By DAVID GORN
Kaiser Health News
Just up the freeway from Disneyland, in the Orange County city of Buena Park, Calif., Paul Leon stood outside the beat-up remnant of a seedy motel. Above him, a faded pink sign advertised the Coral Motel, whose rooms back in its prime cost 35 bucks a night.
Image credit: Heidi de Marco/Kaiser Health News
Victor Ramirez, 61, uses his ventilator at the men's dorm at the Illumination Foundation Recuperative Care in Santa Fe Springs, Calif., Feb. 12. The Guatemalan native became homeless after he lost his job at a car wash in Los Angeles.
"This particular motel was going to be taken back by the city of Buena Park, because of the drugs, alcohol, prostitution," Leon explained.
But Leon, chief executive of the Irvine, Calif.-based Illumination Foundation, a homeless services nonprofit, had a different idea. He proposed turning the motel lobby into a triage center and converting the rooms into clean recovery facilities for homeless people recently discharged from the hospital. And that's what he did.
Recuperative care centers are pricey to set up, but the motel model was just the opposite, Leon said.
"The beauty of this (is) it's the poor man's recuperative," he said. "They're not the Hyatt or the Hilton, but they do serve a purpose for us. The costs to run it are much less."
The motel recovery room costs about half as much as a hospital would — about $2,000 less a day for each patient. And it's like being at home. In fact, it may be even better than home, because it has a nurse on staff to help supervise care and handle complications.
Leon, who was trained as a public health nurse, launched the Illumination Foundation, which has expanded the motel respite care model to six sites in four California counties — Orange, Los Angeles, Riverside and San Bernardino.
Elvin Quiñones, one of the patients at the Coral Motel, padded across the motel parking lot in flip-flops to show off his previous home — a small white Datsun B210 sedan.
Image credit: Heidi de Marco/Kaiser Health News
Elvin Quiñones, 55, visits his two chihuahuas at the Santa Fe Animal Hospital usually every other day. Quiñones put them in the kennel the day he became homeless.
"I'll show you my house," he said, "it's not very big."
Quiñones is a large man, and it's hard to picture him crammed into the car along with his two dogs. In the days immediately following his gall bladder operation, he had to fit a bunch of medical gear, too.
"I'll be honest, I was sleeping in front of the 24-hour Walmart, because they had a bathroom," Quiñones recounted. "I still had a tube stuck inside me that was draining, so I needed someplace where I could empty out the drain." Being homeless and helpless, he added, is something he'll never forget.
"It's surreal. You think you're going to wake up and it'll all be a nightmare. And you wake up and it's not," he said. "It's just the next day."
A week after his medical release, the hospital called and helped place him in the motel.
"This is a new model of care for Orange County," said Ginny Ripslinger, vice president of network of care at the former St. Joseph Health, now combined with Providence Health & Services as Providence St. Joseph Health of Renton, Wash. Ripslinger is on the Illumination Foundation's board. She said St. Joseph's involvement with the foundation began when the foundation was seeking funding about six years ago and secured a $500,000 line of credit, in the form of a low-interest loan, from St. Joseph's foundresses, the Sisters of St. Joseph.
Image credit: Heidi de Marco/Kaiser Health News
The Coral Motel in Buena Park, Calif., a facility that fell into disrepair and disrepute, is now repurposed as an economical respite care center for homeless patients following hospital stays.
Hospitals and health insurers help fund the motel-based care centers, Ripslinger said, because they save money by stabilizing these patients, and because it's the right thing to do. The dollars they contribute are in addition to any payments from Medi-Cal, California's Medicaid program.
"We don't want to discharge (patients) to the street, and there's an obligation on the hospitals to provide continuity of care and safe discharges," Ripslinger said.
She said before the Illumination Foundation began repurposing old motels for respite care for the poor, hospitals patched together piecemeal offerings, such as paying for a short stay in a hotel room.
Now dozens of southern California hospitals send homeless patients to recuperate at the recovery motels, dorms and homes renovated by the Illumination Foundation as recuperative care locations.
Patients also get wraparound services, including help securing follow-up care, medication administration, mental health care and hospice care, when warranted.
With all this support, the clients "become more stable citizens in our community, and we are also able … to link our patients to other social (service) programs, and we have been able then to give them permanent housing," said Ripslinger.
Piece of the puzzle
Kimm Hurley is Southern California regional social services director for San Francisco-based Dignity Health. That region includes six hospitals, most of them in the greater Los Angeles area. Most of those hospitals partner with Illumination Foundation to provide recuperative care for patients. The hospitals have similar contracts with two other recuperative care organizations.
Hurley said the recuperative care complements larger Dignity Health work to provide population health to people, and to meet people's needs wherever they live.
She noted the recuperative care also is in line with work by Los Angeles government agencies, housing providers and health care providers including Dignity to provide long-term support to homeless people in a city that has one of the nation's largest homeless populations.
Hurley said the services Dignity can provide through recuperative care organizations and other partnerships are a key part of Dignity's work to serve the disenfranchised and advocate for them.
Ripe for replication
Leon of the Illumination Foundation said he has been working with dozens of cities across the country to establish respite care services for homeless individuals.
"If you're just starting and you don't have a recuperative care program," he said, "one easy quick method is to use motels. They could basically start within days to house some of the patients that are the most vulnerable."
Every city has a homeless problem, Leon added, and every city has its own version of the beat-up Coral Motel. It's a rare opportunity, he said, to turn two big problems into one solution.
Ripslinger of Providence St. Joseph Health said, " … the relationship we've developed with the Illumination Foundation has really advanced our ability to provide care to the homeless person and protect their dignity as well and move them in to a more positive lifestyle. My feeling is that the outreach that we do with the foundation has had not only an individual impact but also an impact on those of us who care for patients who are so underserved or at risk, because we know that they are receiving the care that we would like them to get.
"That's consistent with the mission and vision of the Sisters of St. Joseph," she said.
This story is part of a partnership that includes KQED, NPR and Kaiser Health News. Julie Minda, associate editor of Catholic Health World, contributed to this report.
Pilot program shows promise for improved outcomes for homeless
Key to the partnership between Providence St. Joseph Health of Renton, Wash., and the Illumination Foundation is the medical-social model that the organizations use to provide wraparound services to the homeless individuals served by the program, according to Ginny Ripslinger, vice president of network of care at Providence St. Joseph.
A pilot program undertaken by the partners provided medical coordination and intense case management to all of its clients, reduced their emergency department visits and connected them with other supports. Data show 89 percent of pilot program participants obtained proper identification, 79 percent connected to medical specialists, 74 percent secured Social Security and 23 individuals secured permanent housing.
The partners implemented the pilot program, called Chronic Care Plus, at St. Joseph Hospital of Orange in Orange County, Calif., now part of Providence St. Joseph.
Over a two-year period, the hospital identified emergency department users who were chronically homeless, who were "high utilizers" of the emergency department and who fit other criteria to take part in Chronic Care Plus. The program provided medical coordination, medication management education, job readiness training, mental health referrals, transportation to services, financial literacy training, social case management services and housing help. It served 38 clients during the study period.
Data from the pilot showed a dramatic decrease in emergency department visits. The program generated an estimated $2.8 million in annual savings.
With the pilot complete, Providence St. Joseph is exploring how best to implement the program in other Providence St. Joseph hospitals.
Ripslinger said of the collaboration with Illumination Foundation, "It's been a story that is extremely gratifying to us that provide medical care, and it is a solution that has sometimes very awesome outcomes."
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