Health Care for the Homeless: the Basics

1. Health Care for the Homeless:the Basics CHE/Trinity Homeless Champions Webinar #1 October 14, 2014 Introduction: Doreen Fadus, CBMO, Mercy Medical Center, Springfield MA Presenters: John Lozier, Executive Director, National HCH Council, Nashville TN Heidi Nelson, CEO, Duffy Health Center, Hyannis MA

2. Catholic Social Teaching A  basic moral test is how our most vulnerable members are faring. In a society  marred by deepening divisions between rich and poor, our tradition recalls the  story of the Last Judgment (Mt 25:31-46) and instructs us to put the needs of the poor and vulnerable first. http://www.usccb.org/beliefs-and-teachings/what-we-believe/catholic-social-teaching/seven-themes-of-catholic-social-teaching.cfm

3. 130 Organizational Members, including: • St. Joseph’s Mercy Care, Atlanta GA • Mercy Medical Center, Springfield MA • HCH Clinicians’ Network • National Consumer Advisory Board • Respite Care Providers’ Network • Practice-Based Research Network • Funding: • National Cooperative Agreement with HRSA to • provide training & TA to 255 HCH grantees and others • 2 HCIA awards from CMS (studying Community Health • Workers and Medical Respite Care) • Additional public and private support

4. The mission of the National Health Care for the Homeless Council is to eliminate homelessness by ensuring comprehensive health care and secure housing for everyone. • The National Health Care for the Homeless Council was founded on the principles that • homelessness is unacceptable; • every person has the right to adequate food, housing, clothing, and health care; • all people have the right to participate in the decisions affecting their lives; • contemporary homelessness is the product of conscious social and economic policy decisions that have retreated from a commitment to insuring basic life necessities for all people; and • the struggle to end homelessness and alleviate its consequences takes many forms, including efforts to insure adequate housing, health care, and access to meaningful work.

5. Who is Homeless? A homeless person is an individual without permanent housing who may live on the streets, stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle, or in any other unstable or non-permanent situation. A recognition of the instability of an individual's living arrangements is critical to the definition of homelessness. *Bureau of Primary Health Care

7. Please Use These Diagnosis Codes for HomelessnessICD-9-CM: v60.0 ICD-10-CM: Z59.0 REFERENCE TERMS: Hobo Lack of housing, shelter Social Migrant Nomad Tramp Transient Vagabond Vagrant

8. Causes of Homelessness Housing Costs + Insufficient incomes = Homelessness In the United States, the 2014 two-bedroom Housing Wage is $18.92. This national average is more than two-and-a-half times the federal minimum wage, and 52% higher than it was in 2000. In no state can a full-time minimum wage worker afford a one-bedroom or a two-bedroom rental unit at Fair Market Rent. -National Low Income Housing Coalition Out of Reach 2014 http://nlihc.org/oor/2014

9. Causes of Homelessness Poor health causes homelessness • Financial impact (medical bankruptcy) • Personal Impact (behavioral health -> exclusion) • Effects of Trauma

10. A Second Relationship Between Homelessness & Health Homelessness causes poor health • Exposure to elements, communicable disease, violence, parasites • Poor nutrition • Poor sleep/rest • Criminalization of homelessness • Exacerbation of existing conditions • Self-medication & depression

11. A Third Relationship Between Homelessness & Health Homelessness interferes with treatment • Competing priorities • Adherence difficulties • Transportation • Uninsurance Institute of Medicine, Homelessness, Health, and Human Needs. Washington: National Academy Press, 1988.

12. CONSEQUENCES • Pervasive homelessness • High rates of illnesses (3-6 times) • Multiple complex morbidities • Premature mortality (30 years) • Deferred care/high costs • Inappropriate ER utilization • Discharge difficulties

13. Health Care for the Homeless Grantees http://www.nhchc.org/resources/grantees/national-hch-grantee-directory/

15. Training & Technical Assistance • National HCH Conference • Washington DC, May 7-9, 2015 • Eastern Regional Training • New York City, March 19-20, 2015 • Live and archived webinars • http://www.nhchc.org/cat/webinars/ • Technical Assistance

16. Community Benefit Needs assessment resources Toolkit: Assessing Your Community’s Health: A Needs Assessment Toolkit for HCH Grantees http://www.nhchc.org/wp-content/uploads/2014/02/chna-toolkit_final_2-21-14.pdf Webinar: HRSA Needs Assessment for HCH Grantees http://www.nhchc.org/2013/09/homeless-persons-memorial-day-2014/ Community benefit examples

17. The HCH Approach to Care • PCMH – Patient-Centered Medical Homes • Coordination of Care • Multidisciplinary Teams • Access • Street outreach • Accessible locations & hours • Elimination of financial barriers • Patient Self-determination Goal Setting

18. Evidence-Based HCH Practices • Motivational Interviewing • Trauma Informed Care • Harm Reduction • Cultural Competency Promising Practice: • Medical Respite Care http://www.nhchc.org/resources/clinical/medical-respite/

19. Adapted Clinical Guidelines • Asthma • Cardiovascular Diseases: Hypertension, Hyperlipidemia & Heart Failure • Chlamydial or Gonococcal Infections  • Chronic Pain • Diabetes Mellitus • General Recommendations for the Care of Homeless Patients • HIV/AIDS • Opioid Use Disorder • Otitis Media • Reproductive Health Care http://www.nhchc.org/resources/clinical/adapted-clinical-guidelines/

20. Coming in this Champions Series Nov. 13, 2014 Redirecting Frequent Users from Emergency Rooms to Primary Care Dec. 11, 2014 Medical Care on the Streets: Homeless Outreach Jan. 13, 2015 Care Transitions: Hospital Discharge and Medical Respite Care Feb. 12, 2015 Payment Challenges Mar. 12, 2015 Housing & Health Care All 3:00 – 4:00 pm Eastern