In many communities, hospitals are the only place where individuals experiencing homelessness can receive medical care. As California hospitals contend with the dramatic growth in homeless patients, they must comply with a new state
law (SB 1152) implemented in January 2019, which requires them to provide homeless patients a meal, clothing and vaccine screenings prior to discharge. Hospitals must also try to find homeless patients a bed at a safe destination, offer transportation and document the steps they have taken to do so.

Patients who are homeless, frail or live alone, or have unstable housing, can occupy hospital beds for weeks or months — long after their acute medical problem is resolved. Meanwhile, acutely ill patients may wait days in the emergency department (ED) to be moved to a floor because a hospital’s beds are full.

California has a staggering number of homeless people compared with the rest of the country. The state’s homeless population last year was almost 130,000, nearly a quarter of the national total. As the number of homeless people continues to grow, California hospitals are committed to doing even more to care for them by creating collaborative partnerships within their communities.

“All of us in the community – social service organizations, fire, ambulance, other providers – need to work together to provide better solutions for how we treat our most vulnerable patients, including the homeless and individuals with behavioral health issues,” said Joe Avelino, CEO of College Medical Center in Long Beach. “Only by working together can we develop and share truly effective best practices.”

College Medical Center is working hard to eliminate barriers that exist between first responders and medical providers. This includes building relationships and asking tough questions about how to improve care coordination at the local level.

Avelino personally visits local fire and police stations, asking, “What can we do better, and are we meeting your expectations?” As a result, College now prioritizes patients dropped off in the ED by Long Beach Police and Fire Departments to reduce wall times, allowing first responders to get back on the street faster. Other area social service organizations College collaborates with include Lutheran Social Services, The Salvation Army and the Long Beach Rescue Mission.

Additionally, College – and other California hospitals – are employing their electronic health records to streamline processes, using automated forms for admissions, transfers and warm hand-offs. Simple shifts such as including forward-thinking language in their transportation agreements and homeless patient checklists are showing great results.

College is also involved in an innovative collaboration with two other Long Beach area hospitals, Dignity Health St. Mary Medical Center and MemorialCare Long Beach Medical Center. Hospital representatives meet regularly to discuss new ways of delivering care to vulnerable patients.

“Working collaboratively with our community partners helps align our overall mission of ensuring that we
are providing quality care to our community,” said Carolyn Caldwell, President and CEO of Dignity Health St. Mary Medical Center. “We have found our working relationship with College Medical Center allows our teams to work toward ensuring that our patients are receiving the highest level of care in the appropriate setting.”

College also has begun partnering with an organization called ButterFLi to improve transportation opportunities for vulnerable patients no longer in need of acute medical care.

ButterFLi utilizes mobile and web technology, along with customer service representatives, to match service providers to customers. Unlike Uber and Lyft, users can book rides by phone — without downloading an app. ButterFLi partners can accommodate people who use wheelchairs or gurneys — or ambulatory riders. The service offers lower rates than traditional ambulance transportation businesses.

“The ButterFLi transportation program has proven invaluable to us,” said Avelino “This service grants us the peace of mind to trust that our patients are getting the warmest hand-off possible.”

ButterFLi is a HASC-endorsed business partner. For more information about ButterFLi, go to HASC’s website at http://hasc.org/endorsed-business- partners or contact Darryl Sanford, HASC’s Director of Member Relations and Association Services, at (213) 538-0772 or by email at dsanford@HASC.org.

Fast Facts

HOMELESSNESS IN CALIFORNIA

129,972 individuals

• 6,702 family households
• 10,836 veterans
• 12,396 unaccompanied young adults (aged 18-24)
• 34,332 individuals experiencing chronic homelessness

Figures are as of January 2018 and reflect individuals experiencing homelessness on any given day. Source: Continuums of Care Report to the U.S. Department of Housing and Urban Development

HOMELESS IN THE HOSPITAL

• Homeless patients made about 100,000 visits to California hospitals in 2017, up 28% from 2015.
• More than one-third of those visits involved a diagnosis of mental illness. By contrast, 6% of all hospital discharges in California during that time involved a mental health diagnosis.
• Los Angeles County, with 35,234, saw the most discharges involving homeless patients in 2017.

Source: The Office of Statewide Health Planning and Development

For additional information about Communities Lifting Communities, contact Karen Ochoa, CLC Project Manager, at (213) 538-0765 or kochoa@hasc.org.