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CFM Grand Rounds Continuing Education I n order to receive credit - - PowerPoint PPT Presentation
CFM Grand Rounds Continuing Education I n order to receive credit - - PowerPoint PPT Presentation
CFM Grand Rounds Continuing Education I n order to receive credit for participating today, please text the code ZEPZAV to 9 1 9 .2 1 3 .8 0 3 3 . Must be entered into system w ithin 1 2 hours of session. This session is 1 hour of CE.
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Donna Biederman, DrPH, MN, RN Duke University School of Nursing & Julia Gamble, MPH, NP Duke Outpatient Clinic
Coordinating Care for Homeless Persons
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Learning Objectives
- Describe the homeless population in Durham, NC
- Describe 5 common needs of homeless persons that
can be met with care coordination
- List 3 things an individual provider can do to assist
with care provision for homeless persons
- List 3 community-based agencies that work to
coordinate care for homeless persons
- Make referrals to the Durham Homeless Care
Transitions program
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Homelessness
- Defining Homelessness -
– HUD (Dept. of Housing & Urban Development) – HHS (US Dept. of Health & Human Services) – Dept. of Education
- Enumerating Homeless Persons
– Annual Point in Time Count
https://www.nhchc.org/faq/official-definition-homelessness/
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Homeless Totals
Year Nationwide North Carolina Durham Area 2009 643,067 12,746 535 2010 649,917 12,157 675 2011 636,017 12,908 652 2012 633,782 13,602 698 2013 610,042 12,147 759 2014 578,424 11,448
- 2015
564,708 10,683 813 2016 753
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Durham Subpopulations 2015
Subpopulations – How many ADULTS are (or have):
Emergency / Seasonal Transitional Unsheltered Total Seriously Mentally Ill
73 20 8 101
Substance Use
225 151 10 386
HIV / AIDS
7 7
Victims of DV
22 11 9 42
Discharges: How many ADULTS were discharged from the following 30 days:
Criminal justice
12 12
Behavioral health
25 25
Health care system
15 1 16
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Homelessness in Durham, NC
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Health Needs of Homeless Persons
“Life on the streets is brutal and
- short. The average age of death for
homeless people is 30 years less than that of housed people”
– James J. O'Connell, Premature Mortality in Homeless Populations: A Review of the Literature. Nashville: National Health Care for the Homeless Council, 2005.
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Health Needs of Homeless Persons
Homeless Health Issues
Mental illness Substance use Tobacco use History of interpersonal violence common History of trauma to head common High ED utilization Aging homeless population – median age close to 50 Multiple comorbid chronic illness common Higher prevalence of Tuberculosis
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Health Needs of Homeless Persons
- Housing
- Primary Care
- Substance Abuse
- Mental Health
- Transportation
- Connection to family/ friends
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Health Needs of Homeless Persons
Housing “Housing comprises more than just
physical shelter. Where we live is where
- ur personal, social, and economic lives
come together. People who lack stable, secure, adequate housing lack a protected space to maintain physical and psychological well-being—finding themselves consistently in stress- producing environments with consequences for mental health and immunological functioning."
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Health Needs of Homeless Persons
Prim ary care
- Attention to chronic illnesses
- DM, HTN, COPD/ Asthma
- Medications
- Daily dosing, bid injections
- Think about formularies and cost (www.ncmedassist.org)
- Screening for cognitive impairment
- MOCA -- http: / / www.mocatest.org
- Don’t wait for the “annual physical”
- Attention to infectious disease screening and
prevention
- TB, HIV, Hepatitis C and STIs
- Vaccines for hep b, pneumonia, flu
- Screening for cancer
- Mammograms, pap smears
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Health Needs of Homeless Persons
Substance Use
- Screen for use (ever)
- Include tobacco
- Assess readiness to reduce or discontinue
- Be prepared to refer – 9 1 9 -5 6 0 -7 1 0 0
- Consider medication
- Prescribe Naloxone kits
- Available at Hospital/ Cancer Center pharmacy
- NCHRC - hnamkoong88@gmail.com
Mental Health Treatm ent
- Screen (PHQ, PC-PTSD)
- Be prepared to refer – 9 1 9 -5 6 0 -7 1 0 0
- Bridge medications until appointment
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Health Needs of Homeless Persons
Transportation
- Bus – 919-485-RIDE
- Discount pass
- Vans - all scheduled via 919-560-1551
- Medicaid ACCESS – 919-560-8607
- Medicaid patients only
- Medical appointments only
- County ACCESS – 919-560-7978
- Rides for work, social, medical
- Paratransit
- Rides for work, social, medical
- Application completed by health care provider
- http: / / godurhamtransit.org/ access
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What can individual providers do?
- Identify Homelessness
– Wake Med Epic Screener
- “Are you currently , or have you been any time
in the past 12 months, homeless or “doubling up” (living with another person without paying rent)?”
– VA Screener
- “In the past two months, have you been living in
stable housing that you own, rent, or stay in as part of a household?”
- “Are you worried or concerned that in the next
two months you may NOT have stable housing that you own, rent, or stay in as part of a household?”
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What can individual providers do?
- Document homelessness
– Use the ICD-10 code Z5 9 .0 – This way the data can be examined on a population level
- Refer to internal and external supports
- Maximize services at each visit or
admission
- Take homelessness into account in
formulating discharge plan
– Is the plan safe given homelessness?
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Total # of Patients within EMR Query System 3,251,727 Homeless Patients Within Study Timeframe in Durham Co. with ED/Inpt Encounters Total Unique Patients Identified 1656 Round 1
Address
745
PADC
183 Unduplicated Pts Rnd 1 889 Round 2
Case Mgmt
343 ICD-9 655 Unduplicated Pts Rnd 2 843 1732
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What can individual providers do?
- Support affordable housing
– Become aware of housing in our community – What are options for more?
- Donate or volunteer
- Become a member of organizations that
support homeless or housing issues
– National Healthcare for the Homeless Council – North Carolina Coalition to End Homelessness – People’s Alliance (Durham) – Durham CAN
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Homeless service agencies in Durham, NC
- Urban Ministries of Durham
– 412 Liberty Street near library – Emergency shelter
- Adult intake Monday or Thursday
- Family intake via DSS
– Meals 365 days a year – Food pantry, clothing closet – Substance abuse program – Resume, interview skills assistance
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Homeless service agencies in Durham, NC
- Housing for New Hope
– Permanent Supportive Housing (3 sites, 64 efficiency apartments) – Street outreach – focus on chronically homeless – Assertive Engagement – mental health care management for uninsured homeless people
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Homeless service agencies in Durham, NC
Williams Square – near Carver and Roxboro
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Homeless service agencies in Durham, NC
- Lincoln’s Healthcare for the Homeless
Clinic
– Full service primary care for adults (1/ 2 day clinic) located on campus of Urban Ministries of Durham – A1C machine and microscope on site – Substance abuse and social work services – Social Security Disability advocacy services Duke Psych resident volunteer clinic in evenings monthly
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Durham Homeless Care Transitions
- Nurse care management for homeless
individuals with medical problems being discharged from emergency room or hospital
- Partnered with Community Health Worker
- Based in LATCH program of Duke Community
and Family Medicine
- Medical respite care also an option with the
care management
– Brief housing to stabilize after a hospitalization or pre/ post procedure – Generally in sober housing setting – Usually limited to maximum of 8 weeks
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Durham Homeless Care Transitions
Online Referral Form
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Durham Homeless Care Transitions
Cases to discuss? Questions? Contact I nfo: Donna Biederman,DrPH, MN, RN 919-684-8849 (office) donna.biederman@duke.edu Julia Gamble, MPH, NP 919-358-1385 (cell/ text) Julia.gamble@duke.edu
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Literature
- Elise D. Riley, PhD, Jennifer Cohen, MPA, Kelly R. Knight, PhD, Alyson Decker, MPH, Kara Marson, MPH, and Martha
Shumway, PhD Recent Violence in a Com m unity-Based Sam ple of Hom eless and Unstably Housed W om en W ith High Levels of Psychiatric Com orbidity Am J Public Health. 2014 September; 104(9): 1657–1663.
- Lebrun-Harris LA1, Baggett TP, Jenkins DM, Sripipatana A, Sharma R, Hayashi AS, Daly CA, Ngo-Metzger Q. Health
Serv Res. 2013 Jun; 48(3): 992-1017. doi: 10.1111/ 1475-6773.12009. Epub 2012 Nov 7.
- Health status and health care experiences am ong hom eless patients in federally supported health centers:
findings from the 2 0 0 9 patient survey.
- Tsai J1, Doran KM, eck RA.. 2013 Dec; 103 Suppl 2: S225-31. doi: 10.2105/ AJPH.2013.301307. Epub 2013 Oct 22.
- W hen health insurance is not a factor: national com parison of hom eless and nonhom eless US veterans w ho
use Veterans Affairs Em ergency Departm ents.
- Lancet. Author manuscript; available in PMC 2015 Jul 30.
- Prof Seena Fazel, MD, Prof John R Geddes, MD, and Prof Margot Kushel, MD The health of hom eless people in
high-incom e countries: descriptive epidem iology, health consequences, and clinical and policy recom m endations Lancet. 2014 Oct 25; 384(9953): 1529–1540.
- Travis P. Baggett, MD, MPH,1,2,3 Stephen W. Hwang, MD, MPH,4 James J. O'Connell, MD,3,1,2 Bianca C. Porneala,
MS,1 Erin J. Stringfellow, MSW,3,5 E. John Orav, PhD,6,2 Daniel E. Singer, MD,1,2 and Nancy A. Rigotti, MD1,2
- Mortality Am ong Hom eless Adults in Boston: Shifts in Causes of Death Over a 1 5 -year Period JAMA Intern
- Med. 2013 Feb 11; 173(3): 189–195.
- Angela A. Aidala, PhD, Michael G. Wilson, PhD, Virginia Shubert, JD, David Gogolishvili, MPH, Jason Globerman, MSc,
Sergio Rueda, PhD, Anne K. Bozack, MPH, Maria Caban, PhD, MA, and Sean B. Rourke, PhD
- Housing Status, Medical Care, and Health Outcom es Am ong People Living W ith HI V/ AI DS: A System atic
Review Am J Public HealthRosenhAm J Public Health. 2016 January; 106(1): e1–e23.
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CFM Grand Rounds Continuing Education
I n order to receive credit for participating today, please text the code ZEPZAV to 9 1 9 .2 1 3 .8 0 3 3 . Must be entered into system w ithin
1 2 hours of session.
This session is 1 hour of CE.
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