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Respite Pilot Initiative Evaluation Results Academy Health June 2006 Suzanne Zerger Research Specialist National Health Care for the Homeless Council E-mail: email@example.com BPHC Respite Pilot Initiative In 2000, $1 million available to support 6- 10 respite pilot/demonstration programs. Eligibility: HCH grantees already supporting a respite program Goal: “to explore the viability of a variety of models of respite services” Respite Pilot Initiative Grantees: Program Model Overview Shelter-Based Care Facility Collaboration with local Collaboration with care shelter for 24-hour beds – facilities, which provide 24- usually separate from hour caregiver staff, shelter population housekeeping, security, Health care providers visit food respite patients daily HCH program provides Shelter staff supervise medical supervision, patients overnight with including admission and medical services available discharge oversight and on-call daily clinical visits CO, MO, WA FL, NY, ME, UT, OR Respite Pilot Initiative Grantees: Program Model Overview, cont. Free-Standing Apartment HCH Program has Administrative needs control over both the provided through collaboration and facility and the medical community care organizations CA HCH grantee provides medical supervision OH Categorizing Models by Facility Type Apartment, Free-Standing, Shelter, Care Facility Or by Medical Services/Coverage clinician visiting a bed (in a shelter, apartment, etc.) vs. 24/7 medical coverage (care facility, free-standing) Respite Pilot Initiative Evaluation Aims Goal: “to evaluate the relative success of these differing models in achieving positive patient outcomes.” Specific aims: To identify and document differing models of care for the delivery of respite services; and To assess the effect of respite services on the health of homeless people Evaluation Design Grassroots, Participatory read: the most labor and time-intensive approach possible Evaluation Methods Program-Level Data Client-Level Data Program Survey Database (pre/post) Submitted quarterly for Telephone interviews consenting clients (pre/post) Client Refusal Forms No-Admit Forms Anecdotal: success stories and ethical dilemmas Finding All of these respite models are effective in caring for homeless persons who critically need health care. This evaluation has helped to articulate pros and cons associated with each, and will help communities develop programs that respond to their own needs and resources. BENEFITS Resourceful (Shelter, Care) “These resources already exist in the community, so money goes toward the patients.” Exposure to others exiting homelessness (Care) Control over program conditions (Stand-alone) Allows families to stay together in privacy (Apt) Easy to win community backing (Apt) Link to broader systems of care (All) CHALLENGES Collaborating with Agencies - e.g. Conflicting missions/procedures, strict requirements, lack of control over discharge (Shelter, Care) Expensive (Stand-alone) Limits to complexity of need that can be met (Apt, Shelter) Location (Apt, Stand-alone) Growing need and shrinking resources (All) Referral Sources 61% - Hospitals 20% - HCH Clinics/Programs 10% - Non-HCH Clinics/Programs 8% - Other (49% supplied medications) Referee Relations “Hospitals…are goal-oriented to get clients into respite.” Recommendations: Clear Criteria Education Efforts (“You cannot understate how much energy it takes to educate.”) Clinically-Coached Face-to-Face Maintain Malleability “Hospitals will lie…” Ethical Dilemmas What do you do when referrals don’t fit the program requirements, but there are no other community resources available for your patients? You have two (individuals) who are referred to the shelter with similar medical issues. You have one bed available. How do you decide who you will give the bed to? Finding Respite clients have multiple, complex health and psychosocial needs - and long histories of homelessness. Client Characteristics (N=1349) 27% education beyond HS/GED 63% became homeless in same city as respite program (74% in same state) 43% homeless 1 year or more 53% single/never married 97% unaccompanied by family members 15% veterans average 48 years old 11% hispanic; 40% white; 32% african american 88% from the U.S. Client Treatment History Psychiatric problems – 33% (51%) (hospitalized for mental health – 16% Alcohol problems – 42% (62%) in treatment for alcohol – 28% Drug problems – 40% (56%) in treatment for drugs – 25% Hospitalization • 77% had been to an ER/ED in prior 30 days • 60% had been hospitalized at least 1 days in prior 30 days Severity Ratings (OASIS) 0=Asymptomatic, no treatment needed at this time 1=Symptoms well controlled with current treatment 2=Symptoms controlled with difficulty – affecting daily functioning; patient needs ongoing monitoring 3=Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring 4=Symptoms poorly controlled, history of rehospitalizations Top ICD-9 Code Categories Primary Diagnosis (N=1507) Injury and Poisoning (21%) Diseases of the Skin and Subcutaneous Tissue (18%) Diseases of the Respiratory System (11%) Diseases of the Circulatory System (9%) Average Severity Rating: 3 Additional Admitting Diagnoses (N=2403) Mental Disorders (44%) Diseases of the Circulatory System (8%) Average Severity Rating: 2 New Diagnoses (N=342 for 14% of admissions) Average Severity Rating: 2 Finding For homeless persons able to receive care in these respite programs, the experience is unequivocally beneficial to their overall health Primary Diagnosis Severity Ratings 50% 45% Level 4 40% Level 3 35% 30% Level 2 25% Level 1 20% 15% Level 0 10% 5% Unknown 0% Admission Discharge Admission/Discharge Comparisons (N=1507) ADMISSION DISCHARGE Income Source None 53% 44% Food Stamps 23% 32% Regular Source of 34% 49% Primary Care Health Insurance – 53% 44% None Housing Status Admission/Discharge (N=1507) ADMISSION DISCHARGE Hospital 34% 8% Shelter 23% 29% Street/camp 13% 4% Doubled up 11% 6% Hotel/Motel 4% 2% Own house/apartment 2% 5% Transitional housing/program 1% 3% Treatment program 3% 6% Other 5% 6% Unknown 2% 32% Reason for Exit Completed Treatment 41% AWOL 15% Administrative Discharge 16% Left Against Medical Advice 9% Admitted to Hospital 8% Other 10% Unknown 2% Finding Much of the need for respite services remains unmet E.g. A preliminary review indicates some of the larger programs (e.g. WA, CO) are unable to admit half to two- thirds of the individuals referred to them. Summary of Findings All of these respite models are effective Respite clients have particularly complex combinations of problems and long histories of homelessness For homeless persons able to receive care in respite programs - experience is beneficial to their overall health Much of the need for respite svs remains unmet
"Respite Pilot Initiative"