Santa Clara hospitals give homeless a respite

Über prosperous Silicon Valley isn¹t a place one expects to find thousands of homeless people. But a 2006 Housing and Urban Development (HUD) count found over 7,600 men, women and children without a home in Santa Clara County, which includes not just Silicon Valley but Palo Alto  and San Jose.

Unnerved by the count, the Santa Clara County Board of Supervisors commissioned a Blue Ribbon panel on Ending Homelessness and Solving the Affordable Housing Crisis. One of the panel¹s recommendations was that a facility for homeless people just released from the hospital be started, so there would be a place for them to recuperate fully. Surprisingly, in 2008, seven private and public hospitals from up and down the county, including Stanford University Hospital, began collaborating on The Santa Clara County Medical Respite Center.

In its first two years, the center spared participating hospitals 783 bed days. As the average cost of a bed day in that area is between $3,000 and $1,000, that¹s works out to be roughly a million dollars in savings in the program’s first two years.

The respite center is situated in wing of a sprawling San Jose homeless shelter called EHC Life Builders. Though close to the big shelter, the center is distinctly separated, along a long wide corridor that¹s breezy and clean with linoleum floors and sofas for socializing and reading. Along the corridor are seven bedrooms. Six have two beds, one has three. Janet Kohl, RN, is the nurse coordinator who ensures residents are following their plan of care and completing paperwork for Social Security Disability (SSI) and Medi-Cal. Those things are what ultimately get the residents into housing. Also on staff is a fulltime social worker, a part-time internist, partime psychologist and partime psychiatrist.

The program is basically “Pay to Play."  The seven original hospitals, and two others that have since joined the collaboration, give $25,000 a year to fund operation of the facility. The county hospital, Santa Clara Valley Medical Center, pays for the five-person staff through its federal Healthcare for the Homeless Program. For their money, each of the nine hospitals gets to refer homeless patients to the center---as long as they’re able to do three things: walk to the bathroom, walk to the cafeteria for meals, and take their own medication. The hospitals end up avoiding expensive, unnecessary bed-days in which homeless people linger around because they have no place to go. They also get to avoid readmissions for conditions that didn’t heal, which in some cases could result in a fine from Medicare.

Kohl said the program is a win-win for everyone. However, not every patient referred can get in, according to Kohl. With only 15 beds, and the average length of stay 66 days, sometimes there isn’t room.

Here are more statistics on the program.

The center had 218 residents in its first two years. Each participating hospital had about 50 percent of its referred patients admitted. In its second year, only three percent of residents returned to the street; four percent to a shelter. In contrast, 64 out of 69 residents in its second year transitioned to housing or moved back with family.

Some residents do end up back in the hospital for something; others go to nursing facilities. Sometimes, residents don’t end up adjusting to life indoors, and leave before staff thinks they’re ready. Kohl recalls one resident, who was confined to a wheelchair, leaving the respite program before staff thought he was ready; he didn’t have his SSI, and didn’t have an apartment to go to. Kohl followed him into the street, as he was wheeling himself away. 

“Please make different choices,” she pleaded, leaning against his wheelchair as he went.

He came back the next day.

Of the residents who do remain until the staff deems them “done”, 95 to 98 percent move into permanent housing, said Audrey Kuang, the center’s medical director.

Kohl likes to share the program's success stories. William Mackey’s story is one of her favorites. He became homeless a few years after being laid off from a company he’d been with for 15 years. While looking for another job, he plowed through his savings, and ultimately lost his apartment. He lived in his car for a while, doing odd jobs. But without health insurance, or a home to prepare healthy meals, his diabetes progressed and he ended up with an ulcer on his foot. In the end, he required a partial amputation of his toes.

After that surgery, Mackey was referred to Santa Clara Medical Respite Center. He stayed for four months, time enough for his foot to completely heal. Plus, he was able to see a nurse at the EHC shelter's clinic and that helped him get his diabetes under control.  Not long ago, Mackey moved into an apartment in Palo Alto, and is reportedly serving on Santa Clara’s Homeless Healthcare Advisory Board. He just received a Certificate of Commendation from the California State Assembly.

The National Healthcare for the Homeless Council reports there are over 60 medical respite centers around the country, and many more in development. “It’s exploding in the last few years,” said Kuang of the new model of care.

The Hospital Association of Southern and Central California is playing a key role in advocating for such programs in this area, because of their savings potential. Local governments and nonprofits like them too because they’re open windows of opportunity for residents.

“It’s a crossroads,” said Kohl “[It’s a time when] residents have a chance to change the trajectory of their path.”