1. Hospital Discharge of Homeless Persons in Chicago

2. National Alliance to End Homelessness Annual Conference 2006
Arturo Valdivia Bendixen
Associate Director
AIDS Foundation of Chicago

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

4. 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

5. Study of Discharges to Respite Care Dr. David Buchanan
Service Respite Care Usual Group
Inpatient Days: mean: mean: 8.1
ER Visits: mean: mean: 2.2
Outpatient Vts: mean: mean: 6.0

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

7. Prevalence of the Homeless at Cook County Hospital - 2006 Dr
Prevalence of the Homeless at Cook County Hospital Dr. David Buchanan
Snapshot of inpatients at hospital:
Homeless (HUD definition): %
Doubled-up homeless: %
TOTAL: %
Mean duration of homelessness: months

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

9. 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

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

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

13. 4-Year Demonstration & Research Project Sept. 2003 to Aug. 2007
First of Chicago’s Plan to End Homelessness

14. 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

15. CHHP Project Design
Hospital
Respite Program
Permanent Housing

16. Systems Integration Team Serving the Intervention Group
Hospital: case managers
Interim/Respite Housing: case managers
Housing: case managers
Coordination: coordinator

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

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

19. CHHP “Intervention” Participants

20. Intervention Group Enrollment
Began September 2003
Concluded May 2006

21. 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%

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

23. Intervention Group Age – 216 Participants
: %
- 64 participants
: %
- 140 participants
: 6%
- 12 participants
MEDIAN: 47 years

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

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

26. Substance Use History 216 Participants
Assessed with Long Term History
153 participants %
Estimated with Long-Term History
186 participants %

27. Mental Illness History 216 Participants
Diagnosed with Long Term History
67 participants %
Estimated with Long-Term History
99 participants %

28. Stably Housed

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

30. 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

31. 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

32. 1+ Year Housed MISA Issues
Substance Use History – 60%
Mental Illness History – 10%
MISA History %

33. 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

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

35. 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)

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