Background & Goals
People experiencing homelessness have high rates of physical and mental illness, increased mortality, and often repeated emergency department visits and hospitalizations. Homelessness exacerbates health problems, complicates treatment, and disrupts continuity of care. Frequently, people experiencing homelessness are discharged from hospitals with care instructions that are difficult to follow while living on the streets or in shelters.
Since hospitals are often reluctant to knowingly release patients into homelessness, some patients remain hospitalized beyond their expected date of discharge, thus increasing costs significantly. The Durham Homeless Care Transitions (DHCT) model addresses the disconnect between health and homelessness systems by providing a place for healing and an opportunity to stabilize housing, health benefits, and relationships with supportive services.
Program Description
Durham Homeless Care Transitions, establishes a pathway for safely discharging persons experiencing homelessness from an acute care setting. The hospital can consult with the transition team regarding their patients and receive expert advice and the opportunity to plan for a safe discharge. Patients who do not meet hospital inpatient criteria, but who are too ill sick or injured to stay in a shelter or on the streets, are offered placements in medical respite locations where they can safely recover and connect with services.
The DHCT model combines the medical respite stay with case management focused on connections to medical care (primary and specialty when appropriate), mental health and substance abuse treatment, acquisition of benefits, linkage to improved housing circumstances and connections to social supports. DHCT is the first health organization in Durham, NC to obtain funding from the local health department for medical respite housing to allow people experiencing homelessness a safe environment for healing and recovery from illness and injury. DHCT is the first health organization in Durham to obtain funding from the city to provide federally funded rapid rehousing services. During the COVID-19 pandemic, we have been the referral point for our three community hospitals and our community shelter for homeless individuals with COVID-19 needing isolation housing assistance funded by our city and county.
Serving homeless people in transition from hospital to community, bridging the hospital and housing systems, and creating connections for our homeless patients to ongoing services are core tenants of the DHCT model.
Evidence of Success
Persons who participated in DHCT had a greater reduction in charges from the year prior compared to the year after referral (53% versus 27%). Program participants also had a greater percentage charge capture during the same time period (55% versus 30%). Our recent analysis demonstrated significant decreases in ED visits, admissions, and bed days for program participants in the year after the program compared to the year before.
A recent outcome analysis of 125 patients who had completed DHCT revealed that 78% were discharged to an improved housing arrangement, 88% had enhanced accessibility to transportation, 77% were reconnected with family or friends, 55% obtained or maintained substance use disorder treatment, 62% obtained or maintained mental health treatment, 90% obtained or maintained specialty care treatment, and 96% obtained or maintained a primary care medical home. This same analysis demonstrated “DHCT participants had lower average counts of hospital admissions (1.63 vs .62), bed days (16.37 vs 5.41), and emergency department visits (3.25 vs 1.71)” (Biederman et al.). After DHCT involvement, more previously homeless people are housed and achieve a number of positive outcomes which benefit the entire community.