Save the Date!
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June 2 - 5, 2010
National Health Care for the Homeless Conference & Policy Symposium
San Francisco Marriott
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MEDICAL RESPITE PROGRAMS PREPARE FOR
SEASONAL AND H1N1 INFLUENZA |
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The flu season is upon us and communities are ripe with concern about a potential national outbreak of the H1N1 virus. In an effort to minimize the spread of influenza, healthcare programs throughout the nation are educating patients about the correct way to cough and sneeze and are engaging in intense efforts to provide seasonal flu vaccinations to as many people as possible.
Homeless service providers are also working closely with public health departments to prepare for a pandemic. Communities developing emergency pandemic influenza plans are finding that medical respite care facilities can play an important role in the isolation, care, and recuperation of homeless patients who have the flu. Many medical respite programs are intensively preparing and developing contingency plans in case an epidemic arrives and more beds than are currently available are needed for those with the flu.
INCREASE CAPACITY BY ADDING MEDICAL RESPITE BEDS TO AN ALTERNATE CARE SITE
For four months, two to three patients a day presented to Fourth Street Clinic (Salt Lake City, Utah) with flu-like symptoms and required a place to isolate and recover. Patients were not sick enough to require hospitalization and emergency shelters were not able to isolate the large numbers of patients requiring services. To respond, Fourth Street Clinic developed a temporary plan to utilize its current medical respite facilities. The medical respite infrastructure was immediately overwhelmed and a new plan was conceived to develop an Alternate Care Site that would operate as both a triage center and medical respite care facility.
According to the plan, patients who come to the clinic with flu symptoms will be directed to a triage center located in the nearby Alternate Care Site where they are screened, treated and have access to vaccination and patient education. The co-located Respite Care Facility which is expected to be in operation from November 15, 2009, through February 29, 2010, will have the capacity to temporarily house, isolate, medically monitor, and support recovery of up to 80 H1N1-infected homeless men, women and children.
The Road Home, a nonprofit organization that operates the largest homeless shelter in Utah, would oversee the operation of the facility, while Fourth Street Clinic staff would coordinate the mobilization of approximately 40 EMS and nursing volunteers who will manage support services. Other community partners would provide meals, materials, laundry services, cleaning, and bedding. The budget for the Alternate Care Site is $175,000.
FLEXIBLE PROGRAM POLICIES REDUCE INFLUENZA TRANSMISSION AND ENSURE PROGRAM CONTINUITY
Baltimore's Health Care for the Homeless project, which serves more than 12,000 people annually and operates 22 medical respite beds, has developed emergency staffing policies to mitigate the impact of a H1N1 outbreak in Baltimore's homeless population. According to Louise Treherne, MSW, LCSW-C, vice president of clinical affairs, flexible policies aimed at reducing the transmission of the influenza virus among staff and clients will help ensure the continuity of operations and maintain the medical respite care program's capacity during a pandemic.
During the 2009-2010 flu season, symptomatic staff at Baltimore's HCH are encouraged to remain at home in an effort to reduce transmission to clients and other staff. The HCH project has also temporarily relaxed three policies regarding leave time and regulations:
- If staff have used their 2009 leave time, they may borrow 2010 leave hours with the provision that they must re-pay used time if they terminate employment before the "borrowed" time has been accrued.
- After having borrowed five days of leave time, staff will be able to use "donated" leave time should there any available in the HCH's donated leave time pool (the Baltimore HCH has a policy that staff may contribute leave hours to a pool as a means of assisting co-workers facing significant health or family emergencies).
- Usually, staff are required to produce a doctor's note after three consecutive sick days. For the remainder of this flu season, however, that requirement has been waived. This may reduce the burden on physicians and prevent staff from returning to work if they cannot afford to see a physician to secure the required note.
HCH Baltimore is beginning an education campaign to teach non-medical staff how to identify clients with potential flu symptoms;
infection control measures (masks, isolation, etc.); and personal/home planning (e.g., emergency child care options should schools or day care centers close). All staff have been supplied with antibacterial hand cleansers and additional N-95 masks have been ordered. Staff were offered the seasonal flu shot in September, and will be offered the H1N1 vaccine in October.
Each clinical team is creating minimum staffing plans and cross-training staff to prepare for a potential surge in patients at a time when staff may themselves become ill or be required to care for an ill loved one. Plans are being made to reschedule non-urgent appointments, if necessary, to accommodate an influx of acute flu-related walk-ins.
The Baltimore HCH is working closely with the Baltimore City Health Department and Baltimore Homeless Services officials to plan a strategic shelter response to a potential H1N1 outbreak. Areas of consideration include isolation rooms in shelters where such an approach is structurally possible, an alternative shelter for individuals residing in shelters where isolation is not an option, and massive shelter vaccination campaigns. Other Baltimore Federally Qualified Health Centers (FQHCs) are at the planning table with the goal of rallying all resources available to vaccinate and treat clients.
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| H1N1 RESOURCES FOR CONGREGATE CARE FACILITIES |
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The Centers for Disease Control and Prevention (CDC) and several municipalities have developed resources to assist congregate facilities in minimizing flu transmission. Select resources are available on our website.
Also, please bookmark our home page and check under the middle column Provision of Care What's New for the upcoming publication: Pandemic Flu Guidance for Homeless Shelters and Homeless Service Providers. We anticipate publishing this manual around November 1.
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| THE REDUCE ACT INTRODUCED IN THE SENATE |
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On October 14, Senators Shaheen (D-NH), Brown (D-OH), and Menendez (D-NJ) introduced the Reduce Emergency Department Utilization through Coordination and Empowerment (REDUCE) Act (S. 1781). This legislation would create a Medicaid demonstration program aimed to reduce frequent use of health services by individuals who have multiple chronic conditions. Ten states would receive Medicaid reimbursement for a number of comprehensive care services including recuperative care in a respite program. The Corporation for Supportive Housing (CSH) has taken the lead in advocating for this bill, and will be working with other organizations to increase the number of co-sponsors. The bill would be offered as a floor amendment during Senate action on health reform. The Senate Finance Committee passed its version of health reform legislation on October 13. That bill must now be combined with legislation passed early this summer by the Senate Health, Education, Labor and Pensions Committee before proceeding to the Senate floor. As the process moves forward, new information, including a summary of the legislation, will be posted on the CSH website. |
NEW RESPITE PROGRAM:
TRANSITION TO WELLNESS, SAN RAFAEL, CALIFORNIA
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In November 2008, San Rafael's recuperative care facility opened its doors to people experiencing homelessness and in need of a place for recuperation. The program was initiated as a pilot project with support from Marin County, Homeward Bound (a residential and support services provider), the Kaiser Foundation, and three local hospitals. The results from the pilot were meritorious. Homeward Bound continues to operate four medical respite beds with the help of a nurse case manager and a social worker. Another bed is available in the community for people who are unable to adhere to the shelter's sobriety policy.
"Several factors have contributed to the program's success," says Mary Kay Sweeney, coordinator for Transition to Wellness. "We involved key stakeholders in the development and implementation of the program from the beginning. Our nurse and social worker developed strong relationships with hospital discharge planners, which has helped in data collection and communication. We are also part of our county's Ten Year Plan to End Homelessness, which gives us a voice in guiding our community's approach to ending homelessness."
SAN RAFAEL'S MEDICAL RESPITE CARE PILOT PROJECT OUTCOMES | NOVEMBER 2008 TO JUNE 2009
- Average length of stay: 22 days
- Number of avoidable hospital days: 84
- Total cost savings (based on Kaiser Hospital's cost per day of $5,000): $420,000
- Number of client days in the program: 774
- Patients placed in stable shelter or housing at exit: 67 percent
- Patients who established a medical home: 100 percent
- Range of benefits obtained through case manager: Housing, scooter, wheelchair, cardiac rehabilitation, nebulizer, SSI, MediCal, glasses, General Assistance, and SSDI
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| Sabrina Edgington, MSSW | Respite News Editor
Respite Care Providers' Network Coordinator
National Health Care for the Homeless Council, Inc.
sedgington@nhchc.org | 615/226-2292 | www.nhchc.org
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Brenda J. Proffitt, MHA | Membership & Communications Director
National Health Care for the Homeless Council, Inc.
bproffitt@nhchc.org | 505/872-1151 | www.nhchc.org
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