite Center at Jefferson Terrace Update for MIDD Oversight Committee October 25, 2012 Janna Wilson, Public Health-Seattle & King County Ed Dwyer-O’Connor, Harborview Medical Center 1

2. 2 MIDD Strategy 12-b: Hospital Re-entry Beds MIDD Policy Goal Alignment Goal 1. A reduction in the number of mentally ill and chemically dependent people using costly interventions like jail, emergency rooms, and hospitals. Strategy area Jail and Hospital Diversion Strategy 12-b, Hospital Re-entry Beds (aka Medical Respite) 2012 MIDD Funding Support $508,500

3. 3 What is Medical Respite? Place for homeless people to recuperate from illness or injury Targets those who are not sick enough to be in the hospital, but too sick to be released to the streets/shelters Medical respite programs typically provide: – Short-term residential care – On-site medical and behavioral health services – Linkage to regular primary care & mental health/substance abuse services – Assistance with benefits, case management, and housing

4. 4 Strong Evidence Base Linking Respite to MIDD Goals Studies document 50% fewer hospital readmissions at 90 days & 12 months compared to patients discharged to own care Reductions in inpatient length of stay and emergency department visits Cost avoidance for hospitals that partner with medical respite programs Source: National Health Care for the Homeless Council, Medical Respite Care: Reducing Costs and Improving Care Policy Brief, April 2011

5. 5 Seattle-King County Medical Respite Expansion 1996: Initial Respite service opens in shelters (22 beds) 2007: Demand increases; hospitals reach out for assistance; Public Health hosts work group to explore options 2008: Jefferson Terrace floor emerges as expansion site option; model developed; economic downturn 2009: ARRA capital grant secured for remodel; MIDD & hospital support lined up; engagement with Jeff Terrace residents in year-long Environmental Assessment process 2010: ARRA funds released in June; aggressive work on design, elevator, & interior remodel 2011: Program opens September 2011

6. A Community Partnership Builds a Community Resource 6 34-bed Edward Thomas House: Opened Sept. 2011 SHA and Jefferson Terrace Residents United Way of King County Committee to End Homelessness in King County Public Health- Health Care for the Homeless Referring Hospital Partners King County Mental Illness & Drug Dependency Action Plan (MIDD) Communit y Health Plan of WA Federal Partners – HUD and HHS; ARRA

7. Edward Thomas House Partners 7 Hospital & Health Plan Partners Program operator Key housing partners Evergreen Northwest Harborview Swedish UW Medical Ctr. Valley Medical Virginia Mason Community Health Plan of WA Harborview Medical Center - Plymouth Housing - Compass Housing - Evergreen Tx. REACH - High Utilizer Set-Aside Units Oversight -Public Health -Steering Committee (includes MIDD rep) - Resident Advisory Committee (SHA) Site Seattle Housing Authority

8. 8 Revenues & Expenses - Big Picture Current Budget – About $2.7 million for 2012 Revenues 2012 Federal HHS & HUD Grants (34%) Partner Hospital Financial Support (30%) MIDD (19%) Medicaid (6%) Everything else, including one-time & prior year funds carried over (11%) Expenses 2012 Personnel & operating costs such as food & laundry (95%) Lease 7 th Floor of Jefferson Terrace from Seattle Housing Authority (5%) Cost per bed day = About $260-300 (Compare to average cost of hospital inpatient day in Washington at $2,810*) *Kaiser State Health Facts, average adjusted expenses per inpatient day, 2010

9. MR. EDWARD THOMAS 9

10. THE FACILITY: 7 TH FLOOR OF SEATTLE HOUSING AUTHORITY’S JEFFERSON TERRACE 10 BeforeAfter: New elevator creates separate entrance to 7 th Floor

11. THE FACILITY 11 Two exam rooms Common areas 34 beds: Most rooms are double occupancy

12. WHO DOES RESPITE SERVE? Homeless men and women with complex needs: Acute medical issues IV antibiotics Multiple chronic conditions Chemical dependency and mental illness Must be independent in mobility (wheelchair OK) Behavior appropriate to the setting Able to serve higher acuity patients than previous Respite site

13. THE PROGRAM MODEL 13 Hospital has eligible homeless adult to refer Meets criteria? Bed available? Discharge Welcome to Edward Thomas House! The Respite Stay -Interdisciplinary care -Medical services -Behavioral health services -Social work support -Link to regular primary care & MH/CD services - Housing placement The Respite Stay -Interdisciplinary care -Medical services -Behavioral health services -Social work support -Link to regular primary care & MH/CD services - Housing placement Improved health & housing stability (the goal!)

14. WHO AND HOW MANY SERVED SO FAR? 14 426 admissions (336 unique patients) Over 7,000 bed days Average length of stay 19.3 days 38% uninsured For period Sept 17, 2011 – Sept 1, 2012

15. WHO AND HOW MANY SERVED SO FAR? 15 MIDD Evaluator Looked at 262 Admissions Prior to 4/1/2012: 80% had MH/CD Diagnosis Mental Health (MH) Only 3714% Chemical Abuse/ Dependency (CA/D) Only 6826% Both MH and CA/D 10340% Neither MH or CA/D (Medical Only) 4818% Unknown 62%

16. LEADING REASONS FOR ADMISSION 16 Reason for admission (may be multiple per case) # of admits with this condition (out of 426) Percent of admits with this condition Abscess25459% Post-operative10023% Fracture4510% Diabetes cellulitis5613% COPD (Respiratory)276% Pneumonia154% Lacerations133% Cancer184% Amputation51%

17. TO WHERE ARE PATIENTS DISCHARGED? 17 N = 369(9-17-11 to 9-1-12)

18. WHAT WE’RE EXCITED ABOUT 18 Positive relationship with Jefferson Terrace residents & Seattle Housing Authority Multiple hospitals making referrals Operating at capacity Healing, supportive community – harm reduction approach Serving more women More completing their respite stay More discharged to stable housing Initial signs of hospital cost avoidance

19. Funding and sustainability Strengthening housing placements Analyzing outcomes Client-level (improved health status, housing stability) Hospital-level (reduced readmissions, better continuity of care, reduced unnecessary ER visits) Community-level (e.g., less utilization of jail and crisis services) Working with MIDD evaluation team WHAT WE’RE WORKING ON 19

20. Edward Dwyer-O’Connor BS, RN Senior Manager Downtown Programs Harborview Medical Center 206-744-1515 capeo@u.washington.edu THANK YOU 20