Office Hours: COVID-19 Planning and Response May 8, 2020 Reminders - PowerPoint PPT Presentation

Office Hours: COVID-19 Planning and Response May 8, 2020

Reminders • A recording of today’s session, along with the slide deck and a copy of the Chat and Q&A content will be posted to the HUD Exchange within 2-3 business days • Event information for upcoming Office Hours, along with copies of all materials can be found here: https://www.hudexchange.info/homelessness-assistance/diseases/#covid-19-webinars- and-office-hours

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Speakers Department of Housing and Urban Development • Norm Suchar, Director, Office of Special Needs Assistance Programs (SNAPS) Centers for Disease Control and Prevention • Emily Mosites, PhD MPH- COVID-19 At-Risk Population Task Force, Senior Advisor on Health and Homelessness National Healthcare for the Homeless Council • Barbara DiPietro, PhD, Senior Director of Policy 4

Speakers (continued) • Esther Magasis, Director of Human Services, Yakima County, WA • Rhonda Hauff, COO/Deputy CEO, Yakima Neighborhood Health Services • Stephanie Corrente, MSW, LICSW, Sr. Psychiatric Social Worker – Respite Team, Healthcare for the Homeless, Minneapolis, MN Department of Veterans Affairs Carma Heitzmann, Director, Homeless Veterans Community Employment Services • (HVCES) 5

Agenda • Centers for Disease Control and Prevention - Updates • Presentations on Medical Respite Care & Alternate Care Sites o National Healthcare for the Homeless Council o Yakima County Department of Human Services o Yakima Neighborhood Health Services o Healthcare for the Homeless (Minneapolis, MN) • Dept of Housing and Urban Development - Updates • Dept of Veterans Affairs - Updates 6

Emily Mosites, PhD MPH COVID-19 Response Centers for Disease Control and Prevention COVID-19 and Homelessness For more information: www.cdc.gov/COVID19

Over 1.2 million cases reported in the United States

CDC guidance related to homelessness Under “Schools, workplaces, and community locations” Shelters and other homeless service providers https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/plan- prepare-respond.html Providers serving people experiencing unsheltered homelessness https://www.cdc.gov/coronavirus/2019-ncov/community/homeless- shelters/unsheltered-homelessness.html

Other CDC Materials on Homelessness Resources l lan andi ding pag page: https://www.cdc.gov/coronavirus/2019- ncov/community/homeless-shelters/index.html FAQs  Communications materials for people experiencing homelessness  Symptom screening tool  Morb Morbidity Mor Mortality W Weekly R y Report: https://www.cdc.gov/mmwr/Novel_Coronavirus_Reports.html

For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

COVID- 19 AND T HE HCH COMMUNIT Y HUD OF F ICE HOURS Ba rba ra DiPie tro, Ph.D. Se nio r Dire c to r o f Po lic y Ma y 8, 2020

NE W ISSUE BRIE F : ME DICAL RE SPIT E CARE & AL T E RNAT E CARE SIT E S • e nt ne e d: Suppo rt se rvic e s Cur r while in she lte r/ ACS pro g ra ms • De finition: Ac ute / po st-a c ute c a re fo r unsta b ly ho use d pa tie nts re a dy fo r ho spita l disc ha rg e b ut to o fra il to re c o ve r o n the stre e ts o r in she lte rs • al goal: pro vide sa fe & Ce ntr he a ling spa c e w/ suppo rtive se rvic e s tha t sta b ilize he a lth c o nditio ns

NE W ISSUE BRIE F : ME DICAL RE SPIT E CARE & AL T E RNAT E CARE SIT E S COVID- 19 F ac ility Conside r ations: • Asse ss she lte r c a pa c ity fo r She lte rs “sic k ro o ms” Missio ns • L o o k fo r o the r spa c e s in Clinic s c o mmunity Suppo rtive ho using T ra nsitio na l ho using • L e ve ra g e ho te l/ mo te ls F re e sta nding • Co nside r a c c e ssib ility Mo te ls Apa rtme nts

NE W ISSUE BRIE F : ME DICAL RE SPIT E CARE & AL T E RNAT E CARE SIT E S COVID- 19 Staffing & Se r vic e s Conside r ations: • Pe rfo rm he a lth a sse ssme nts & Prima ry c a re a c tive ly pro vide / c o nne c t to Be ha vio ra l he a lth c a re Ca se ma na g e me nt • T ra in ACS sta ff o n tra uma , Spe c ia lty c a re de -e sc a la tio n & ha rm re duc tio n Me dic a tio n • Co nduc t we ll-c lie nt c he c ks ma na g e me nt • Co mple te ho using a pplic a tio ns He a lth e duc a tio n Ho using a ssista nc e • Disc ha rg e to a mo re sta b le Co mmunity pla c e c o nne c tio n

NE W ISSUE BRIE F : ME DICAL RE SPIT E CARE & AL T E RNAT E CARE SIT E S COVID- 19 F unding Conside r ations: Ho spita ls • F E MA Pub lic Assista nc e Sta te / lo c a l Gra nt Pro g ra m funds • HUD CDBG, E SG, HOPWA Me dic a id/ MCOs Priva te do na tio ns Phila nthro py

ME DICAL RE SPIT E CARE IN YAKIMA, WASHINGT ON E sthe r Magasis Dire c to r o f Huma n Se rvic e s Ya kima Co unty, Wa shing to n Rhonda Hauff COO / De puty CE O Ya kima Ne ig hb o rho o d He a lth Se rvic e s Ya kima , Wa shing to n

April 23, 2020 May 2, 2020

Community Health Center + Permanent Supportive Housing + Medical Respite Care = Housing IS Health Care Housing: 120 Participants Medical Respite Care: 72 Patients Average Length of Stay • Average Length of Stay: 19.7 Days • 552 ( 35 leavers) • Range: 3 – 90 days • 557 ( 98 stayers) • Why they Left Us: • Why they Left Us: • 20% (14) left for • permanent housing 66% (23) left for • 3% (2) died • permanent housing 3% (2) entered SUB • Treatment 6% (2) died • 69% (49) returned to • 17% (6) returned to homelessness • homelessness 11% (8) in respite end of • 2018 11% (4) lost to • followup

2019 PROFILE HEALTH CARE AND HOUSING 2019 ALL YNHS Patients 2019 Homeless Profile People Experiencing 3,816 All Primary Care Patients 28,830 Homelessness Primary Care Visits 146,114 Primary Care Visits 16,517 (medical, dental, mental health, (medical, dental, mental health, outreach, case management) outreach, case management) Youth Served at The Space 126 Permanent Supportive Housing 108 households (LGBTQ Youth Resource Center) 181 people 2,001 Visits at The Space Medical Respite 84 People (Average 21 days each) 1,782 nights Women, Infants & Children 4,500 Nutrition Program Clients / Basic Needs / Emergency 833 People Month Assistance 448 Households Affordable Care Act Applications 13,983 Unaccompanied Homeless Youth 109 Youth & Young Adults

Yakima’s Continuum of Care

84 PATIENTS STAYED 1,782 DAYS- HERE’S WHY (AVERAGE 21 DAYS PER PATIENT) Length of Stay People Reason for Respite One Week or Less 15% Flu, Cellulitis, Pneumonia, Bronchitis, Acute Asthma, COPD One to Two Weeks 28% Wound care, Gunshot wound, Esophageal varices, Hip Replacement, Uncontrolled Diabetes Three to Four Weeks 22% Medication Assisted Treatment Induction (Suboxone), Neck Wound, Gunshot Wound, Abdominal Abscess, Hernia Repair Four Weeks or Longer 35% Adult Failure to Thrive, Dementia, Acute Liver Failure, Frostbite, Abscess, Diabetic Foot Ulcers, Cellulitis

Improving rate of successful connection to primary care Yakima Neighborhood Health Services Increasing rate of compliance with care plans Yakima, WA Improvement in chronic disease measures (e.g. A1c scores, BP measure) Reduction in communicable disease (e.g. TB, STDs, Hep C) Connecting Outcomes Reduction in behavioral health crisis episodes of the Triple AIM to Medications are better managed Supportive Housing More likely to obtain and maintain employment or education and Medical Respite Greater success for recovering SUD recovering patients in supportive housing Care

MEDICAL RESPITE OUTCOME – REDUCE ADMISSIONS/ READMISSIONS TO HOSPITALS

MEDICAL RESPITE CARE SAVES $$ HOSPITAL STAFF REPORT A SAVING OF 53 INPATIENT DAYS IN 2018 ( $65,773 FOR DEPRESSION OR $190,800 FOR REHAB) Average Average Average Hospital Charge Hospital Charge Respite for Depression* for Rehab* Program Respite care reduces Average Length of 13 days 8.1 days 20 days Stay public costs associated Average Charge $16,133 $29,166 $4,275 Per Patient (includes avg of with frequent 8.5 primary hospital care) utilization. Average Charge / $1,241 $3,600 $354.28 Cost per Day (includes one primary care visit per day) * WSHA Hospital Pricing –www.wahospitalpricing.org

YAKIMA COUNTY HOMELESS SYSTEM COVID-19 RESPONSE PLANNING Funding • Washington State Department of Commerce COVID Emergency Housing Grant • Washington State Consolidated Homeless Grant • FEMA funds Partners • Yakima County Board of County Commissioners • Yakima County Department of Human Services • Yakima County Health District/Office of Emergency Management • City of Yakima • Providers • Foundations

YAKIMA COUNTY HOMELESS SYSTEM COVID-19 ACTION PLAN Prevention • Increase distancing and sanitation in congregate settings to reduce transmission Preperation • Develop a plan for isolation and recovery beds – before they are needed