Pilot project aims to stop revolving door at emergency room for the homeless

OMAHA — It’s called a “first” for Nebraska: a program that provides homeless people who are discharged from a metro area emergency room with a place to live temporarily and recover instead of returning to the streets.

“Health and Dwelling” is a medical respite initiative, boosted by $500,000 from CHI Health’s national foundation, that’s been tried in various models elsewhere across the country.

Curbing repetitive hospital visits

The hope, locally, is to make the two-year pilot project long term, bringing together key community agencies to offer a healthy transition from an acute short-term care facility.

Organizers see it as an alternative to readmission to hospitals for minor ailments that do not require hospitalization but do require monitored medical treatment.

The Charles Drew Health Center network is a part of the pilot. Chief executive Kenny McMorris said that individual partner agencies have long carried out their own work to help the homeless population.

Now there is to be a more deliberate, coordinated case-management strategy so that the homeless person does not fall back to square one.

“The intentionality of this really is where the magic rests,” he said. “It’s not necessarily new thinking, just a difference in how we’re engaging people.” 

A new team effort

As envisioned, the Siena Francis House will step in with shelter, food, clothing and other services.

Charles Drew will roll up to the participants in a mobile medical unit and provide post-acute care, behavioral health, dental and pharmacy services. The clinic will keep ties with the patients in an effort to keep them on a consistent and lifetime health care program.

CyncHealth, the designated health information exchange for Nebraska and western Iowa, is to supply information technology support. That includes patient records and provider notifications, as well as a referral platform that allows linkage to community-based social service organizations.

“We are excited to launch this pilot and improve the system of care for individuals who are experiencing homelessness and have needs that cannot be met in a traditional shelter setting,” said Michelle Bobier, chief program officer at Siena Francis.

She and others said that such medical respite programs shorten hospital stays, reduce hospital readmissions, improve health outcomes and lower overall cost of health care.

Voluntary admission

The pilot starts off relatively small. Up to 24 people annually likely will be served through the intensive program, McMorris said.

Participants must be 19, willing to be admitted to the services and able to manage medications.

The pilot is the result of a study by the Health and Housing Coalition, a group of metro area advocacy agencies, aimed at identifying the needs of the chronically homeless, medically complex population.

In developing the project, the group considered data compiled for CyncHealth that looked at a sample of 450 people from 89 counties in Nebraska and Iowa. Among the findings was that the population averaged 246 emergency department visits per month in 2020.

Charles Drew’s model, even beyond the pilot project, means no patient is turned away for lack of ability to pay. Any insurance or Medicare or Medicaid payments paid on behalf of pilot participants will help sustain the medical respite project, he said. The goal is to keep participants attached to the clinic’s preventative care services.

‘Enough is enough’

Joy Doll, vice president of community programs at CyncHealth, said the program will benefit hospitals as it provides a safe discharge opportunity.

“The medical respite program can make a significant impact in our community,” Doll said. “Connecting health care with social care allows providers and care coordinators to meet patients where they are, when they need support the most.”

McMorris said political will, resolve and a “sense of enough is enough” led to this moment. 

“I think we’ve gotten to this point where a lot of people are looking at, ‘We have to figure out how to bend this cost curve in terms of health care.’ ”

He said solutions must look at engaging specific individuals.

“It has to go beyond a billing code or diagnosis code,” he said.