to Recover
posted 09.29.2017
Editor’s note: The
SCAN Foundation, The John A. Hartford Foundation, the Administration for
Community Living, the Gary and Mary West Foundation, the Marin Community
Foundation and the Colorado Health Foundation have united to fund a three-year
grant to develop and establish the Aging and Disability Business Institute,
housed within n4a. Under the grant, ASA and n4a are
collaborating on a series of articles and case studies in Aging Today that will
help to prepare, educate and support community-based organizations and
healthcare payers to provide quality care and services.
Bay Area Community
Services (BACS), in Oakland, Calif., deals with one of today’s more visible
and heart-wrenching issues—homelessness in a high-cost-of-living area. The
60-year-old nonprofit provides short-term and long-term housing,
rehabilitation services and mental health services, all for people ages 18 and
older, and also offers older adult services and programming. A recent pilot
program for short-term housing and respite motivated them to seek a partnership
with a healthcare entity, and the collaboration proved it is possible to keep older
adults off the streets, at least while they recuperate from hospital
stays.
In 2013, BACS joined
The SCAN Foundation’s Linkage Lab Initiative, which BACS Executive Director
Jamie Almanza says “was like getting an MBA for our organization.” The tutelage
helped BACS to think of themselves as a business first and to price their
services accordingly, versus relying on the “old-school nonprofit model of
cobbling things together to make it work.”
Programming Is Geared to Partner's Needs
BACS first approached
their current partner, a large healthcare system (serving 100 Northern
California communities) by presenting a package of services based on what they
had assumed the health system might find of interest. In talking with them,
however, BACS realized that more than anything else, their partner needed help
with the burgeoning older homeless population in Oakland. These individuals
had nowhere to go after hospital stays had rendered them too frail to live on
the streets. The healthcare system knew BACS already served the frail homeless
population, so BACS quickly developed a program to match its needs in
Oakland.
“We heard what the
potential [partner] wanted, and [we] … looked at our existing resources and
assets, constructed a program design, made a financial plan and developed a
budget,” Almanza says. BACS met with hospital discharge planners and leadership
to ask which individuals were the most challenging to serve, and who needed the
most support. This demographic turned out to be those with nowhere to
transition, post-hospital stay.
“Originally, these
people would get a referral to a local community shelter [upon leaving the
hospital], but what’s tragic is most homeless exiting the hospital have no
transportation ability (financial or skills-based) to get to the shelter, and
the hospital doesn’t have the capacity to ensure that will happen,” Almanza
says. Even if the older homeless adult were to find transportation to a
homeless shelter, recuperating on a cot in a congregate shelter is not optimal.
The BACS facility is a seven-story single room occupancy (SRO)–style building,
but adapted for the medically frail, with private rooms, wheelchair-accessible
bathrooms and a second floor used for respite.
The healthcare
system’s discharge protocols meant that BACS would not have the time to labor
over assessing and interviewing individuals; the partner wanted “extreme
flexibility,” according to Almanza, which would allow them to provide a place
for people to recover in a safe environment, quickly upon discharge. The health
system trusted BACS’ level of care and BACS developed a program that was
flexible, negotiated the rate and signed the contract (while adding in a
contract provision to ensure the program was mutually financially beneficial,
even if it started out slowly with few people).
But from day one,
BACS’ beds (they now have 30 in their Oakland facility for this program) were
full all year, and the hospital discharge planners were “gracious and so happy
to have this resource,” says Almanza.
Replication Efforts Cross County Boundaries
The pilot Short-Term
Housing & Respite program began a year and a half ago, and has far surpassed
both BACS’ and the healthcare system’s expectations, serving twice as many
people as planned, and allowing BACS to double the size of its contract (number
of individuals served) with its partner. “This particular intervention is very
pragmatic and simple—not overly complex,” says Almanza, who adds that the
bureaucracy in much of America’s healthcare system is too onerous.
One unexpected benefit
to the success of this Short-Term Housing & Respite program is the
reduction in the recidivism rate of older adults’ return to the streets while
in a heightened medically vulnerable state. Additionally, the readmission rate
to the hospital is low, at 5 percent.
This year, BACS
decided to scale this success and, after a year and a half of providing the initial
Short-Term Housing & Respite service, BACS has replicated the program in
Fairfield, a city in Solano County, 50 miles northeast of Oakland. This
included purchasing a property that can provide housing and respite for 10
individuals (or older adults), and is modeled on their Oakland program, in
partnership with Solano County Mental Health Services. Almost immediately, the
Solano County program cut down on emergency stays in local hospitals and
reduced the county’s homeless surge.
Almanza’s greatest
challenge now in further replicating the program is to find the capital with
which to buy properties. “It’s in the strategic plan now to find capital to
create more small respite programs,” she says.
Though Almanza sees
daily the difference the program makes, the program’s positive impacts recently
came into sharper focus. In mid-June, a Short-Term Housing & Respite client
passed away at age 66 with Stage IV cancer in hospice care at BACS’ Oakland
facility. The on-duty nurse had noticed he was fading and was preparing him to
return to the hospital for pain management, when he requested to instead stay
in his “home.” Even though he had only been there a week, he looked upon the
respite center as his home and preferred to live out his life there rather than
in a hospital. Almanza was buoyed by the thought that he had a choice, and was
able to avoid dying on the streets.
Editor’s Note: This
article appears in the September/October, 2017, issue of Aging Today, ASA’s bi-monthly
newspaper covering issues in aging research, practice and policy nationwide.
ASA members receive Aging Today as a member benefit; non-members
may purchase subscriptions at our online store.
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