[Reblog] Hospitals find ways to navigate homeless into shelters

From the 17 May 2015 post by Susan Abram

Patient dumping, or when a hospital discharges a homeless patient to Skid Row or onto the street, has become rare, but still does occur. With so many homeless people who require medical care, hospitals in Los Angeles and across the nation are trying to find ways to help the homeless recuperate after being discharged. There are programs in Los Angeles, but they still are few and far between. Jonathan Lopez, who is a former homeless navigator, has helped many.  Many more like him are needed. From my story (Daily News, October, 2013): 

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[Press release] SAMHSA’s new report tracks the behavioral health of America

From the press release, Monday, January 26, 2015

A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) illuminates important trends — many positive — in Americans’ behavioral health, both nationally and on a state-by-state basis.

SAMHSA’s new report, the “National Behavioral Health Barometer” (Barometer), provides data about key aspects of behavioral healthcare issues affecting American communities including rates of serious mental illness, suicidal thoughts, substance use, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows this data at the national level, and for each of the 50 states and the District of Columbia.

The Barometer indicates that the behavioral health of our nation is improving in some areas, particularly among adolescents. For example, past month use of both illicit drugs and cigarettes has fallen for youth ages 12-17 from 2009 to 2013 (from 10.1 percent to 8.8 percent for illicit drugs and 9.0 percent to 5.6 percent for cigarettes). Past month binge drinking among children ages 12-17 has also fallen from 2009 to 2013 (from 8.9 percent to 6.2 percent).

The Barometer also shows more people are getting the help they need in some crucial areas. The number of people receiving treatment for a substance use problem has increased six percent from 2009 to 2013. It also shows that the level of adults experiencing serious mental illness who received treatment rose from 62.9 percent in 2012 to 68.5 percent in 2013.

 

The data in the Barometer is drawn from various federal surveys and provides both a snapshot of the current status of behavioral health nationally and by state, and trend data on some of these key behavioral health issues over time. The findings will be enormously helpful to decision makers at all levels who are seeking to reduce the impact of substance abuse and mental illness on America’s communities.

“The Barometer provides new insight into what is happening on the ground in states across the country,” said SAMHSA’s Administrator, Pamela S. Hyde. “It provides vital information on the progress being made in each state as well as the challenges before them.  States and local communities use this data to determine the most effective ways of addressing their behavioral healthcare needs.”

The Barometer also provides analyses by gender, age group and race/ethnicity, where possible, to further help public health authorities more effectively identify and address behavioral health issues occurring within their communities, and to serve as a basis for tracking and addressing behavioral health disparities.

For the first time, the Barometer provides analyses broken down by poverty level (above or below) and health insurance status. This data can help provide researchers, policy makers, public health authorities and others a better understanding of how income and insurance coverage affect access and utilization of behavioral healthcare services.

To view and download copies of the national or any state Behavioral Health Barometer, please visit the SAMHSA web site at http://www.samhsa.gov/data/browse-report-document-type?tab=46.

For more information, contact the SAMHSA Press Office at 240-276-2130.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (DHHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Last Updated: 01/26/2015

[Reblog] Connections between housing, health: Finding stories and getting the reporting right

Connections between housing, health: Finding stories and getting the reporting right | Association of Health Care Journalists.

Excerpt

People who are homeless face many health threats and are among the heaviest users of hospital services. Safe and affordable housing, some experts assert, is a necessary first step to care effectively for people with chronic mental health and substance abuse problems who live on the streets. And there is some evidence that this approach may, in some circumstances, even save taxpayers money (but probably not as much as is often claimed).

In an influential 2009 study in Seattle, researchers analyzed medical and law enforcement costs for 91 people given supportive housing and found that costs dropped to about half the level seen among 35 comparable homeless people on a waiting list. But note that this savings estimate doesn’t include the capital costs of building and refurbishing apartments. Raising capital is likely to be a tall hurdle for many communities and this issue often gets ignored in news reports about the promise of supportive housing.

Read the rest of the core topic on this issue here

 

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[Article] Hospitals find ways to navigate homeless into shelters

From the 6 November 2013 Los Angeles Daily News article

WOODLAND HILLS >> Almost once a week, Guadalupe Tolentino’s liver and bloodstream drown in liquor and sorrow, and that gets him a free ambulance ride to Kaiser Permanente’s Emergency Department.

There, doctors and nurses flush the alcohol out of the 55-year-old man’s veins with IV fluids, calm his tremors with vitamins and medications and, if he stays long enough, provide him a meal and clean clothes.

Despite an existence in crisis, liquor is never far from Tolentino’s mind, and neither is Kaiser’s emergency department in Woodland Hills, which he visits up to 40 times a year.

For Tolentino and other chronic homeless men and women like him, the emergency department is a place of stability and peace, where the sound of rushing crash carts and the beeps of telemetry monitors can be a lullaby compared to the sounds of sleeping on the streets.

But for the hospital’s “homeless navigator” Jonathan Lopez, those such as Tolentino, known as frequent flyers, also are never far from his mind. Most pose no harm, but those repeated returns show that their chronic drug or alcohol dependence as well as their homelessness go untreated. And it means the hospital pays an average of $1,500 a night for their stay, money that is never recuperated.

“When a frequent flyer returns to our ED my adrenalin gets going,” said Lopez, “I instantly start to process where I might be able to coordinate a placement,” Lopez said. “I get to relate to these individuals in an extraordinary way.”

Hospitals around the country have been increasingly using homeless navigators to help place indigent men and women into treatments centers or housing after discharge. In the Kaiser system, which has 14 medical centers in Southern California, Lopez’s position is part of a first-of-its-kind, two-year-old pilot program launched at the Woodland Hills campus. He said he crafted the program after watching a similar approach formed by the San Gabriel Valley Consortium on Homelessness.

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Read the entire article here

 

When Housing For The Homeless Allows Alcohol, Heavy Drinkers Imbibe Less

 

Image by pixieclipx via Flickr

When Housing For The Homeless Allows Alcohol, Heavy Drinkers Imbibe Less

From the 20 January Medical News Today article

 

A study of a controversial housing project that allows chronically homeless people with severe alcohol problems to drink in their apartments found that during their first two years in the building residents cut their heavy drinking by 35 percent.

For every three months during the study, participants drank an average of 8 percent fewer drinks on their heaviest drinking days.

They also had fewer instances of delirium tremens, a life-threatening form of alcohol withdrawal.

The findings were published in the American Journal of Public Health.

Housing for chronically homeless people usually comes with many conditions, including abstinence from drugs and alcohol and compliance with psychiatric and substance abuse treatment. But such requirements can become barriers to staying in housing.

“These individuals have multiple medical, psychiatric and substance abuse problems, and housing that requires them to give up their belongings, adhere to curfews, stop drinking and commit to treatment all at once is setting them up to fail. The result is that we are relegating some of the most vulnerable people in our community to a life on the streets,”

Related articles

• Alcohol OK in Housing for Formerly Homeless (nlm.nih.gov)
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• How to Curb Chronic Homelessness? First, a Home! (abcnews.go.com)

Commercial Sexual Exploitation of Children (CESC) and Youth Homelessness

From the 15 November 2011 Summary

CSEC is A Growing Problem It is commonly estimated that 100,000 children are victims of commercial sexual exploitation each year. Futher, there is evidence that the number of children being exploited is increasing. The U.S. Department of Justice (DOJ) reports there is an increase in the online solicitation and “grooming” of children for CSEC, the incidence and violence of online pornography involving children, and online advertisements of children available for prostitution. CSEC may be growing in part because it is highly lucrative. DOJ reports CSEC is growing in popularity because it conveys greater financial gains with fewer risks than the drug trade and other illegal activities. It is also challenging for law enforcement to combat. Solicitation of prostitution is moving from city streets to online forums and pimps move children frequently between cities. It is difficult, therefore, to identify children victimized by CSEC and when children are identified they are more likely to be arrested for prostitution than those who solicited or exploited them.

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Majority Of Homeless People Have Chronic Health Conditions

From the 26 August 2011 Medical News Today article

More than eight out of 10 homeless people surveyed by researchers at St. Michael’s Hospital and elsewhere have at least one chronic health condition and more than half have a mental health problem. People who are “vulnerably housed” – meaning they live in unsafe, unstable or unaffordable housing – had equally poor, and in some cases worse, health, the survey found. The underlying cause for these health issues is poverty, said Dr. Stephen Hwang, the principal investigator of the study and a physician-researcher at the hospital’s Centre for Research on Inner City Health

“Poor housing conditions and poor health are closely linked,” said Dr. Hwang. “We need to treat both problems.” …

Read the article

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Homeless people without enough to eat are more likely to be hospitalized

Homeless people without enough to eat are more likely to be hospitalized
Mass. General study is first to document association between food, use of health services

From the February 3, 2011 Eureka news release

Homeless people who do not get enough to eat use hospitals and emergency rooms at very high rates, according to a new study. One in four respondents to a nationwide survey reported not getting enough to eat, a proportion six times higher than in the general population, and more than two thirds of those had recently gone without eating for a whole day. The report will appear in the Journal of General Internal Medicine and has been released online.***

“The study is the first to highlight the association between food insufficiency and health care use in a national sample of homeless adults,” says lead author Travis P. Baggett, MD, MPH, of the Massachusetts General Hospital (MGH) General Medicine Division. “Our results suggest a need to better understand and address the social determinants of health and health-care-seeking behavior,”

Baggett and a team of investigators at MGH and the Boston Health Care for the Homeless Program analyzed survey data from 966 adult respondents to the 2003 nationwide Health Care for the Homeless User Survey. They found that homeless people who did not have enough to eat had a higher risk of being hospitalized in a medical or psychiatric unit than did those with enough to eat and also were more likely to be frequent users of emergency rooms. Neither relationship could be explained by individual differences in illness. Nearly half of the hungry homeless had been hospitalized in the preceding year and close to one-third had used an emergency room four or more times in the same year.

Baggett explains the study was sparked by his clinical experience caring for homeless individuals. “Homeless patients with inadequate food may have difficulty managing their health conditions or taking their medications. They may postpone routine health care until the need is urgent and may even use emergency rooms as a source of food. Whether expanding food services for the very poor would ameliorate this problem is uncertain, but it begs further study.” Baggett is an instructor in Medicine at Harvard Medical School.

 

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