The HealthCare Action Team (HAT) is a project of Planning for Elders. HAT has worked for several years on the issue of appropriate hospital discharge planning. HAT advocated for and helped create legislation that created the San Francisco Hospital and Nursing Home Discharge Planning Task Force.

HAT is leading the work to improve how homeless patients are discharged. In September, HAT members and allied community organizations held a press conference to bring attention to the issue. HAT has continued to press for solutions to this issue before both the Board of Supervisors and the Hospital Council.

Regarding the area of homeless patient discharge in San Francisco there are several key areas in need of improvement. These are HAT’s recommendations:

1. In the absence of affordable housing, there need to be more accessible and appropriate respite beds in the shelter system. Currently, there are about 60, and this is not nearly enough. If people are expected to recover from surgeries or other acute conditions they require a place to do so. Acutely ill patients who lack appropriate respite facilities are likely to end back in the emergency room. This unnecessary use of already overstretched emergency rooms could be significantly reduced with the expansion of respite slots.
2. These respite beds need to be accessible to all homeless patients, not just those in SF General. There needs to be a streamlined referral procedure from all hospitals and skilled nursing facilities. Currently only patients in SFGH and possibly St. Francis are able to be referred to respite. This could be modeled after the Coordinated Case Management Program, (or Case Management Connect). Although this would require communication between hospitals and homeless respite programs, it is not impossible in this era of high speed internet connections and telephones.
   1. A subcomponent of this recommendation is that the computer database currently in use be adjusted so that shelter residents who have 60 or 90 day beds and become hospitalized during their stay do not lose their 60 or 90 day status upon discharge from the hospital. The way it is now, shelter residents often leave the hospital with shelter reservations that they have to renew on a weekly basis. Acutely ill patients should not be expected to go through this process to simply keep themselves sheltered.
3. Transitional care case management programs like the Homecoming Services Network need to be included in the discharge planning process for patients without homes. There is capacity in that network to handle some homeless patient discharge cases, although given the recognized health crisis of homelessness, expansion is imperative. It should be mandatory that homeless patients are assisted by existing transitional care case management programs.
4. The inclusion of a resource page geared towards informing homeless patients of the resources available to them in the community. This would also inform patients of their legal rights regarding the procedures to appeal their plan of care. HAT has developed a one page form entitled “Preparing to Leave the Hospital” that has been vetted in the community and approved by the Hospital Council. This could easily be modified to address the concerns of persons without home.
5. Expansion of the San Francisco Long Term Care Ombudsman Office to include acute hospitals. Currently the Ombudsman office monitors only nursing homes and skilled nursing facilities. It is a valuable program that provides a vehicle for consumer issues to be voiced and for systemic problems to be identified. The SF Ombudsman’s office endorses this recommendation although it will require additional funding from the state level.

James

This entry was posted on Saturday, December 1st, 2007 at 12:04 am and is filed under Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.