Hospital Discharge of

Homeless Persons in Chicago

2000 - 2006

National Alliance to End Homelessness Annual Conference

2006

Arturo Valdivia BendixenAssociate Director

AIDS Foundation of Chicagoabendixen@aidschicago.org

Presentation• The Interfaith House Experience

• Snapshot Study of Cook County Hospital – 2006

• Integrating Systems of Care

• The CHHP Experience

Interfaith House• 64 bed respite care facility

• Hospital referrals from hospital discharge social workers

• At capacity most of the time

• 3 largest referral sources:

- Cook County Hospital (Stroger)

- Mt. Sinai Hospital

- West Side VA Hospital

Study of Discharges to Respite Care

Dr. David Buchanan

Service Respite Care Usual Group

• Inpatient Days: mean: 3.4 mean: 8.1

• ER Visits: mean: 1.4 mean: 2.2

• Outpatient Vts: mean: 6.7 mean: 6.0

Hospital Discharges

• Interfaith House

• Variety of Shelters

• Temporarily with family / friends

• Some discharged to the streets

• Some placed inappropriately at nursing homes

Prevalence of the Homelessat Cook County Hospital - 2006

Dr. David Buchanan

Snapshot of inpatients at hospital:• Homeless (HUD definition): 19.8%

• Doubled-up homeless: 12.6%

TOTAL: 32.4%

• Mean duration of homelessness: 15.6 months

Homelessness =THE FAILURE OF

MULTIPLE SYSTEMS OF

CARE

Chicago Area• No tracking of the homeless at hospitals• No designated social workers to serve the

homeless• Expedited hospital discharges often

result in poor referrals and placements• Poor integration of hospital social

services with shelter or housing systems

Organizational Partners

• 3 Key Medical Centers / Hospitals

• 11 Supportive Housing Providers

• 3 Respite/Interim Housing Providers

• 7+ Health Care Foundations

• HUD / HOPWA

Client Partners

• Adults who are homeless

• In-patient at 3 area hospitals

• At least 1 chronic medical illness

• Willingness to give consent

4-Year Demonstration & Research Project

Sept. 2003 to Aug. 2007

First of Chicago’s Plan to End Homelessness

CHHP Project Design

• Systems Integration - Council of Executive Directors

- Oversight Committee of Directors

- Systems Integration Team of Social Workers and Case Managers

- Integrated Funding Opportunities

CHHP Project Design

• Hospital

• Respite Program

• Permanent Housing

Systems Integration Team

Serving the Intervention Group

• Hospital: 2 case managers• Interim/Respite Housing: 3 case managers• Housing: 10 case managers• Coordination: 1 coordinator

Project Design - Housing

• Supportive Housing – variety of models

• Intensive Case Management – 10:1 ratio

• “Housing First” approach

• “Harm Reduction” models

• Research Component

CHHP ParticipantsJune 30, 2006 – Final Enrollment

• Intervention: 216

• Usual Care: 220

• TOTAL: 436

CHHP “Intervention”

Participants

Intervention GroupEnrollment

Began September 2003

Concluded May 2006

Intervention GroupTop Multiple Diagnoses - 216 Participants

HIV/AIDS 75 participants 34%

Hypertension 73 participants 33%

Cardiovascular Diseases 33 participants 14%

Pulmonary Diseases 39 participants 18%

Diabetes 32 participants 14%

Gastrointestinal / Liver 14 participants 6%

Seizure Disorders 18 participants 8%

Intervention GroupGender – 216 Participants

0

10

20

30

40

50

60

70

80

Male TransG

Gender

• Male: 74%

- 159 participants• Female: 25%

- 56 participants• Transgender: 1%

- 1 participant

Intervention GroupAge – 216 Participants

0

10

20

30

40

50

60

70

21+ 41+ 61+

Age

• 21 - 40: 30% - 64 participants

• 41 - 60: 64% - 140 participants

• 61 - 82: 6% - 12 participants

• MEDIAN: 47 years

Intervention GroupRace/Ethnicity – 216 Participants

0

10

20

30

40

50

60

70

80

Race/Eth

• African A / Black: 77%

- 166 participants

• Hispanic / Latino: 8%

- 17 participants

• Caucasian / White: 10%

- 22 participants

• Other: 5%

- 11 participants

Long-Term Homelessness216 Participants

• Long-Term Homelessness (HUD)

151 participants - 70%

• Short-Term Homelessness

65 participants - 30%

Substance Use History216 Participants

• Assessed with Long Term History

153 participants - 71%• Estimated with Long-Term History

186 participants - 86%

Mental Illness History216 Participants

• Diagnosed with Long Term History

67 participants - 31%

• Estimated with Long-Term History

99 participants - 46%

Stably Housed

Reached Stable HousingIntervention Group – 11/03 to 6/06

• 75% are reaching permanent housing

• 60% are remaining housed for 1+ year

Housed Less Than 1 YearJune 2006

• 11 died in stable housing

• 2 went nursing home (terminal illness)

• 5 went to prison / jail

• 13 lost housing – eviction, illegal or violent behavior

Reached Stable HousingIntervention Group – 11/03 to 6/06

Length of days to reach housing after hospital discharge-

• Average: 76 days

• Range: 70 – 90 days / {outliers: 0 – 371 days}

• Median: 62 days

1+ Year HousedMISA Issues

• Substance Use History – 60% • Mental Illness History – 10% • MISA History - 20%

Not Achieved Stable Housing25%

Common Challenges

• 50% disengaged after hospital discharge• Serious mental illness history with

neuropsychiatry issues for some• Serious MISA histories• Felony histories – esp. sex offenders• Chronic illness complications – in nursing

homes• Death before housing placement• Return to jail or prison

Preliminary OutcomesJune 2006

Nursing Home Days

Intervention Group:

• 2,146 days

Usual Care Group:

• 6,553 days0

1000

2000

3000

4000

5000

6000

7000

Days

Intervention Usual Care

Preliminary OutcomesJune 2006

0

0.5

1

1.5

2

2.5

3

3.5

4

Visits

Intervetion Usual Care

Emergency Room Visits

Intervention Group• 2.5 times less

(mean: 1.6)

Usual Care Group• 2.5 times more

(mean: 4.0)

Preliminary OutcomesJune 2006

HospitalizationsIntervention Group:

• Mean: 1.5

Usual Care Group:

• Mean: 2.30

0.5

1

1.5

2

2.5

Hospitalizations

InterventionUsual Care