Program to Focus on Costly Emergency Room Patients

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A group of 20 people, who are among Orange County’s most expensive chronic emergency room users, will now get help managing their health thanks to a new program established by the Illumination Foundation.

The nonprofit agency, which has served Orange County’s homeless residents since 2007, recently won a $400,000 grant from the Los Angeles-based UniHealth Foundation to provide a “health navigator” to each of the top 20 ER users at St. Joseph’s Hospital who are either currently or formerly homeless.

The navigator, someone with a nursing and social work background, will be available whenever needed to advise and assist on medical issues as well as help secure long-term services such as regular preventive health care, housing, food stamps and mental health support.

“We’re going to take 20 of the most costly patients at St. Joe’s and follow them 24/7 for two years,” said Paul Leon, CEO of the Illumination Foundation. Chronic Care Plus, as the initiative is known, could be a model that other hospitals might use to improve health and reduce costs, he said.

Leon said two of 20 patients have been contacted so far and agreed to participate. The first patient suffers from seizures and head injuries and has visited the emergency room frequently, where he was prescribed numerous expensive imaging procedures. The man’s hospital bill is currently more than $5 million, Leon said.

The man was homeless, but since the Illumination Foundation project began this summer, he has been placed in permanent housing, Leon said. Federal health reform is expected to make more funding available for mental health and substance abuse services that Chronic Care Plus will draw on, according to Leon.

Leon said the concept stems from a project in Los Angeles.

Early results from LA’s initial 20 participants are overwhelmingly positive, with a 74 percent decrease in hospital costs from $282,157 to $73,954, a 57 percent decrease in emergency room visits and a 67 percent decrease in patient readmissions, according to the Corporation for Supportive Housing. Readmissions often occur when homeless people are discharged from hospitals without a place to recuperate.

The medical issues facing homeless people were the subject of a training conference by the National Health Care for the Homeless Council in Irvine on Wednesday.

Speakers at the session called for bringing medical care directly to homeless people who are often reluctant or unable to go to a doctor’s office. Sometimes the reason is severe mental health problems and at other times, embarrassment. For example, some patients are uncomfortable with a foot exam, which is vital in managing diabetes, if they haven’t showered or changed their socks.

Dr. Leslie Enzian, who serves homeless patients in Seattle, said homeless people suffer disproportionately from diabetes and heart disease, succumbing to these chronic illnesses in far greater numbers than they do from inhospitable weather.

In general, she said, homeless people have high mortality rates. and their bodies age rapidly as a result of violence, poor nutrition and communicable diseases.

She advocated for a service called respite care, which provides temporary housing and medical attention after a hospital stay, saying it not only fosters better health but also can be a turning point.

Respite is “the pivotal experience that can lead to long-term stabilization,” said Enzian.

Willie McKay, a former homeless man from Santa Clara County, told the conference that “living on the street, we often feel isolated, doubting our self-worth. But I quickly learned from respite that there are a lot of people in my corner.”

Amy DePaul is a Voice of OC contributing writer and lecturer in the UC Irvine literary journalism program. You can reach her directly at depaula@uci.edu

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