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HomeMy WebLinkAboutMINUTES - 12142010 - C.124RECOMMENDATION(S): 1. ACCEPT the report from the Health Services Department regarding Health Care for the Homeless; and 2. DIRECT that staff report on an annual basis to the FHS Committee regarding progress and status of the Project, with an additional report to the full board, annually. FISCAL IMPACT: No impact. The HCH Project is funded through a Public Health Services Act Section 330(h) grant from the Health Resources Services Administration. BACKGROUND: Since 1990, the Health Care for the Homeless (HCH) Project has provided health care services to the homeless population through mobile clinics, as well as through the CCHS integrated ambulatory system of care, and the Departments of Mental Health and Alcohol and Other Drugs. Primary health care services provided by the APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 12/14/2010 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Gayle B. Uilkema, District II Supervisor Mary N. Piepho, District III Supervisor Federal D. Glover, District V Supervisor Contact: Wendel Brunner, M.D., 313-6712 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: December 14, 2010 David J. Twa, County Administrator and Clerk of the Board of Supervisors By: June McHuen, Deputy cc: Tasha Scott, Rachael Birch, Barbara Borbon C.124 To:Board of Supervisors From:William Walker, M.D., Health Services Director Date:December 14, 2010 Contra Costa County Subject:Health Care for the Homeless Project Update BACKGROUND: (CONT'D) HCH Mobile Team include routine physical assessments, basic treatment of primary health problems such as minor wounds and skin conditions, respiratory problems, TB screening, acute communicable disease screening, and coordination and referrals for follow up treatment of identified health care needs. A significant portion of the homeless patients seen in the mobile clinics have chronic diseases, including asthma, hypertension, diabetes, and mental health/substance abuse issues. The mobile team is comprised of a Medical Director, Family Nurse Practitioners, Public Health Nurses, Nurses, Community Health Workers, Financial Counselor, Mental Health Specialist, and a Substance Abuse Counselor. Homeless patients who receive care on one of the mobile clinics are referred into one of the CCHS ambulatory care health centers for primary and specialty care, into County mental health and substance abuse services and to Contra Costa Regional Medical Center for emergency, inpatient hospital, outpatient surgeries, laboratory and radiology. There are currently three ambulatory care clinics, located throughout the County, designated specifically for homeless patients to help them transition from the mobile clinic setting into the ambulatory care system. HCH staff members are present at each of these clinics. During 2009, CCHS treated 15,094 homeless patients who generated 96,572 visits. This is an increase from 2008, when CCHS saw 12,372 homeless patients who generated 82,432 visits. The increase is likely due to the economic recession, which placed further demand on the safety-net system, including CCHS. Data for 2010 will be available in late Spring 2011, and will be presented to the Family & Human Services committee. Table 1 (below) indicates the Board of Supervisor’s District where homeless patients reside. If no residential zip code data are available, the zip code where a patient received care is used. Table 1: Percent of Homeless Patients by Supervisorial District, 2009 District 1- Supervisor Gioia 31% District 2- Supervisor Uilkema 15% District 3- Supervisor Piepho 2% District 4- Supervisor Bonilla 20% District 5- Supervisor Glover 31% New Actions The following activities have occurred since the last briefing to the Board of Supervisors on HCH activities: 1. American Recovery and Reinvestment Act (ARRA) Funding Stimulus funds through the ARRA have provided close to $13Million for services and facilities improvement. In May 2009, the HCH Project was awarded $224,000 in stimulus funds to address the “Increased Demand for Services.” This amount of funding was calculated by a formula based on the number of homeless patients served by the HCH Program. Funding is for a two-year period and is providing services to additional homeless patients. The Health Resources and Services Administration (HRSA) has recently indicated that this funding award may be added to the HCH base grant at the end of the current project period (May, 2011), although we are still awaiting verification. In July 2009, the HCH Project received a Capital Improvement Project award to replace the Martinez Family Practice Site (Building 2 on the CCRMC Campus) with a new building. This project will modernize the clinic and streamline clinic flow for maximum efficiency. The new unit will enhance the effectiveness and efficiency of providing clinical services to patients through reduced waiting times for clinic appointments at the Martinez site and throughout the CCHS system. A homeless-specific clinic will be offered at this site upon its opening. Funding for this project was calculated on a formula basis at $683,000. During the past year, CCHS devoted time to meeting all conditions associated with the grant award prior to beginning construction. The federal government has reviewed all submitted documents and has given CCHS the clearance needed, through a Final Notice of Grant Award, to proceed with construction of the new building. Demolition of the antiquated structure has already occurred and construction is expected to begin mid-Spring. Last December 2009, Supervisor Gioia and Dr. Walker were invited to the White House for the exciting announcement by President Obama regarding the Facility Investment Awards by the Department of Health and Human Services. CCHS received $12 Million in ARRA funds for the construction of a new West County health center, to replace the Richmond Health Center. CCHS is currently working diligently on clearing the various grant conditions to obtain construction clearance. All grant conditions are expected to be cleared by early February 2011 in time for the first phase, site preparation, to begin mid-Spring. 2. Respite Care Program Opened June 2010 Under the direction and leadership of Cynthia Belon, Director of County Office of Homeless Programs, the respite care program opened, with a 24-bed capacity to serve approximately 380 clients annually with a higher level of care than what is currently provided in the emergency shelter. Health Care for the Homeless staff provide the medical care on site with a full time registered nurse dedicated to the respite program and two weekly visits by the mobile team providing services to both respite and shelter clients. Since opening, the respite facility has received over 230 referrals and has admitted over 80 patients. Kate Schwertscharf, HCH Public Health Nurse Program Manager, developed medical policies regarding patient acuity for this program, in collaboration with the HCH Medical Director, Dr. Kate Colwell, and Ms. Belon. To prepare for the respite program, HCH has been setting up the clinic to be located in the respite facility and updated its policies and protocols for taking discharge planning phone calls from local hospitals looking to discharge homeless patients to a shelter. Upon admission to the respite unit from a local hospital, a diagnostic medical assessment and treatment plan will be developed for each client. Medical providers on sight will coordinate with primary care physicians and/or hospital staff in our integrated health care delivery system. The anticipated average length of stay will be 14-21 days, or whenever the homeless client is medically stable and can transition into the general emergency shelter population. 3. Improved Collaboration for Re-entry Program for Individuals Exiting Incarceration The Health Care for the Homeless program has also been working in collaboration with the County Office of Homeless Programs, the Mental Health Division, and Dr. Walker’s office to address the transition of prison inmates back into our communities, including those to be released under Non-Revocable Parole, those being given “compassionate” release for medical reasons, and others. In particular, the role of the HCH Program has been to develop systems that help clients gain access to primary, specialty, and behavioral health care and establish a medical home. HCH staff provide outreach services at Parole and Community Together (PACT) meetings, assisting parolees in finding appropriate health coverage and connecting them with mobile and ambulatory care clinics. 4. Pro-Bono Dental Health Services for Homeless Clients The Homeless Consumer Advisory Board and HCH recently launched a new partnership with a small group of private dental providers who will provide services free of charge to homeless individuals who do not qualify for dental coverage through other programs. The Advisory Board has been a strong advocate about the need for this free service given a lack of affordable dental services, and we are very pleased that a pilot program will address some of this unmet need. The first client received free treatment and she now has a full set of dentures, at no cost, courtesy of the generous care from Dr. Alijanian, DDS, of Walnut Creek. A second client recently began care with Dr. Alijanian and will soon be receiving a full set of dentures. Dental services are essential to regaining employment, exiting homeless, and assist homeless patients in gaining confidence and a sense of self-worth. 5. Project Homeless Connect HCH staff participated in the 6th annual Project Homeless Connect in Antioch on September 16th, 2010. A total of 165 clients were seen by HCH staff, 131 patients received Flu, Pneumococcal and TDAP vaccinations and 34 were seen by the complete HCH team for other medical problems. 6. New Mobile Sites HCH added new mobile clinical service sites for homeless patients at: - Martinez Waterfront (corner of Ferry St & Joe Di Maggio Dr.) - Antioch Fairgrounds - Neighborhood House (drug treatment facility on 23rd St, Richmond) In addition, HCH expanded services at Home Depot in El Cerrito to a weekly clinic with longer hours and increased clinics at Bay Area Rescue Mission in Richmond to two days per week. CONSEQUENCE OF NEGATIVE ACTION: Not Applicable CHILDREN'S IMPACT STATEMENT: Not Applicable.