# Presentation: 691225

## Hospital Discharge                             of Homeless Persons in Chicago

**2000–2006**

## Presentation

**The Chicago Experience**
**Snapshot Study of Cook County Hospital – 2006**
**Integrating Systems of Care**
**The CHHP Experience**

## 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**

## Hospital Discharges

**Interfaith house**
**Variety of shelters**
**Temporarily with family/friends**
**Some discharged to the streets**
**Some placed inappropriately at nursing homes**

## Prevalence of the Homelessat Cook County Hospital – 2006Dr. David Buchanan

_**Snapshot of inpatients at hospital**_:
**Homeless (HUD definition):    19.8%**
**Doubled-up homeless:****	****	**** **_**12.6%**_
**                 ****TOTAL:****	****	****	**** 32.4%**
**Mean duration of homelessness:  15.6 months**

## Homelessness =

**THE FAILURE OF MULTIPLE SYSTEMS OF CARE**

## CHHP Project Design 

**Hospital**
**Respite Program**
**Permanent Housing**
** **

## Slide 8

## Organizational Partners

**3 Key Medical Centers/Hospitals**
**11 Supportive Housing Providers**
**3 Respite/Interim Housing Providers**
**7+ Health Care Foundations**
**Housing Opportunities for Persons with HIV/AIDS (HUD/HOPWA)**

## Client Partners

**Adults who are homeless**
**Inpatient at three area hospitals**
**At least one chronic medical illness**
**Willingness to give consent**

## 4-Year Demonstration ProjectSeptember 2003–August 2007“CHHP”

**First of Chicago’s Plan to End Homelessness**

## Project Design

**Supportive housing – variety of models**
**Intensive case management – 10:1 ratio**
**“****Housing first” approach**
**“****Harm reduction” models**
**Research component**
**Policy initiatives planned**

## CHHP ParticipantsJune 30, 2006 – Final Enrollment

**   ****Intervention: 216**
**   ****Usual Care:   **_**220**_
**      ****TOTAL:     436**

## CHHP“Intervention” Participants

## Intervention GroupTop Multiple Diagnoses – 216 Participants

## Intervention GroupGender – 216 Participants

**Male:              74%**
**     ****- 159 participants**
**Female:           25%**
**     ****- 56 participants**
**Transgender:   1%**
**     ****- 1 participant**

## Intervention GroupAge – 216 Participants

**21–40:              30%**
**     ****- 64 participants**
**41–60:              64%**
**     ****- 140 participants**
**61–82:   ****	****	****6%**
**     ****- 12 participants**
**MEDIAN: 47 years**

## Intervention GroupRace/Ethnicity – 216 Participants

**African A./Black:   77%**
**     ****- 166 participants**
**Hispanic/Latino:      8%**
**     ****- 17 participants**
**Caucasian/White:   10%**
**     ****- 22 participants**
**Other:****	****	****    5%**
**	****- 11 participants**

## Long-term Homelessness216 Participants

**Long-term Homelessness (HUD)**
**	****	****151 participants****	****	****-****	****70%**
**Short-term Homelessness**
**	****	**** ****65 participants****	****	****	****-****	****30%**

## Substance Use History216 Participants

**Assessed with Long-term History **
**	****	****153 participants****	****	****	****-****	****71%**
**Estimated with Long-term History**
**	****	****186 participants****	****	****	****-****	****86%**

## Mental Illness History216 Participants

**Diagnosed with Long-term History **
**	****	****67 participants****	****	****	****-****	****31%**
**Estimated with Long-term History**
**	****	****99 participants****	****	****	****-****	****46%**

## Stably Housed

## Reached Stable HousingIntervention Group – 11/03 to 9/06

**142 out of 216****	****	****-****	****66%**
**     ******* 20 engaged and currently being housed*****
**142 out of 196****	****	****-****	****76%**

## Reached Stable HousingIntervention Group – 11/03 to 9/06

**Length of Days to Reach Housing –**
**Average: 76 days**
**Range: 70 – 90 days   /     ****{outliers: 0 – 371 days}**
**Median: 62 days**

##  Stably HousedIntervention Group – 9/01/06

**97 participants in partner agency housing**
**8 participants with families**
**TOTAL: 105 participants**

##  Left Stable HousingIntervention Group – 9/01/06

**15 died in stable housing**
**2 at nursing home (terminal illness)**
**5 in prison/jail**
**15 lost housing – eviction, illegal or violent behavior**
**        ****TOTAL: 37 participants**

##  Stably Housed for 1+ YearIntervention Group – 11/04 to 9/06

**	****	****	****	**
**70 Participants**

## 1+ Year HousedMISA Issues

**Substance Use History   – 60%**
**        *****42 participants***
**Mental Illness History    – 10%**
**        *****7 participants***
**MISA History                  – 20%**
**        *****14 participants***
**                                    ****Total 63 of 70**

##  Stably Housed for 1+ YearIntervention Group – 11/03 to 9/06

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

## Systems Integration TeamServing the Intervention Group

**Hospital:                        2 case managers**
**Interim Housing:          3 case managers**
**Housing:****	****	****           10 case managers**
**Coordination:****	****             1 coordinator**

## Not Housed

## Not Achieved Stable Housing74 Intervention Group Participants

**  ****74 participants since September 2003**
**- **_**20**_** participants engaged/being housed**
**   ****54**** (of 216) participants not housed after 120 days of enrollment at hospital (or 25%)**

## 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 1–2 weeks in Stage 2**
**   ****19 remained engaged 2+ weeks following discharge from hospital**

## Not Achieved Stable Housing“Engaged Participants”After 120 Days After Hospital Discharge

**  **
**   ****19 out of 216 =                                  **** 9% ******

## Preliminary OutcomesJune 2006

_**Nursing Home Days**_
**Intervention Group:**
**2,146 days**
**Usual Care Group:**
**6,553 days**

## 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)**

## Preliminary OutcomesJune 2006

_**Hospitalizations**_
**Intervention Group:**
**Mean: 1.5**
**Usual Care Group:**
**Mean: 2.3**