Heat wave response: Philly’s quadrupling homeless outreach for Code Red

The “feels like” temp could hit 113 degrees.

The incoming heat wave had only started to tease Philadelphia on Thursday morning, but the 85-degree thermometer reading was already paired with an uncomfortable dose of humidity.

In Logan Square, Carrie Wagner and Owen Riordan were working their way around the park.

Not everyone accepted the bottles of water they offered, but most did. Fewer took them up on the suggestion to come back with them to a shelter, where air conditioning would provide a respite from the sweltering air.

With the mercury forecast to reach the high 90s, bringing “feels like” temps up to 113 degrees, the National Weather Service has issued an excessive heat warning for the region, and the city extended a heat health emergency through Monday evening.

For Philly’s homeless population, that means a Code Red is in effect — and outreach workers are scrambling to get them inside.

On regular weekends, the Department of Behavioral Health and Intellectual disAbility Services and the Office of Homeless Services typically deploy one or two groups of workers. But this weekend, they’re sending out four team, all-in-all quadrupling the number of people on the street.

LINK – https://billypenn.com/2019/07/19/heat-wave-response-phillys-quadrupling-homeless-outreach-for-code-red/

Help coming for homeless in Glynn County

LINK – https://thebrunswicknews.com/news/local_news/help-coming-for-homeless-in-glynn-county/article_af114611-0470-5cef-939d-a868212aaac2.html

Three local organizations have been awarded a combined total of more than $439,000 in state grants to help support homeless and HIV/AIDS populations in the Golden Isles.

Coastal Georgia Area Community Action Authority, Inc. was awarded two grants, collectively worth $90,000, for homeless prevention and rapid rehousing.

Gateway Behavioral Health Service was awarded four grants worth more than $129,000 to help support rapid rehousing, street outreach, shelter plus care support services/harm reduction programs.

Safe Harbor Children’s Shelter, Inc. was awarded five grants worth over $220,000 to help support emergency shelter, street outreach, hotel motel voucher, Emergency Solutions Grants support services and Georgia Homeless Management Information System programs.

The grants awarded by the Georgia Department of Community Affairs were announced Wednesday by state Sen. William Ligon, R-St. Simons Island.

“I am thankful that DCA realizes the hard work, dedication and funding it takes to keep these life-saving services available to vulnerable populations,” Ligon said in a statement. “These organizations serve as valuable resources to many people in Glynn County and the surrounding areas. These groups provide assistance to those who are struggling with difficult life situations and work to help them mend their lives and renew family relationships.”

Downtown homeless encampment now at ‘crisis’ stage, Milwaukee business leader says

LINK – https://www.jsonline.com/story/news/local/milwaukee/2019/07/19/milwaukee-homeless-encampment-crisis-stage-business-leader-says/1777865001/

A sprawling homeless encampment beneath the Marquette Interchange has reached a “crisis” stage after a stabbing, increased heroin use and recruitment of occupants for criminal activities, a downtown business leader said.

The encampment beneath the I-794 overpass has swelled to more than 60 tents — more than 50 that are inhabited — since being nearly empty in April, according to Milwaukee County housing officials.

Known as “Tent City,” the camp has become increasingly squalid, unsanitary and dangerous, said Elizabeth Weirick, CEO of Milwaukee Downtown Business District #21.

“No human being should have to live under these conditions, period,” Weirick said.

“For us to continue to allow people to live this way, I believe, is inhumane.”

An update on the encampment was presented to the district’s board of directors this week by Eric Collins-Dyke, outreach services manager for the Milwaukee County Housing Division’s Housing First/Street Outreach program.

The growth of the camp has occurred despite the best efforts by outreach workers, who placed 89 occupants of the camp into housing from October to February, Collins-Dyke said.

“We’ll house three people one day and get five new people coming to the camp the next day,” Collins-Dyke said Friday.

“The bubble is bursting in terms of those living in entrenched poverty and the inflow into our homeless services system is rapidly increasing.”

The encampment, on property owned by the state Department of Transportation, was once an almost unnoticable cluster of makeshift shelters between 6th and 7th Streets south of Clybourn Street.

It has now spread west of 7th Street and south toward St. Paul Avenue.

Tents — some large enough to shelter multiple people — have replaced cardboard and plywood structures, and couches, coolers and barbecue grills now sit amid piles of garbage and debris.

Tents and an armchair sit in a tent village near 7th and Clybourn Streets, underneath the I-794 overpass, on Friday, July 19, 2019. (Photo: Colin Boyle / Milwaukee Journal Sentinel)

Heroin use has sprung up in a small quadrant of the camp, along with consistent reports of violence and physical assaults, Dyke-Collins said.

On July 11, a 69-year-old man was stabbed during a domestic dispute by a 45-year-old woman with whom he shared a tent, according to Milwaukee police.

The man’s injuries were not life-threatening, police said.

“When you introduce drugs and alcohol into this environment it is a dangerous mixture,” Weirick said.

Some camp residents have been recruited for illegal activities, including some by a group from Georgia who travel the country cashing forged checks, Collins-Dyke told the district board.

Compassion or enablement?

The camp has grown in part because of well-meaning and compassionate individuals who regularly drop off tents, food and other provisions, Weirick said.

“Is the way we are enabling people to stay at this encampment compassionate? Absolutely not,” Weirick said, urging those who want to help people who are homeless to donate time or money to shelters, meal programs or other resources.

Shelly Sarasin of the Milwaukee Street Angels, which provides tents and meals to people who are homeless, said her organization is as concerned about the situation at 6th and Clybourn as BID #21 or anyone else.

“But we are not responsible for this surge in numbers,” Sarasin said.

“Frankly, (providing) a meal three times a week does not entice someone to live under the freeway.”

In contrast to previous occupants who were chronically homeless, 89% of the people currently living at the camp have been homeless six months or less, Collins-Dyke said.

Both he and Sarasin pointed to people moving to the camp after leaving the Milwaukee Rescue Mission.

Twenty-five camp occupants have recently left or have been asked to leave the mission at 830 North 19th Street, Collins-Dyke said.

“This is a very concerning trend,” he said.

Sarasin said her organization is alarmed by the number of people who say they choose to live on the street because, “living outside was better than the dehumanizing treatment they received in shelter.”

Rescue Mission president Patrick Vanderburgh said people are asked to leave its single men’s shelter for being violent, and that reasons people say they’ve left on their own must be taken at “face value.”

“There is definitely a segment of individuals who don’t like being in an institution with any kind of rules,” Vanderburgh said.

“However in our situation, in which we serve such large numbers of people, (rules) are a necessity.”

Both Collins-Dyke and Weirick said more financial resources are needed to address homelessness, as well as more sustainable solutions, such as the county’s Housing First program.

“At this point, we are trying to mitigate the inflow into the encampment,”Collins-Dyke said.

“To keep everyone safe so we can efficiently and comprehensively serve the individuals that are currently there.”

Homelessness outreach workers to update Newport Beach on accomplishments

LINK – https://www.latimes.com/socal/daily-pilot/news/story/2019-07-19/homelessness-outreach-workers-to-update-newport-beach-on-accomplishments

The recently convened homelessness task force in Newport Beach will meet Monday to discuss land-use regulations for emergency shelters and the accomplishments of its new street-level outreach contractor.

The 10-member task force, made up of City Council members and citizens, will hear from City Net, a Long Beach-based nonprofit the city partnered with in March to enhance social services provided by the Police Department.

The department also partners with the Orange County Health Care Agency to help homeless people with social, health and housing needs.

City Net has a five-year, $1-million contract with the city to help people transition into an initial shelter and find and stay in longer-term housing. It also assists the city with community outreach.

Between April and June, City Net workers helped eight people leave the streets, according to a report from the organization.

The task force also will hear about where a potential emergency shelter could be built in Newport under current zoning.

Theoretically, a shelter could open in areas zoned in the private institutions or office-airport categories, which are scattered around town and total about 190 combined acres. Staff reports do not indicate that building a shelter is imminent, and the item is for review only.

This is the task force’s second monthly meeting since its formation.

The task force meeting starts at 4 p.m. in the Friends Room of the Central Library, 1000 Avocado Ave.

Downtown SF businesses to tax themselves to pay for clean streets, homeless outreach

LINK – https://www.sfchronicle.com/bayarea/article/Downtown-SF-businesses-to-tax-themselves-to-pay-14104083.php

San Francisco businesses rarely celebrate new taxes.

But when given the choice to pay a little extra for more street cleaning, trash collection, power washing and street-beautification — all of which help attract tenants and customers — most landlords and businesses embrace the idea.

Merchant corridors have for years created commercial benefit districts, or CBDs — special zones where primarily commercial property owners elect to tax themselves a little extra to pay for additional services.

And at a time when the city is straining to keep its streets clean and attend to its homelessness and mental health crises, CBDs are increasingly stepping in to fill gaps in services.

On Tuesday, the Board of Supervisors unanimously approved the city’s newest CBD — the Downtown Community Benefit District. It’s also one of the largest: Extra assessments on the 669 parcels on 43 blocks that make up the district will raise nearly $4 million annually to “help augment the city’s baseline services on everything from pressure washing to homeless outreach,” Supervisor Aaron Peskin said in a statement Wednesday.

Peskin was a longtime supporter of this CBD and represents the district where it resides. While merchants take a vote on whether to create CBDs, they have to be approved by the Board of Supervisors.

Supervisors also renewed CBDs encompassing portions of the North of Market/Tenderloin districts and Union Square. The board is scheduled to vote to renew and expand the Civic Center CBD next week.

CBDs began cropping up in places like Fisherman’s Wharf, Noe Valley and the Castro district in 2005. With the support and encouragement of city officials — the districts are overseen in part by the Office of Economic and Workforce Development — they’ve flourished. The Downtown CBD is the city’s 18th.

“A lot of cities are not set up the same way,” said Marco Li Mandri, the president of New City America who’s helped steer the formation of 10 CBDs in San Francisco and others in Los Angeles and San Diego. “The machinery is in place to make the whole thing work in San Francisco.”

Debra Niemann, executive director of the Noe Valley Association, a CBD, stressed that each district is different, offering varying services in response to the unique needs of individual neighborhoods and the size of the district overall, since smaller districts mean smaller revenue streams to pay for services. Unlike some CBDs, Niemann’s, for example, doesn’t hire extra security guards, focusing more resources on installing amenities like flower baskets and benches.

“Everyone is different. The problems in central Market or Union Square are very different than Noe Valley or even the Castro,” Niemann said. “I’m one of the smaller CBDs. But I’ll shamelessly tell you I’m one of the mightiest in terms of the improvements on the street.”

Each CBD has somewhat different priorities. The Yerba Buena Community Benefit District employs two full-time social services workers tasked with connecting people in need to services. The Lower Polk Community Benefit District partners with UC Hastings College of the Law, La Voz Latina and the San Francisco Bar Association to operate a landlord-tenant clinic meant to smooth out housing disputes that can lead to displacement — in addition to a host of daily street-cleaning services.

“We’re out there seven days a week, cleaning and doing maintenance work, picking up trash, needles, feces, abating graffiti — just basically adding extra boots on the ground to stay on top of those issues that affect quality of life for businesses, residents and visitors to the neighborhood,” said Christian Martin executive director of the Lower Polk CBD.

Mobile Integrated Healthcare comes to Siuslaw region

LINK – https://thesiuslawnews.com/article/mobile-integrated-healthcare-comes-to-siuslaw-region

Jan. 31, 2018 — Western Lane Ambulance District (WLAD), in partnership with PeaceHealth Siuslaw Region, is looking to change how healthcare is administered in western Lane County.

Through a $200,000 donation from the PeaceHealth Peace Harbor Medical Center foundation, the organizations have created a new Mobile Integrated Healthcare (MIH) program that will help reduce the rates of emergency room returns in the region, and, in the process, save the quality of life for hundreds of residents — with the potential to save millions of dollars.

Managed by WLAD Operations Manager Matt House, and staffed by Chris Martin, who came from another MIH program in South Carolina, the initiative is a two-year pilot program that will eventually be rolled out throughout Lane County.

“We manage the operations of the MIH Program, and PeaceHealth identifies patients and provides computer software such as the Epic Program,” House said. “The goal is to bridge the gaps of community patient care needs.”

As of right now, MIH provides in-home services to three types of patients: 30-day readmissions, emergency room (ER) high utilizers and Emergency Medical Services (EMS) high users. Other types of users may be identified as the program progresses.

“These are all patients that are referred to the hospital system that have been deemed ‘high risk’ of falling back into the emergency department several times for follow up,” House explained.

For example, a patient is diagnosed with congestive heart failure, which is exacerbated by not taking their medications correctly or not eating the right meals.

“So, they go back home and into their own habits,” House said. “They’re eating a salty steak diet, and not taking their medications on top of it. They become exacerbated, call 911 and the whole process starts over again. So the whole goal is trying to prevent these patients from falling back into the system.”

Patients may return to their habits for multiple reasons. During the stress of an emergency room visit, specific instructions by a doctor can be missed or misinterpreted. In other cases, environmental factors at homes can make it difficult to make healthier choices. In addition, old habits simply can be hard to break.

Whatever the reasons, to prevent a return, the doctors will contact MIH after a patient is discharged, requesting a patient checkup. That’s when Martin steps in.

Instead of having the patient come back in to the hospital for a checkup — or have the patient reach emergency status again — Martin will visit the patient at their home.

“Sometimes people are more relaxed in their house and I can go in and explain things a little bit better,” Martin said.

With a home visit, Martin can see the entire environmental picture of a patient, something that can be lost in translation between a patient and emergency personnel, particularly during a stressful period.

“I can go out and figure out, is the place clean? Do they have the right type of food? I can see with my own eyes what’s going on in their residence,” he said. “And it does help because the (patient) thinks it’s one thing, but it’s really not. They think (the home) is clean, but maybe there’s mold growing and that’s the cause of their respiratory problems.”

In some cases, Martin can use the time to educate the patients on how their lifestyle may be affecting their health.

“I can sit there and educate them on their diet. ‘The reason your ankles are swollen are because of all the salt that’s in that food,’” he said.

Or maybe the patient is having frequent falls, and the unknown cause is as simple as a loose mat on the floor.

“We can’t find any other reason why they’re falling other than education on fall prevention,” House said. “We look at the triggers. How do we prevent them falling and getting hurt, which would enter them into the hospital system?”

Sometimes, the help Martin provides can go beyond just education.

“If we’re talking about a mold issue, that may not be something that (Martin) can impact directly, but he may know the resources that we can plug (the patient) into and eventually get them help,” House said. “By having an official visit, if there is an issue with a landlord, that person then has documentation that’s substantial that says, ‘Hey, there’s a mold issue in here and it does seem to be affecting their health.’”

Even though the program is in its infancy — it officially started Jan. 2 — the program has already assisted 34 patients and the results have been noteworthy.

“This month alone, Chris was referred two patients from the emergency department just to go visit, watch and maintain,” House recalled. “These were really high users, five to seven times a week. Almost every day.”

But since the program?

“They haven’t been back yet because he goes out there visiting,” House said. “And if he’s not visiting, he’s still calling to check in, asking if they need anything.”

While the MIH program has had early success, House and Martin do foresee some possible hurdles in the future, particularly with how the program, and emergency medical services as a whole, is viewed. These concerns can be seen in why there is such a preponderance of emergency visits in the first place.

The reasons that people don’t visit primary care physicians and rely on emergency visits vary. One reason is convenience.

“Some people say, ‘Well, I can’t get into the hospital for three days, but I can get into the ER right now,’” House said. “You can always get into EMS services, as they’re open 24 hours a day.”

But more often than not, it’s a lack of availability.

Peace Harbor’s resent physician shortage made headlines, though House stated that PeaceHealth has made strides in correcting the issue.

“The hospital has done a really great job recruiting and they’re not down on the staffing in the way that they were three years ago,” House said.

However, the shortages in staff and availability are a global problem.

“We were having a discussion about the healthcare system in general, and it’s stressed in its capacity,” WLAD Chief Director Jim Langborg said. “I remember receiving an email last year where there were two or three hospital beds left in the state. This isn’t just a local or state problem. We all knew this was coming when the baby boomers came to retirement.”

Programs like MIH could help relieve that stress, not only by freeing up physical space in the hospitals but by focusing on preventative care that would alleviate the need for patients to check into facilities in the first place.

In order to practice preventative medicine, the patients have to accept the help. Some people still have a fear of services like MIH.

“We’re trying to change their lives for the better, if they’ll accept it,” Martin said.

People have offered several reasons to not want MIH services.

“There’s a lot of people out there that are essentially isolationists who prefer to be by themselves and not have anybody bother them,” House said. “Or they feel like they’re being bothersome to us.”

Martin added, “And sometimes it’s fear that they have of being taken out of the home or not being brought back to their home. It’s all on a case-by-case basis. I have people who are afraid to come to the hospital because they’re scared they aren’t going to come home. And so, you have to talk to them and reassure them that they will come home, and if not, there’s a reason behind it.”

The MIH program won’t come out to a patient’s home if uninvited.

“If they say not to come out there, we’re not going to go,” House said.

“But the irony of it is, if they accept the help, their chances of independence is much greater,” Langborg said.

It’s not just patient independence that the program can help with. MIH, and programs like it, can also contribute to financial independence for the entire healthcare system.

“From a long-term funding standpoint, people are trying to prove the value of these programs,” Langborg said. “Because the reality is, through prevention and decrease in the number of ER visits and admissions in the hospital that are more costly, they’re hoping to fund this and ultimately save money. They’re preventing strain on the system and their finances.”

As an example, House pointed to MedStar Mobile Healthcare out of North Texas, which was one the first national systems to offer the MIH program. It prevented 1,893 emergency department visits, which saved Medicare more than $800 million.

It’s those types of savings that Martin, House and Langborg are looking to pass on to the district.

As for the future of the MIH program, the current iteration is only the starting point. The program is starting small right now, collecting data from each visit and looking at the gaps in the healthcare system that it can help fill.

“A lot of what we’re seeing is anecdotal,” Langborg said, “But I don’t think we know the scope of what we can do with this yet. I’m sure it’s a lot larger than what we are doing. But I imagine that within 10 years, this program could easily have three (techs) that are going out and staying busy the entire day. I think it’s entirely feasible, but a lot of it goes back to finding out where it’s appropriate.”

The MIH program is not looking to overtake any existing program, but it is looking for gaps in the system as a whole to see where additional support can be given.

This can be particularly important for those who are unable to enter the large healthcare system due to lack of insurance and who rely solely on emergency services.

Medical systems in Lane County are closely watching how the MIH program progresses, and what challenges it decides to address. As the pilot program for the entire country, Florence’s MIH work is vital to shaping the future of healthcare in the region.

The program is up to the challenge.

“I’m not patting myself on the back here, but we’ve got a very good EMS system,” Langborg said. “It has a reputation in the county, the region, and it’s starting to get to the state level, as being one of the best EMS systems in the entire state. The district is trying to be cutting edge. By stepping out there a little bit and taking these projects on, it sets the whole county up for future success. We hope that our community sees that.”

MIH program between paramedics, hospitals produces significant results

LINK – https://www.ems1.com/community-paramedicine/articles/227513048-MIH-program-between-paramedics-hospitals-produces-significant-results/

Individuals enrolled in the MIH program receive home visits from paramedics over a four-week period

The “First 100 Days” is typically a time metric reserved for elected officials, but in St. Charles County, a collaborative effort between paramedics and BJC Healthcare posted some impressive results of its own during the first 100 days.

The initiative, called Mobile Integrated Health, has resulted in an estimated $149,000+ expenditure savings and vast improvements in patients’ health status self-assessments.

The program starts at Barnes-Jewish St. Peters and Progress West Hospitals, where physicians and case managers identify patients at high-risk for readmission to the hospital following an in-patient stay for certain serious health conditions: congestive heart failure, chronic obstructive pulmonary disease, acute myocardial infarction or pneumonia.

“Without strict adherence to care plans and medication regimens, conditions such as these can become exacerbated quickly,” explains Jill Skyles, VP of Nursing for both hospitals. “They can be particularly challenging for those who are newly-diagnosed and trying to adjust to new healthcare routines.”

Enter St. Charles County Ambulance District advanced practice paramedics Russ Allen and Kimberlyn Tihen, who meet with the patient and BJC case managers prior to discharge. Together, the group works to identify needs and goals specific to each patient. Individuals enrolled in the MIH program receive home visits from paramedics over a four-week period, where their health condition is monitored through physical exams, medication reviews, dietary compliance discussion and disease management education. Lab and other diagnostic tests and interventions also may be performed in-home as needed, and results are reported back to enrolled individuals’ physicians. The program’s overarching goal is to teach patient self-management while avoiding unnecessary readmission during the 30-day post-discharge period.

From Nov. 1 to Feb. 15, the program enrolled 28 patients; 17 successfully completed the program and 11 were actively enrolled on Feb. 15. Of the 17 who completed the program, 13 successfully avoided readmission and four were hospitalized – a program success rate of 76.5 percent. Using data from Centers for Medicare and Medicaid Services regarding costs related to emergency department and hospital admissions, direct avoidance of 13 patients from readmission potentially saves $149,097 in unnecessary care and associated cost to the healthcare system with subsequent hospitalization.

In addition, patients indicated significant gains on health status self-assessment, with those who completed the program reporting average improvements of 46.7 percent in ability to perform usual activities and 37.7 percent in overall health status. Level of pain/discomfort, anxiety/ depression and mobility also saw notable improvements. According to those enrolled, the program’s success can be attributed to those canvassing St. Charles County, visiting patients from all walks of life.

“Keep hiring the same quality of employees – people with compassion, concern and kindness,” said 88-year old Mary Walters, who even after graduation from the program continues to stay in touch with Allen and Tihen.

Given the success achieved during the MIH program’s pilot period, BJC and SCCAD are working closely to develop strategies for making the initiative a permanent fixture in St. Charles County.