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Hospitals, Counties Seek Alternatives To ‘Patient Dumping’

Sammy Caiola / Capital Public Radio

Laurie Teel, who used to be homeless, recovered from a heart attack at Placer County’s Whole Person Care program this spring. Staff there helped her find an apartment, which she moved into this May.

Sammy Caiola / Capital Public Radio

When Laurie Teel was nearing the end of her stay at Sutter Auburn Faith hospital this January, she was terrified she’d end up back in the streets.

Teel, then 54, was recovering from a heart attack. It happened just weeks after a landlord evicted her and her pit bull. She told staff at the hospital that she didn’t feel safe on her own.

“I wasn’t going back,” she said. “I couldn’t go back. I’m homeless, and I didn’t want to go back to her old neighborhood because it wasn’t good for me.”

So the hospital’s caseworkers made some calls. They got Teel a spot at an interim care program in a local shelter. Run by WellSpace health and funded by Sacramento’s four major health systems, interim care programs all over the region give homeless people a warm, clean place to recover from illness or injury. Residents also get connected to follow-up medical care, legal aid, food assistance and other social services while applying for permanent housing. The programs serve about 600 people each year.

There’s a high demand for spaces like this to combat a practice called “patient dumping,” whereby hospitals send homeless patients to places that are not equipped to handle their ongoing medical needs. Advocates say it endangers patients and puts a strain on local service agencies. A survey from the nonprofit Sacramento Regional Coalition to End Homelessness recently found that patients are frequently dropped at shelters by ambulance or cab, still in a hospital gown and often with an open wound.

A new bill from Democratic Senator Ed Hernandez could require hospitals to discharge homeless patients with a plan for their follow-up care, and would prohibit hospital staff from sending these patients anywhere other than where they live, or a licensed facility or social services provider that has agreed to take the patient.

“I firmly believe how we treat the most vulnerable among us is a reflection on our society,” Hernandez said in a press release. “I want to see hospitals work more closely with homeless services agencies and other providers to ensure they are given the proper care and not discharged in unsafe circumstances.”

Hospitals say the interim care program — established in 2005 — is a best practice for protecting these patients, but it has its limits. Holly Harper, director of external affairs for the Sutter Health Valley Area, said staff can only step in if patients are willing to accept the help.

“There also has to be an empty bed, which is not always the case,” she said. “Because these programs are so useful and so valuable, they get full.”

Kaiser Permanente recently made a $200 million pledge to combat homeless nationally, including in the Sacramento region. Sutter Health recently invested $1 million into keeping the city’s triage center in North Sacramento open through the end of August and an additional $1.3 million to support the building of longer-term emergency triage centers.

Harper said hospitals want to see people housed and healthy, not returning to the emergency room with the same ailments.

“This is a community problem,” she said. “This isn’t a hospital problem, this isn’t a problem for one person to fix. We’re very proud of the collaboration we’ve had, and we continue to need more.”

More medical respite programs could open up as counties and cities launch Whole Person Care initiatives. These projects use federal funding — acquired by California through a Medicaid waiver — to get homeless people integrated into the community.

Placer County opened their Whole Person Care program in November. It includes an eight-bed medical respite in a renovated facility run by The Gathering Inn in Auburn.

Robert Oldham, public health director for Placer County, says post-hospitalization is a crucial window for getting a homeless person support.

“Really, it was designed for those people who didn’t require admission to have somewhere to go,” he said. “We now have this fluid system where people who didn’t get admitted can go to the interim care program, and people who did get admitted can come here. It’s just more resources

 Laurie Teel stayed at Placer’s new medical respite for most of this spring.

She said staff helped her find the doctors she needed and drove her to appointments. They also helped her apply for a new apartment, which she moved into last month.

“I feel normal, I feel like me again,” she said. “I don’t feel so devastated on a daily basis, thinking, ‘what is going to happen today? How am I going to survive and keep a roof over my head?’”

“Not all of us have somebody out there, family or anybody to care for us,” she said. ‘They became my family.”

The City of Sacramento has $64 million in Medicaid funding to implement Whole Person Care from July 1, 2017 through December 31, 2020.

Correction: This story has been updated to reflect Kaiser Permanente’s contributions to combatting homelessness.

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