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Discharge Planning Advisor
Sutter program addresses homeless housing, care
Reducing ED use is goal
A two-pronged initiative under way at Sutter Medical Center in Sacramento, CA, aims to provide interim housing for homeless patients who need home support services or assistance with medications as well as reduce the use of the hospital emergency departments (EDs) for primary care among homeless patients.
The T3 Continuum Project is the latest phase of an ongoing interim care program (ICP) designed to address the medical challenges presented by the homeless population, says Kate Tenney, RN, manager of case management at Sutter General Hospital.
The ICP was started in 2005 as a way to avoid situations such as the one in which a homeless patient discharged from a Kaiser Permanente hospital was dropped off by a taxi in the Skid Row area of Los Angeles dressed in a hospital gown and slippers, Tenney notes.
As part of the T3 Continuum Project, Sutter Medical Center is contracting with an existing primary care clinic and then adding housing, she adds. The pilot is being conducted at Sutter General, one of two hospitals that comprise the medical center and, in 2008, the program will be rolled out to the ICP collaborative, Tenney says.
T3 Continuum will be "a significant investment," she says, with an estimated cost of $250,000 a year. Sutter will provide 100% of the funding for the pilot, and will negotiate future costs with the collaborative.
Meanwhile, the respite shelter that is the centerpiece of the existing ICP "is working well for homeless patients in Sacramento," Tenney notes, with the 18 beds frequently filled.
The Salvation Army provides the space, infrastructure, and management for the 24-hour unit, she says. The three participating hospitals provide in-kind donations of beds and other equipment and also commits annual funding of $50,000 per hospital to coordinate discharge services, participate in clinical review committees, and find durable medical equipment and prescriptions as needed, she says.
The county of Sacramento provides oversight for the shelter, as it does for all community shelters, and other funding to support the program, Tenney says.
Participating patients must meet all standard hospital screening criteria, and have a short-term need for respite housing of no more than six weeks, Tenney notes. "The six-week period is based on a typical course of intravenous antibiotic treatment, which was the most common need for the respite housing."
Since the ICP began, 54 patients from Sutter have been served, resulting in approximately 1,300 saved hospital bed days, Tenney says. There are other measurements of the program's success, she adds, for the first quarter of 2007: