Health and Dignity for the Homeless

Nancy Hu, a Social Worker with California Hospital Medical Center, Dignity Health, would like to see lower readmission rates, reinfections and fewer visits to the emergency department for her patients. Nancy works with patients who are about to be discharged from the hospital and the majority of her caseload is individuals who are without a home.

“I see myself as someone who advocates for my patients and collaborates with the nurses, doctors and case managers to work towards a safe discharge,” shared Nancy, “The challenge is that when someone is not able to heal in a clean and safe environment, it puts the person at a much greater risk of another hospitalization and further exacerbating their illness, all of which can be prevented.”

Since 2015, National Health Foundation’s Pathways Recuperative Care has become one avenue for safe discharge of homeless patients from partner hospitals. Pathways offers temporary housing with medical oversight to individuals who are without a home. The advantage for patients is that they can heal safely and are given the support needed to adhere to follow-up care schedules. For partnering hospitals the advantage is peace of mind, “The hospital feels reassured that the patients are able to go somewhere clean and safe to heal while getting assistance with follow-up appointments and housing,” says Nancy.

Not every homeless patient opts for accepting Recuperative Care and not all are a fit. As a social worker, Nancy assesses each patient who is homeless to see if they are appropriate for recuperative care, if they are motivated to get housing, and those who wish to recover from their medical condition. Not all homeless patients want to be housed, “Personally, it makes me sad because it doesn’t have to be that way. But I also know that we all have rights to make choices that we feel is best for ourselves and to choose to take help when it is offered.”

On any given day, Nancy is balancing and prioritizing between a victim of crime, someone who is homeless and being discharged while it is cold and raining outside, and another who is dealing with a life changing/altering diagnosis. We at National Health Foundation’s Pathways Recuperative Care are grateful to Nancy and Social Workers everywhere who are providing essential care to patients at their most vulnerable; upon discharge from the hospital.

Celebrating #SocialWorkMonth: Care and Compassion in the Face of Homelessness

Frank healing at NHF's Pathway Recuperative Care center.

Ron Jacobs, LCSW, Social Work Services at White MemorialMedical Center (WMMC) in Los Angeles, works closely with patients as they prepare for discharge from the hospital. Nearly every day Ron is faced with the challenge of discharging a patient who does not have a home to return to. 

“I make sure that those I serve are listened to and heard. I motivate individuals to enhance their strengths and abilities and help restore their sense of dignity while avoiding stigmatizing anyone as homeless,” says Ron of his role, “and I also realize that along with empathy, there must be action, resources and referrals.

March is #SocialWorkMonth and National Health Foundation(NHF) is celebrating the invaluable work that social workers do in the community, in particular the work of those who coordinate the discharge and referral of patients who are homeless.

 Until 2015, patients in Los Angeles County who were without a home and were discharged from the hospital faced completing their healing on the street. For many, a lack of follow-up care meant a certain return to the hospital. For social workers like Ron, it meant forming a connection with an individual upon discharge only to see them back in the hospital. “Knowing that there is a resource that is an alternative to the streets is a wonderful advantage we can now offer these individuals,” shared Ron, “Pathway Recuperative Care provides the opportunity for transitional healing, emotional support, resources and concrete solutions to enable our patients to reconnect with their community.”

Shakoya Green, MA, MSW, National Health Foundation’s Recuperative Care Program Director had this to say about Ron, “We simply cannot do what we do without Social Workers like Ron who go above and beyond their ‘job’ to really connect with their patients on a deeper level. Ron sees the whole person and addresses their needs from a place of love. We have been able to work closely together to achieve some incredible outcomes for our patients.”

Frank was discharged from WMMC last fall after several complex procedures. Ron ensured a smooth referral to Pathway Recuperative Care and helped to secure every possible form of care to ensure Frank recovered from his physical issues. Frank was able to benefit from the full spectrum of services that the partnership provided and has since fully healed physically and has been provided with a stable housing solution. “Frank’s case exemplifies what is possible when there is a ‘champion’ for the homeless who sees beyond the sometimes harsh exterior and works compassionately and diligently to ensure success,” added Shakoya.

Ron’s motto is a moving one, “I strive to meet each person as he/she is and I begin where the person is at in their journey in life. I try to remember that we are all ‘poor’ in one way or another and we all need some degree of healing at some time in our lives. There is no ‘healer and would be healed’. When we help someone in need, we are all better off. We all share a common humanity.”

All of us at Pathway Recuperative Care and National Health Foundation salute you, Ron, and all Social Workers.

Increasing Opportunities for Exercise in Historic South Los Angeles

On February 13^th, 2017, Central Avenue Jazz Park in Historic South Central Los Angeles was transformed into an outdoor fitness space with community members and instructors moving through workouts designed to increase cardiovascular capacity, boost energy levels and increase the feeling of wellbeing. For community member Claudia Durango, it was a welcomed event, “This is going to be really good for the community; we just need to continue having people show up.” The new program is part of the rollout of National Health Foundation’s (NHF) BUILD Health LA Initiative Community Action Plan for Historic South Central.

In 2016, NHF’s BUILD Health LA Community Health Liaisons, a group of local high school students and their mentors, surveyed the community to understand residents’ barriers to health. The results of the survey were captured in the Community Action Plan that aims to improve the health of the community through methods that have been identified by the community’s residents and that capitalize on partnerships and the assets available.

Historic South Central Los Angeles is 6 square miles, and is home to roughly 103,000 people. In this community, there are no gyms and there is only 0.4 acres of park space for every 100,000 people. Along with having limited access to open space, this community is considered both a food desert (with few healthy food retail choices) and a food swamp (categorized by a prevalence of unhealthy food outlets). Obesity and diabetes are common in this community, and while physicians recommend healthy eating and exercise, these lifestyle changes are challenging to practice with what is available in the community.

One of the needs the Community Action Plan addresses is for programs to keep residents physically active. Many stated that the classes that were available were too expensive and that the free programs had extensive waitlists of residents eager to join. We learned that these residents want to exercise and they will – if the opportunity is there.

As a result, we partnered with 3WINS Fitness, an innovative program spearheaded by Dr. Loy and Kinesiology students from California State University, Northridge. 3WINS Fitness “adopts” parks in Los Angeles, and sends Kinesiology students to teach community members how to exercise while nurturing a community mentality that leads to friendships, accountability and results!

In addition to 3WINS Fitness, NHF also partnered with California Hospital Medical Center, LA County Department of Public Health, LA City Parks and Recreation, Newton Community Police Station, All People’s Community Center, and A Place Called Home, to launch the fitness program. Classes take place Mondays, Wednesdays, and Fridays at Central Avenue Jazz Park and All People’s Community Center.

Community members are thrilled with this new opportunity and have already built great rapport with the instructors from 3WINS. For NHF, the program represents a new way of delivering health to the community. “By creating an opportunity for the community to express their needs and actively engage in finding solutions to the health barriers they were experiencing, they are bringing about healthy changes from within,” shared NHF CEO Kelly Bruno.

Consistency is always the key with taking on a new behavior, but we are sure that with this new partnership and with the different components of the BUILD Health LA Initiative and Community Action Plan, the residents in Historic South Central Los Angeles will have new opportunities to live a healthier lifestyle.

Two Men, Two Paths

Arnie and Mat arrived at National Health Foundation’s (NHF) Pathway Recuperative Care from partner hospitals in early December 2016. Both were in need of additional medical supervision and both were homeless. The similarities in their cases ended there. The task of delivering essential care and helping the two men find stable housing required an individualized plan that took into account their stories, their needs and their goals.

Arnie's multiple chronic medical conditions require monitoring and medication, both of which are challenging to maintain on a modest monthly social security check. He found himself unable to pay for rent and his condition deteriorated until he needed to be hospitalized. Upon discharge from the hospital he was homeless and in need of follow-up care. At Pathway Recuperative Care, Arnie worked closely with staff members on his care plan. This plan looks at the patient’s needs both medically and with respect to housing. Staff then began connecting Arnie to services available to him via the Department of Mental Health as well as medical services to ensure continuous improvement on both fronts. With Arnie’s motivation and Pathway staff persistence, he was able to secure stable housing that will ensure a sustained return to health.

For Mat, the struggle was no less intense. He came to Pathway Recuperative Care from a partner hospital with no money, no identification and no home. Struggling to recover from substance abuse, the 20-year-old had spent years in the foster care system and found emancipation to be more difficult than he had the skills to cope with. Upon arriving at Pathway Recuperative Care, the staff worked with Mat to reapply for General Relief, obtain a replacement Electronic Benefit Transfer card and kept him proactive in attending the necessary medical and social services appointments that would ensure his return to health. The last piece of Mat’s health plan was to secure stable housing.  Mat’s stable housing is such that he will receive the support he needs to maintain his health while acquiring the skills he needs to navigate adulthood.

For Pathway Recuperative Care staff, each patient has a vastly different set of circumstances that has led to the decline in their health and the loss of their home. “Each person who comes to Pathway is seen as an individual with distinct health needs. We take the time to understand their history and work with them to devise a plan that matches their needs and capacity for managing their progress to sustained health," explained Kelly Bruno, MSW, President/CEO National Health Foundation. For Arnie and Mat, the prospect of an end to homelessness was welcomed with large grins and a sense of accomplishment. “We find it impossible to speak about health without addressing the most fundamental social determinant of health: housing. Without a home, there can be no health,” asserts Bruno. With secure and supportive homes both Arnie and Mat can now turn their attention and energy towards their healing and health.

The Healing Journey

When Frank was discharged from a Southern California hospital, he was in need of intensive follow up care; he was also homeless.

For hundreds of Angelenos who are without a home, a hospitalization can cause a momentary interruption of homelessness, but the reality of receiving follow-up care and healing on the street is such that many homeless patients find their way back into the hospital.

National Health Foundation’s (NHF) Pathway Recuperative Care offers patients like Frank a safe and supported environment where they can continue their healing journey and, thanks to our continuum Bridge Housing program, find a permanent and stable home to return to upon discharge.

Patients spend an average of 7-10 days in recuperative care and this respite often triggers a desire in our guests to find a stable home; however, the process is often challenging and takes a team of individuals to connect the guest with the best possible permanent housing solution. Since our program began in 2010, we have helped more than 3,000 formerly homeless individuals heal and nearly half find their way home.

On #GivingTuesday, we are inviting the community to donate generously to NHF’s Pathways and Bridge Housing programs. Your donations will provide taxi vouchers for patients to be transported from the hospital to our facilities, personal hygiene supplies, clothing and basic furnishings to help a formerly homeless individual make a house into a home.

For more information about Pathway recuperative care, click here.

For more information on Bridge Housing, please click here.

Teens Bring Mini-Farm Stands to the Classroom, Reduce Food Waste in the Process

Youth engagement provides young people with the opportunity to develop leadership skills and address challenges they face head-on in their own communities. For the past three years, National Health Foundation’s Health Academy has been working alongside youth from Historic South Central Los Angeles to address upstream barriers to healthy weight such as access to healthy food in their community. NHF Health Academy’s “Legion of Health” youth team is one of four teams in the program that engaged in youth participatory action research to identify issues impacting access to healthy food and food waste and develop and implement solutions to tackle those barriers. Here is one example of their success.

In the fall of 2014, Los Angeles Unified School District implemented Breakfast in the Classroom (BIC), a program that enables students to eat breakfast provided by the school in their classrooms rather than before they get to school. This was especially important at Thomas Jefferson High School where the surrounding community is labeled a food desert¹ and access to healthy foods is an extreme challenge. Living in a “food desert” means that at least one third of the residents live more than one mile from a grocery store and in a dense urban environment, that is a significant barrier. In addition, those grocery stores serve significantly more people than in areas with better access. A 2010 Community Health Councils report indicated that South Los Angeles’s 60 full-service grocery stores serve approximately 22,156 residents each. In comparison, West LA’s 57 grocery stores each serve approximately half the number of residents. Layer onto this story the fact that 60% of South Los Angeles eateries are fast food restaurants. Clearly, BIC was an essential program providing increased access to fresh, healthy foods and students needed to take greater advantage of this opportunity. Within these statistics, the Legion of Health youth team saw an opportunity to make real impact.

As the Legion of Health team investigated the BIC program, they discovered that one of the unintended consequences was an increase in food waste, specifically the fruit accompanying the breakfast meal. A meeting and tour of the cafeteria with the Cafeteria Manager gave the youth real insight into the actual volume of food waste. The youth team began re-envisioning the BIC program as a way to encourage consumption by recovering the food and offering it as a snack to students throughout the day. This option would reducing food waste and minimize cost of healthy snacks. Legion of Health developed a pilot project to provide healthy snacks throughout the day at no cost to students by saving the surplus of fruit and/or non-perishable food items from the BIC program. Youth placed decorative baskets in classrooms and set uneaten food from BIC into the basket. Legion of Health named their project “Health Academy Mini-Farm Stand” and designed baskets to hold the fruit in classrooms. Legion of Health partnered with several of their high school teachers to implement the pilot project in select classrooms. Youth also developed a tracking system to record the number of students that grabbed a snack. Legion of Health hypothesized that students would consume all the items by the end of each school day.

The project findings proved the Legion of Health’s hypothesis to be correct: all food from the farm stand baskets were consumed by the end of each school day. Legion of Health presented these findings to school administration and advocated for school-wide implementation. School leaders agreed to implement the project school-wide so that every classroom would have a “Health Academy Mini-Farm Stand” basket and students would have access to healthy food anytime of the school day in any classroom on campus. Since school-wide implementation, the Cafeteria Manager is reporting a near complete reduction of food waste from BIC.

Legion of Health recently expanded the “Health Academy Mini-Farm Stand” project to Nava College Prep Academy. Legion of Health presented the benefits of the baskets to students and staff along with delivering baskets to each of the classrooms. This past school year, Legion of Health met with Laura Benavides Co-Director of LAUSD Food Services who applauded the youth’s efforts. In the coming year, Health Academy’s Legion of Health will seek out partnerships at other schools to expand the program in hopes of ultimately meeting with the LAUSD School Board to advocate for district-wide implementation.

^[1] ‘Free and Reduced Meal,’ Analysis, Measurement, & Accountability Reporting Division. California Department of Education, 2013; http://www.cdph.ca.gov/programs/cpns/Documents/SNAP-Ed%20FFY%2015%20Att%201%20FRPM%202013%2005%2024.pdf

Zip Codes as Indicators ... of Actively Engaged Communities

 

By Danielle Cameron, Chief Strategy Officer for National Health Foundation

Too many times we have heard how zip codes have a greater impact on individuals’ health than their genes; usually in the negative sense. Social determinants of health – conditions in the places where people live, learn, work, and play – can have wide ranging impact on health risks and outcomes.[i] But these zip codes facing troublesome social determinants of health have an opportunity to rise up and tackle these challenges head-on so that these zip codes are no longer synonymous with poor health, but rather signify some of the most willful, engaged communities working together to improve their environment and collective health.

Rather than viewed for their economic policies, environmental circumstances, social norms, or educational experiences that poorly impact health, these zip codes often indicate the presence of a powerful community of organizers, advocates and change agents. They are shifting the tide in terms of population health – in their own neighborhoods. It’s these zip codes where hospitals, health plans and community-based organizations should be looking to establish multi-sector partnership that leverage local resources and ambition to create the most impactful change.

NHF has had just that experience in South Los Angeles.

According to the ‘Mapping LA’ project of the Los Angeles Times, South Los Angeles is a 51 square-mile region encompassing 28 neighborhoods that are home to more than 749,000 residents and some of the most troublesome zip codes in Los Angeles County.

For the past four years, NHF has been working in a handful of these zip codes with a generation of engaged teens, learning to bring about dramatic changes in their community and succeeding! In particular, they are changing the way South Los Angeles residents view their physical environments, personal health practices, the healthy development of their children, as a means of improving their overall health and wellbeing.

Through a series of student-led programs that emphasize information gathering as well as peer and public input, healthy changes are afoot in a zip code that otherwise has many negative associations.

At Jefferson High School, National Health Foundation’sHealth Academy, a student-led, healthy change initiative has, over the past three years, implemented such ground breaking ideas as a hydration station offering fresh water as an alternative to sodas and juices, reconfigured the lunch room so that all students have time to get lunch and eat it, versus having to go to the snack shop to buy sugary treats to replace meals, and have tested and introduced healthy meal options that are now on the lunch menu. Perhaps the biggest victory was the creation of classroom-based mini farm stands where students can help themselves to a piece of fresh fruit when needed. The initiative caught the eye of the Los Angeles Unified School District’s food services director who acknowledged the thoughtful use of fruit left over from breakfast service, the reduction of food waste, and the increase in opportunity for students to snack on healthy fruits. The district is considering expanding the program to other LAUSD school sites.

Through another project, NHF’s BUILD Health Challenge grant in collaboration with California Hospital Medical Center and the LA County Department of Public Health, student ”Community Health Liaisons” spent several months interviewing residents about their perceptions and needs as they relate to their physical environment. Residents voiced concerns ranging from a need for safe, open spaces for play and exercise, to a desire to walk more and have more opportunities to purchase fresh fruits and vegetables. The partnership took the information gathered and formulated a Community-Driven Action Plan for Historic South Central. The purpose of the plan will be to implement upstream, meaning preventative rather than curative, solutions to the health issues faced by the community. By lowering or even eliminating some of the social and environmental barriers to health, the team hopes that the community will defy the current statistics that point to lower life expectancy and a higher than average rate of preventable illnesses.

As part of Mayor Eric Garcetti’s Great Street’s Initiative, another group of inspired students championed the creation of a Walking Corridor along Central Avenue. Through the use of clever wayfinding signage, the community can now see how far the nearest transit, entertainment, shopping and recreational facilities are located on foot. The signage, unveiled during a community event in May, has been met with the resounding approval of the community and visitors alike.

The community is seeing first-hand that change is most meaningful when it comes from within and is possible when it is led by the energy and passion of one of its most valuable assets: its youth. The remarkable success of these empowered and engaged youth is a reflection of a new and brighter outlook in the zip codes of South Los Angeles.

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[i] World Health Organization