[Slide 1]{.underline}

**Hospital Discharge of Homeless Persons in Chicago**

2000 to 2006

[Slide 2]{.underline}

**Presentation**

The Chicago Experience

Snapshot Study of Cook County Hospital, 2006

Integrating Systems of Care

The CHHP Experience

[Slide 3]{.underline}

**Chicago Area**

No tracking of the homeless at hospitals

No designated social workers to serve the homeless

Expedited hospital discharges often result in poor referrals and
placements

Poor integration of hospital social services with shelter or housing
systems

[Slide 4]{.underline}

**Hospital Discharges**

Interfaith house

Variety of shelters

Temporarily with family slash friends

Some discharged to the streets

Some placed inappropriately at nursing homes

[Slide 5]{.underline}

**Prevalence of the Homeless at Cook County Hospital, 2006**\
Doctor David Buchanan

Snapshot of inpatients at hospital:

Homeless, HUD definition: 19.8 percent

Doubled-up homeless: 12.6 percent

Total: 32.4 percent

Mean duration of homelessness: 15.6 months

[Slide 6]{.underline}

**Homelessness Equals the Failure of Multiple Systems of Care**

[Slide 7]{.underline}

**CHHP Project Design**

Hospital

Respite Program

Permanent Housing

Arrows appear to connect the above concepts in order.

[Slide 8]{.underline}

**Logo: Chicago Housing for Health Partnership**

[Slide 9]{.underline}

**Organizational Partners**

3 Key Medical Centers Slash Hospitals

11 Supportive Housing Providers

3 Respite Slash Interim Housing Providers

7-plus Health Care Foundations

Housing Opportunities for Persons with HIV Slash Aids; HUD Slash Hopwa

[Slide 10]{.underline}

**Client Partners**

Adults who are homeless

Inpatient at three area hospitals

At least one chronic medical illness

Willingness to give consent

[Slide 11]{.underline}

**4-Year Demonstration Project: September 2003 to August 2007**\
CHHP

First of Chicago's Plan to End Homelessness

[Slide 12]{.underline}

**Project Design**

Supportive housing: variety of models

Intensive case management: 10-to-1 ratio

Housing First approach

Harm Reduction models

Research component

Policy initiatives planned

[Slide 13]{.underline}

**CHHP Participants: June Thirtieth, 2006, to Final Enrollment**

Intervention: 216

Usual Care: 220

Total: 436

[Slide 14]{.underline}

**CHHP**\
Intervention Participants

[Slide 15]{.underline}

**Intervention Group: Top Multiple Diagnoses, 216 Participants**

HIV Slash Aids: 75 participants, 34 percent

Hypertension: 73 participants, 33 percent

Cardiovascular Diseases: 33 participants, 14 percent

Pulmonary Diseases: 39 participants, 18 percent

Diabetes: 32 participants, 14 percent

Gastrointestinal Slash Liver: 14 participants, 6 percent

Seizure Disorders: 18 participants, 8 percent

[Slide 16]{.underline}

**Intervention Group: Gender, 216 Participants**

Male: 74 percent, 159 participants

Female: 25 percent, 56 participants

Transgender: 1 percent, 1 participant

[Slide 17]{.underline}

**Intervention Group: Age, 216 Participants**

21 to 40: 30 percent, 64 participants

41 to 60: 64 percent, 140 participants

61 to 82: 6 percent, 12 participants

Median: 47 years

[Slide 18]{.underline}

**Intervention Group: Race Slash Ethnicity, 216 Participants**

African-American Slash Black: 77 percent, 166 participants

Hispanic/Latino: 8 percent, 17 participants

Caucasian/White: 10 percent, 22 participants

Other: 5 percent, 11 participants

[Slide 19]{.underline}

**Long-term Homelessness: 216 Participants**

Long-term Homelessness, HUD: 151 participants, 70 percent

Short-term Homelessness: 65 participants, 30 percent

[Slide 20]{.underline}

**Substance Use History: 216 Participants**

Assessed with Long-term History: 153 participants, 71 percent

Estimated with Long-term History: 186 participants, 86 percent

[Slide 21]{.underline}

**Mental Illness History: 216 Participants**

Diagnosed with Long-term History: 67 participants, 31 percent

Estimated with Long-term History: 99 participants, 46 percent

[Slide 22]{.underline}

**Stably Housed**

[Slide 23]{.underline}

**Reached Stable Housing: Intervention Group, November 2003 to September
2006**

142 out of 216, 66%

20 engaged and currently being housed

142 out of 196 , 76%

[Slide 24]{.underline}

**Reached Stable Housing: Intervention Group, November 2003 to September
2006**

Length of Days to Reach Housing

Average: 76 days

Range: 70 to 90 days; outliers: 0 to 371 days

Median: 62 days

[Slide 25]{.underline}

**Stably Housed: Intervention Group, September First, 2006**

97 participants in partner agency housing

8 participants with families

Total: 105 participants

[Slide 26]{.underline}

**Left Stable Housing: Intervention Group, September First, 2006**

15 died in stable housing

2 at nursing home; terminal illness

5 in prison slash jail

15 lost housing; eviction, illegal or violent behavior

Total: 37 participants

[Slide 27]{.underline}

**Stably Housed for 1-plus Year: Intervention Group,** **November 2004
to September 2006**

70 Participants

[Slide 28]{.underline}

**1-plus Year Housed: MISA Issues**

Substance Use History: 60 percent, 42 participants

Mental Illness History: 10 percent, 7 participants

MISA History: 20 percent, 14 participants

Total: 63 of 70

[Slide 29]{.underline}

**Stably Housed for 1-plus Year: Intervention Group,** **November 2003
to September**

14 of the 70 have lived at more than one CHHP agency, or the same agency
at two different times

[Slide 30]{.underline}

**Systems Integration Team: Serving the Intervention Group**

Hospital: 2 case managers

Interim Housing: 3 case managers

Housing: 10 case managers

Coordination: 1 coordinator

[Slide 31]{.underline}

**Not Housed**

[Slide 32]{.underline}

**Not Achieved Stable Housing: 74 Intervention Group Participants**

74 participants since September 2003

20 participants engaged slash being housed

54 of 216 participants not housed after 120 days of enrollment at
hospital, or 25 percent

[Slide 33]{.underline}

**Not Achieved Stable Housing: After 120 Days, 54 Participants**

54 participants since September 2003

24 disengaged immediately after hospital

30 engaged with full intervention team

11 disengaged within 1 to 2 weeks in Stage 2

19 remained engaged 2-plus weeks following discharge from hospital

[Slide 34]{.underline}

**Not Achieved Stable Housing: Engaged Participants After 120 Days After
Hospital Discharge**

19 out of 216 equals 9 percent

[Slide 35]{.underline}

**Preliminary Outcomes, June 2006: Nursing Home Days**

Intervention Group: 2,146 days

Usual Care Group: 6,553 days

[Slide 36]{.underline}

**Preliminary Outcomes, June 2006: Emergency Room Visits**

Intervention Group: 2.5 times less; mean: 1.6

Usual Care Group: 2.5 times more; mean: 4.0

[Slide 37]{.underline}

**Preliminary Outcomes, June 2006: Hospitalizations**

Intervention Group: Mean, 1.5

Usual Care Group: Mean, 2.3