[ad_1]
The conversation
Homeless COVID-19 patients often return to life on the streets after hospital care, but there is a better way
In 2019, approximately 567,715 homeless people lived in the United States. Although this number has been declining steadily since 2007, it has started to increase in the past two years. For New York, even before COVID-19, 2020 was already proving to be a banner year for homelessness. But as the lockdown began in mid-March, the 60,923 homeless people who were staying in the city’s shelter system have been disproportionately affected by the pandemic. Not all of the city’s homeless, of course; the 60,000 and over do not include the homeless hidden on patient lists and emergency department waiting rooms. In 2019, the city’s annual hospital homelessness count shows more than 300 patients, every night, who are patients or use the hospital as a temporary shelter. As a health professional, educator and researcher in the field public health and social epidemiology the city, I am fully aware of the challenges to be met and the tragedies already seen. As of May 31, the New York City Homeless Services Department had reported 926 confirmed cases of COVID-19 in 179 shelters and 86 confirmed deaths from COVID-19. In April alone, the DHS reported 58 homeless deaths from COVID-19, 1.6 times higher than the city’s overall rate. Although there is no reliable analogous data for other cities, what is happening in New York may be a lesson for others. Homeless shelters are vulnerable The vulnerability of the homeless population to COVID-19 is not unique to New York City. Homeless shelters almost everywhere are particularly vulnerable to the transmission of disease. Shelters are usually not equipped, heavily trafficked, and generally unable to provide safe care, especially for those recovering from surgery, injury or illness. Add to that the inability to isolate, quarantine or physically remove the homeless from each other during COVID-19. New York City responded by using nearly 20% of its hotels as temporary shelters, with one to two guests per room. It helped, but it wasn’t a perfect situation. So the question is, where do homeless patients go to recover when they are released from acute medical care, especially in the post-COVID-19 era? do not fully recover from their illnesses. Some inevitably end up in the hospital. This results in a damaging and costly cycle for both patients and the healthcare system, and the situation continues to deteriorate: between July 2018 and June 2019, 404 of the city’s homeless people died – 40% more than previous year and most significant year – year-over-year increase in a decade. There is no data since the start of the epidemic, but the first evidence suggests that the number of deaths is higher between June 2019 and June 2020. Medical respite: a possible solution Medical respite is a catch short-term residential charge for homeless people who are too sick or frail to recover. the streets, but not sick enough to be in a hospital. It provides a safe environment to recover and access post-treatment care management and other social services. Medical respite care can be provided in self-contained facilities, homeless shelters, nursing homes and transitional housing. Medical respite has worked in municipalities across the United States; patient health outcomes improved and hospitals and insurers, especially Medicaid, saved money. But these programs are rare. In 2016, 78 programs were operating in 28 states. Most programs are small, with 45% having fewer than 20 beds. Models of care vary, but they essentially provide beds in a space designed for convalescence, appointment tracking, medication management, medically appropriate meals, and access to social services such as navigation through housing. and benefit assistance. Some programs offer clinical care on site. Research shows that homeless patients in New York City stay in hospital 36% longer and cost an average of $ 2,414 more per stay than those with stable housing. By referring patients to respite programs, hospitals reduced post-discharge emergency room visits by 45% and readmissions by 35%. The New York Legal Assistance Group, which conducted a cost-benefit analysis, showed savings of nearly $ 3,000 per respite stay (provider saved $ 1,575, payers saved $ 1,254) through reduced readmissions in hospital and the length of stay. Studies outside of New York City also show improvement in health in a variety of ways. One noted that 78% of patients obtained their respite leave “in better health”. Patients showed increases of 15% to 19% in relation to primary care after discharge for medical respite. In addition, at least 10% and up to 55% of relief patients who were discharged ended up in permanent or improved housing. Next Steps While there are nationally agreed standards for medical respite, program models can be adapted to meet the needs of a specific community. Already, dozens of respite models exist across the country, both in large cities and in small towns. One complication, however, is the sheer magnitude of the medical respite approach. Because it intersects with housing, homelessness and health care, medical respite does not fit seamlessly into a single system and would require collaboration and agreement between multiple city and state agencies.[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]Yet a growing number of communities are seeking medical respite to fill the void. Chicago partners with providers to provide healthcare to the homeless. This includes providing them with temporary residential facilities and clinics to help mitigate the impact of COVID-19. There is an urgent need to help the homeless with housing and health care. Medical respite is a potential solution. It has successfully provided recovery housing and medical care during a pandemic. Why shouldn’t it become a permanent part of our service system? Andrew Lin, Supportive Housing Program Developer at BronxWorks, a nonprofit group that provides homeless and housing support services in the Bronx, contributed to this article. The Conversation, a non-profit news site dedicated to sharing ideas from academic experts. It was written by: J. Robin Moon, City University of New York Read More: * Shattering 3 Common Myths About Homelessness * Only 1 in 10 Homeless Votes in Elections – Here’s Why Robin Moon does not work, consult, own stock or receive funding from any company or organization that would benefit from this article, and has not disclosed any relevant affiliation beyond his academic appointment.
[ad_2]
Source link