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MIDD Strategy 12-b: Hospital Re-entry Beds

Edward Thomas House Enhanced Medical Respite Center at Jefferson Terrace Update for MIDD Oversight Committee October 25, 2012 Janna Wilson, Public Health-Seattle & King County Ed Dwyer-O’Connor, Harborview Medical Center. MIDD Strategy 12-b: Hospital Re-entry Beds. MIDD Policy Goal Alignment

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MIDD Strategy 12-b: Hospital Re-entry Beds

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  1. Edward Thomas HouseEnhanced Medical Respite Center at Jefferson TerraceUpdate for MIDD Oversight CommitteeOctober 25, 2012Janna Wilson, Public Health-Seattle & King CountyEd Dwyer-O’Connor, Harborview Medical Center

  2. MIDD Strategy 12-b: Hospital Re-entry Beds MIDD Policy GoalAlignment Goal 1. A reduction in the number of mentally ill and chemically dependent people using costly interventions like jail, emergency rooms, and hospitals. Strategy area Jail and Hospital DiversionStrategy 12-b, Hospital Re-entry Beds (aka Medical Respite) 2012 MIDD Funding Support $508,500

  3. What is Medical Respite? • Place for homeless people to recuperate from illness or injury • Targets those who are not sick enough to be in the hospital, but too sick to be released to the streets/shelters • Medical respite programs typically provide: • Short-term residential care • On-site medical and behavioral health services • Linkage to regular primary care & mental health/substance abuse services • Assistance with benefits, case management, and housing

  4. Strong Evidence Base Linking Respite to MIDD Goals • Studies document 50% fewer hospital readmissions at 90 days & 12 months compared to patients discharged to own care • Reductions in inpatient length of stay and emergency department visits • Cost avoidance for hospitals that partner with medical respite programs Source: National Health Care for the Homeless Council, Medical Respite Care: Reducing Costs and Improving Care Policy Brief, April 2011

  5. Seattle-King County Medical Respite Expansion • 1996: Initial Respite service opens in shelters (22 beds) • 2007: Demand increases; hospitals reach out for assistance; Public Health hosts work group to explore options • 2008: Jefferson Terrace floor emerges as expansion site option; model developed; economic downturn • 2009: ARRA capital grant secured for remodel; MIDD & hospital support lined up; engagement with Jeff Terrace residents in year-long Environmental Assessment process • 2010: ARRA funds released in June; aggressive work on design, elevator, & interior remodel • 2011: Program opens September 2011

  6. A Community Partnership Builds a Community Resource

  7. Edward Thomas House Partners Hospital & Health Plan Partners Program operator Key housing partners - Plymouth Housing - Compass Housing- Evergreen Tx. REACH - High Utilizer Set-Aside Units Evergreen Northwest Harborview Swedish UW Medical Ctr. Valley Medical Virginia Mason Community Health Plan of WA Harborview Medical Center Site Seattle Housing Authority Oversight • Public Health • Steering Committee(includes MIDD rep) - Resident Advisory Committee (SHA)

  8. Revenues & Expenses - Big Picture Current Budget – About $2.7 million for 2012 Revenues 2012 • Federal HHS & HUD Grants (34%) • Partner Hospital Financial Support (30%) • MIDD (19%) • Medicaid (6%) • Everything else, including one-time & prior year funds carried over (11%) Expenses 2012 • Personnel & operating costs such as food & laundry (95%) • Lease 7th Floor of Jefferson Terrace from Seattle Housing Authority (5%) Cost per bed day = About $260-300 (Compare to average cost of hospital inpatient day in Washington at $2,810*) *Kaiser State Health Facts, average adjusted expenses per inpatient day, 2010

  9. Mr. Edward Thomas

  10. The Facility: 7th Floor of Seattle Housing Authority’s Jefferson Terrace Before After: New elevator creates separate entrance to 7th Floor

  11. The Facility 34 beds: Most rooms are double occupancy Two exam rooms Common areas

  12. Who does respite Serve? Homeless men and women with complex needs: • Acute medical issues • IV antibiotics • Multiple chronic conditions • Chemical dependency and mental illness Must be independent in mobility (wheelchair OK) Behavior appropriate to the setting Able to serve higher acuity patients than previous Respite site

  13. The Program Model Hospital has eligible homeless adult to refer Meets criteria? Bed available? Welcome to Edward Thomas House! • The Respite Stay • Interdisciplinary care • Medical services • Behavioral health services • Social work support • Link to regular primary care & MH/CD services- Housing placement Improved health & housing stability (the goal!) Discharge

  14. Who and How many Served So far? 426 admissions (336 unique patients) Over 7,000 bed days Average length of stay 19.3 days 38% uninsured For period Sept 17, 2011 – Sept 1, 2012

  15. Who and How many Served So far? MIDD Evaluator Looked at 262 Admissions Prior to 4/1/2012: 80% had MH/CD Diagnosis

  16. Leading Reasons for Admission

  17. TO Where Are Patients Discharged? N = 369(9-17-11 to 9-1-12)

  18. What We’re Excited About Positive relationship with Jefferson Terrace residents & Seattle Housing Authority Multiple hospitals making referrals Operating at capacity Healing, supportive community – harm reduction approach Serving more women More completing their respite stay More discharged to stable housing Initial signs of hospital cost avoidance

  19. What We’re Working On Funding and sustainability Strengthening housing placements Analyzing outcomes • Client-level (improved health status, housing stability) • Hospital-level (reduced readmissions, better continuity of care, reduced unnecessary ER visits) • Community-level (e.g., less utilization of jail and crisis services) Working with MIDD evaluation team

  20. Thank You Edward Dwyer-O’Connor BS, RN Senior Manager Downtown Programs Harborview Medical Center 206-744-1515 capeo@u.washington.edu

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