Yakima Neighborhood Health Services

1. Our mission is to provide accessible, affordable, quality health care, provide learning opportunities for students of health professions, end homelessness and improve quality of life in our communities. Yakima Neighborhood Health Services

2. Yakima Neighborhood Health Services Partnering in our Communities Henry Beauchamp Community Center YNHS – Sunnyside Campus Comprehensive Health Services Neighborhood Connections Medical/Dental Granger Dental Granger Medical Sunnyside Walmart Plaza Supportive Housing Neighborhood Connections HRC Lower Valley Mobile Unit

3. 2018 ProfileHealth care and housing Homeless Services = 14% of our Business 90% of our Time !

4. How YNHS Entered the Housing World • YNHS providers speak – “if you want us to make a difference in the health of these patients, you need to help get a roof over their heads… “ 2006 – Continuum of care restructure • Shelter and housing provider dissolves • HUD McKinney providers withdraw • need for medical respite care emerges

5. No single cause of homelessness – other than a lack of stable housing • A strong continuum of services includes: • Street outreach and services • Emergency Shelter (including DV) and Supportive Housing • Permanent Supportive Housing • Medical Recuperative Respite Care • Medical, dental, behavioral health services • Supportive Housing and Supportive Employment

6. (slide courtesy of Homeless Network of Yakima County)

7. (slide courtesy of Homeless Network of Yakima County)

8. 2011 HHS Promising Practice Yakima’s Supportive Housing Collaboration Shared Learning Trauma informed Care / Housing First / Harm reduction/ motivational Interviewing • YNHS • Triumph Treatment Services • YWCA • Yakima Housing Authority • Building Changes • County Government • Private Landlords Standardized Intake Assessment Tool Regular intervals Identifies barriers Develops plan Data sharing

9. Housing & Health Partnerships

10. Drink the Kool-Aid Housing is Health Care Outcomes Tied to the IHI Triple AIM

11. YNHS Supportive HousingEligibility criteria (very health focused)

12. Medical Recuperative Respite CareCare for homeless not sick enough to be in the hospital, and for those being discharged from the hospital but not well enough to be back on the streets. • Eligibility Criteria for Medical Respite: • Acute medical condition • Living on Streets or in Emergency Shelter • Independent in Activities of Daily Living (ADLs) • Continent • No IV Lines • Can administer own medications

13. 72 patients stayed 1,418 Days- Here’s Why(Average 19.7 days per Patient)

14. 2018 PSH and Respite Participants • Medical Respite Care: • 72 Patients • Average Length of Stay 19.7 Days • Range 3 – 90 days Why they Left Us: • 20% left for permanent housing • 3% died • 69% returned to homelessness • Housing: • 123 Participants • Average Length of Stay • 565 (leavers) • 567 (stayers so far) Why they Left Us: • 73% left for permanent housing • 6% died • 20% returned to homelessness

15. Respite staff closely aligned with CHC staff • Respite Staff: • Registered Nurse • Behavioral Health Specialist • Case Manager • Housing Specialist • Neighborhood Connections (HCH Clinic): • Family Nurse Practitioner • Dentist • Health Insurance Navigator • Health Home Care Coordinator • Supportive Housing / Supported Employment Specialists

16. Families Individuals Location, Location, Location! “Everybody Loves Us Until….” Marty Miller, ORFH Respite Young Adults Inherit, Buy, Lease, or Build ?

18. RDH CenterOpens March 2019 22 Units 37 Individuals 6 dedicated for families 3 dedicated for Veterans

19. Five “Dwelling Units” • 4-5 individual units • Shared kitchenettes • Shared restroom and shower • Public / Visitor Center 9am -10pm • Enrichment / Learning Center and resident’s storage area. • Private open-air courtyard access from interior only for residents. • Resident laundromat accessible from inside. • Public Laundromat accessible from outside (open daytime hours). • Resident Manager 24/7. • Contracted Security. Enter Here

20. Back to the Kool-Aid Housing is Health Care Outcomes tied to the IHI Triple AIM Back to our Providers’ Request…

22. Increasing Access to Care 2018 Health Coverage

23. 2018 Improving Connection to Primary CareMedical Visits Per User

24. Improvement in Chronic Disease Measures

25. Reduction in Communicable Disease

26. Inter-Disciplinary Teams Serve High Needs Individuals and Families: Reduction in Behavioral Health Crises Patients with at Least One Mental Health Diagnosis

27. Multi-Disciplines – One Record

28. Foundational Community Supports 2018Supportive Housing / Supported Employment • Most Common Qualifying Risk Factors: • 2 or more stays in adult residential care setting (Supportive Housing); PRISM Score > 1.5, Homeless at least 12 months. • Disruptive Behavior, previous terminations, mental health issues (Supported Employment)

29. Medical Respite Care Saves $$Hospital Staff Report a Saving of 53 Inpatient Days in 2018($65,773 for Depression or $190,800 for Rehab) Respite care reduces public costs associated with frequent hospital utilization. *WSHA Hospital Pricing –www.wahospitalpricing.org *WSHA Hospital Pricing –www.wahospitalpricing.org

30. Medical Respite Outcome – Reduce Admissions/Readmissions to hospitals

31. Since January 2018 30 days Inpatient (rehab) = $37,230 8 visits to E.R.(avg $600e) = $ 4,800 48 days in respite = $ 5,330

32. Average PSH Cost Per Chronic Disabled at YNHS: $13,244 • Housing ($7,644 for 1 br. unit @$637/mo) • Case management and Supportive services ($5,600)

33. “We Know a Thing or Two Because We’ve Seen a Thing or Two”

34. Rhonda Hauff, COO / Deputy CEO, Yakima Neighborhood Health Services Chair, Respite Care Provider Network, National Health Care for the Homeless Council rhonda.hauff@ynhs.org