This past weekend, California Governor Jerry Brown signed a law that mandates a new process for discharging homeless patients from California hospitals. Though well-intentioned, this new law misses the bigger and more urgent problem: assuring that sufficient beds and supportive care are actually available for homeless patients.
Under this new policy, hospitals are now required to discharge a homeless patient to a safe and appropriate location. For these patients, hospitals must also have a written plan in place for coordinating services and referrals with health care and social service providers.
But even before these new mandates, many hospitals were already working closely with non-profit service providers like National Health Foundation to access recuperative care centers where homeless patients could receive supportive care after leaving a hospital, as well as help finding housing. Given this groundwork already in place between many hospitals and service providers, procedures for homeless patient discharge aren’t likely to change that much under the new law.
The real problem lies with the number of service providers available for contract to handle the growing number of homeless patients who still need aftercare and housing once discharged from a hospital.
Plans for many proposed new homeless facilities consistently face significant resistance from nearby communities and residents, making their completion nearly impossible. In response to their constituents’ concern, many elected officials stall the planning process.
Service providers also face numerous funding challenges that prevent more services from getting off the ground, despite the fact that Los Angeles voters directed considerable funding toward housing the homeless with ballot initiatives in November 2016 and March 2017. Challenges include below-cost reimbursement rates from government agencies. Providers of temporary and emergency housing are reimbursed just $40 per person per day, while the real average costs to provide such services can be up to three times that much, depending on program location and size.
Low payment rates do not encourage new services for homeless patients seeking a safe place with supportive care to recover. They do increase the likelihood of more poorly run, substandard facilities cropping up. Inferior facilities often fail to meet even basic health and sanitation standards, further dehumanizing the experience of the very individuals they have been entrusted to help.
Service providers have managed to string together other financial resources and grants to close the cost-payment gap over the years. Yet, the current local government payment model is neither sustainable nor practical, and it is the reason why housing providers are reluctant to offer more of this specialized service. Higher payment rates could result in better services that communities would welcome, solving both problems at once.
Looking beyond the new law, we need to make sure that our neediest citizens have clean, safe, and professionally staffed places to go to heal. Creating more sustainable, realistic and data-driven payment models could do a lot to jumpstart the creation of emergency housing so desperately needed in many of our communities. Simply mandating hospital discharge protocols will not solve this much larger problem.
Kelly Bruno is CEO of National Health Foundation, a leading provider of recuperative care in Los Angeles County, offering those without homes a safe place to heal once they are discharged from area hospitals.
Michael Hunn is founder and president of Hunn Group, LLC Healthcare Advisors, which counsels hospitals, health systems, physicians, medical groups, health plans and other related clients. He is also president of the National Health Foundation Board of Directors.
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