Bridge Housing: Connecting the Homeless to Housing After Hospitalization

The recent 2015 homeless count conducted by the Los Angeles HousingServices Authority showed a staggering 44,359 homeless individuals in LA County, a 12% increase in the last two years. Although partly due to a change in methodology, the count is seen as more accurate than ever before. In addition, LA’s chronic homeless population has grown to 12,536 since 2013, accounting for more than 1/3 of the Nation’s chronically homeless. Many of these individuals are plagued by chronic health issues, frequently sending them to the hospital for care.

At the core of these individuals’ health issues is their lack of housing. Social determinants of health tell us that housing equals health. But to help these individuals make the transition into a home, it takes more than finding a vacancy.

Each year, National Health Foundation (NHF) provides recuperative care to more than 1,000 homeless patients who have been safely discharged from partnering hospitals. Recuperative care provides homeless patients with a safe place to heal while receiving comprehensive care management. Often during their stay in recuperative care, clients experience a disruption in homelessness and, if they were not already, become willing to participate in the process to secure housing. When the client is interested, securing housing is a goal. However, funding for recuperative care rarely last more than 14 days and this is often not enough time to connect a client to needed housing resources, let alone transition them into their new home. If a client is forced to return to the street while waiting to transition, their chances for a successful move diminish.

Through its bridge housing program, NHF is able to provide these individuals with additional or “bridge” time in the recuperative care center. During their lengthened stay, they receive help with applications for birth certificates, identification cards, and applications for state and federal benefit programs. Connections are made to medical homes and referrals are made to substance abuse and/or mental health programs and social support groups. Clients have a safe, clean place to stay while waiting for their home to become available. When the time comes, bridge housing clients receive comprehensive discharge instructions and continued follow-up for six or 12 months post-transition.

Bridge housing makes transitioning into a home more feasible for homeless clients and is more economical for the community. According to the Los Angeles United Way Homeless Cost Study (2011), the total cost of public services for two years on the streets was estimated at $187,288 compared to $107,032 for two years in permanent housing with support services—a savings of $80,256 or almost 43%. But more than that, housing the homeless resolves one of their biggest barriers to a healthy life.

With support from the Conrad N. Hilton Foundation, the Ahmanson Foundation and the Harold Edelstein Foundation, NHF is implementing the bridge housing program with a goal to place 150 clients in permanent or permanent supportive housing over two years.

Recuperative Care: Healing the Homeless

In 2005 and 2006, Los Angeles’ Skid Row grabbed national headlines after images surfaced of individuals in hospital gowns being dropped off on the street. These images brought immediate and substantial attention to a struggle that continues today, ten years later: safe discharge options for homeless clients after an acute hospital stay.

Public outcry for better treatment of the homeless, steep fines for poor discharge practices, and hospitals’ clear need for safer, healthier discharge options resulted in development and subsequent proliferation of the region’s recuperative care programs. For National Health Foundation (NHF), a multi-year pilot project that began in 2007 to conceptualize and test recuperative care resulted in a strategic shift in our services several years later. Not only did NHF help to develop a self-sustaining program concept that serves both homeless clients and hospital partners in Los Angeles and Orange Counties, but in 2014 it took on the operation of direct service for the first time. Operating these services has provided valuable insight into best practices for delivering compassionate and cost-effective care to the homeless upon discharge from the hospital setting. Perhaps more importantly, the program has demonstrated how a safe and supportive environment in tandem with a concentration of services can create a disruption in homelessness, result in clients’ willingness to move into a permanent home, and ultimately dramatically shift their long-term health outcomes.

Pathway Recuperative Care a program of National Health Foundation in Los Angeles, now in its sixth year of operations, bridges a critical healthcare service gap by providing homeless clients who are transitioning out of an acute care hospital with basic medical oversight in a clean, safe environment. This service allows clients to continue their recovery and receive treatment for any additional minor illnesses, thereby reducing the chances of relapse and costly re-hospitalization. Prior to partnering with recuperative care facilities, hospitals would be forced to keep patients no longer in need of acute care for roughly 4.5 additional days to provide the basic oversight. The differential in cost for one day of hospitalization versus one day of Recuperative Care is in the thousands. . To date it is estimated that this program has helped hospitals avoid $17,924,184.00 in cost. Partnering hospitals have also noted that streamlined referral procedures, diligent communication with the hospitals, data collection and analysis, as well as an innovate ‘pod’ concept (allowing for more service points in large geographic areas) have improved the experience for the partners while maintaining excellent service for the patients.

For NHF, the real measure of success has been the percentage of recuperative care patients who were discharged into housing. Through intensive care management, care managers help clients identify the root causes of their health issues, work to overcome those challenges, facilitate connections within the community that support a clients’ continual improvement, and for many, provide smooth transitions from the hospital to housing. NHF prioritizes the needs and wishes of the client, working to understand their housing and supportive service preferences, and securing housing during their time in recuperative care. In 2015, NHF added a “bridge housing” component to its program, enabling clients to remain in the recuperative care facility past their hospital-provided days, so they did not have to return to the street while waiting for their housing placement to become available. During fiscal year 2015-2016, NHF served 694 clients with recuperative care, 45% having been discharged into permanent or transitional housing. In addition to helping these clients recover from injury and illness, many of these homeless individuals were connected to critical social and healthcare services. NHF has been able to house approximately 30% of these clients within 14 days, in either transitional or permanent housing (7-10% in permanent housing alone).  As a result of NHF’s partnerships, recuperative care is able to address both health and social service needs of the client while connecting patients to a stable home.

Currently, NHF operates two sites in Los Angeles County, one in the Mid-City area of Los Angeles and another in San Gabriel Valley.  Under the current model, NHF offers 40 recuperative care beds to clients from 60 participating Southern California hospitals. This fall, NHF anticipates launching a third site in Ventura County.