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Homeless and Housing MEETING Recap For July 7, 2020 @ 9:30

(MSCC) John Mudd, Sharon Jasprizza, Posted: August 18, 2020

PURPOSE: To develop partnerships and resources to identify problems and find solutions for our homeless and housing crisis

TO TRIAGE: In order to give adequate time to pressing topics, please forward items at least 24 hours prior to meetings.

If any content below is mischaracterized or needs more clarity please let us know. And don’t forget to check out the announcements from our partners at the end of this recap!

CHAIR (July 7, 2020 meeting): Sharon Jasprizza, Midtown South Community Council, MSCC

POLICY COMMITTEE’S REPORT FOR JULY 7, 2020, 8:30AM MEETING

The prior 8:30am Policy Meeting’s hour was spent discussing whether there is a need for unifying policy for hotel shelters, Medical Respite Beds Advocacy Plan’s status (see Addendum D), hotels to housing, and improving our current meetings. (Please see Addendum B for details)

SPEAKER(S)

Elise Levy, Natalie Naculich, HCC, WSNA, housing and homeless advocacy updates: 

  • #Cancel Rent Progress
  • For eviction and legal issues reach out to Elise
  • Housing courts are opening
  • Not sure whether the (eviction) courts will operate in person or zoom
  • NYS Tenant Safe Harbor Act was past: the expansion of the eviction moratorium, criteria for hardship is lost of income

John Mudd spoke about the program being developed between HCC and MSCC to educate propel on the connection between homeless and housing. If anyone has avenues to present and educate please forward to john.mudd@usa.net.

Leilani Irvin, Department of Social Services, DSS: Updates: shelter, isolation, conversion of hotel sites or other to housing and or supportive housing, potential properties or opportunities.

  • DHS moved single adults from congregate settings to smaller and safer setting: commercial hotels
    • Moved 1,000s of clients every day, under two week across the city, mostly in CB4, CB5 where most of the commercial hotels were
    • The move started with seniors
    • Two to a room with personal bathrooms, microwave and fridge
    • Staff and clients were contracting COVID

Challenges to sheltering in the hotels

  • Indoor congregation areas has not been negotiated or developed and the loss of programs has caused: loitering, community complaints.

DHS is working to resolve issues by:

  • Increase street outreach
  • Holistic approach (accountability from providers, security tours to ask clients not to loiter, increase street outreach…)
  • Given sanitizers and masks when they leave and enter
  • Coordinate with others to expand options: space for gatherings, programs for social, education, life-skills, and others
  • Meetings with communities to reduce density of hotel shelters

The committee asked to review policy and procedures of hotel sheltering. Leilani spoke about the Model Budget, which is on the DHS website. The Model Budget outlines staffing levels to accommodate the services needed.

What about the internal policies of each provider. Leilani said the providers do not have separate policies, and must follow DHS requirements. But, the providers may have their own rules.

The committee followed up on Thuy’s question from 8:30 policy meeting: “I learned through my network that there is a nurse who says that some homeless people have been placed in nursing homes.  Can this please be confirmed with the homeless coalitions, whether this is true?  The source is in Brooklyn, but not sure if it is happening in Manhattan, too.” This is unanswered and followup is needed.

Leilani: exiting people from shelters to housing now, during COVID it was not possible.

Josephine Ishmon, CB4, wanted a point of contact for shelter issues. Leilani provided midtown point contact: JCC, Joint Command Center: 212-607-6040.

Allen Oster asked if any structural changes to the previously used shelters while people are out of them. The answers is no.

Leilani confirmed that the hotel shelters are being used as COVID isolation. They are actively wiping areas down every 30 minutes. 

Anthony Coleman said there are many shelter resident sitting, drinking, eating, loitering, and that resident are concerned. He asked: What is the concentration in the area, how long will they be there? He also needs more communication.

Leilani added her name in the chat asking for problematic locations.

QR Codes for oversight: These codes are placed around the area on street furniture (lap posts, phone booths) for security staff to scan. This records the time and location of perimeter checks.

Maria Ortiz reframed John Mudd’s question, the non profit providers contact list can be provided, it’s not necessary for the addresses of sites. Leilani said CB4 has it already. 

ANYTHING COVID-19 

William Arboleda, Chelsea Ryan Clinic, COVID and updates on programs 

  • Increase in visits to the clinic
  • Resident doctors back from Mount Sinai where they were sent during the lockdown
  • 35% of visits are telehealth visits
  • Clinic isolates on average 2 people per day for COVID-19
  • Temperature checks carried out on arrival at clinic
  • Testing and antibody testing is done at another site uptown
  • Dental services are again operating
  • Working with others to provide antibody testing at clinic

Hotel COVID-19 Program

  • Details and procedures of this program (see addendum C)

Mental health, suicide assessment in isolation wards and shelters

  • William noted mental health visits are mostly through telehealth, possible increase

Laurie Hardjowirogo, NYC Council’s Senior Wellness Checks, said the program is being expanded.

MOBILE SHOWERS

Julia Chambers, Shower Power is continuing Harlem’s Mobile Showers Program. 

  • We’re looking for another midtown location, need at least 3,000 square feet. If you know of a space location in proximity to Midtown, please contact us john.mudd@usa.net, 917-520-3009
  • There are 4 Mobile showers operating in Harlem
  • Serving an average 40 people per day
  • Open M, W,  F, 1pm – 5pm

CITY’S PROPOSED NEW RULE (ISP)

DHS’s ISP, Income Saving Program mandate for shelter residents. Further information and links are provided in the Objections and Suggestions to the ISP Rule (see google docs link) :

MEDICAL RESPITE BEDS

Medical Respite Bed Advocacy Plan (see addendum D)

  • Sharon Jasprizza has sent medical/respite facilities’ budgets to accountant for comparison study

ANNOUNCEMENTS / CALLS TO ACTION

ACTION LIST

See accumulative actions(see Homeless and Housing Recap 5.5.2020, Addendum A: Accumulative Action)

  • What to add from today’s meeting
    • Request link from Leilani for the model budget and list of the providers
    • Follow up with Leilani about Thuy’s nursing home question
    • John Mudd spoke of community meeting for 9th Ave. John is to invite Anthony Coleman 
    • Alexandra Urman, MPH, Analyst, Genomic Revolution, ARK Invest: Mobilizing the Commercial Real Estate Industry to Minimize the Spread of Disease in an At-Risk Population in New York City (Needs following up)

ADDENDUM A: ACCUMULATIVE ACTIONS

A discussion is needed at our 8:30am Homeless and Housing Policy meeting to outline the studied and unstudied issues, and how best to progress them. Discussions should include team development for furthering planning, statistics, finance, procurement, and actions.

ACTIONS

Listed from more recent, to later items. 

  • Outreach and police monitoring for 8th Avenue around 34th and 35th Streets
  • Communication with precinct  
  • Voucher: Additional information and discussion needed
  • Daycare resources, discussion and development
  • SOI: Speaker to discuss department’s policy and actions
  • Comunilife: Establishing relationships with other homeless services, particularly Urban Pathways
  • DHS’s General Welfare Committee held a hearing in September 2019 on medical respites; Erin Drinkwater suggests that we look at the testimony and transcripts of that hearing 
  • DHS is to provided information about institutional referrals & process for hospital discharges
  • DHS with the Medical Director’s office are having ongoing conversations to find the nexus in which to operate among DHS, hospitals, and providers
  • DHS is looking for ways to:
    • Reduce cyclical returns to emergency rooms
    • Transition people to medically appropriate shelters when needed
    • Source stable housing for people after discharge
    • Improve communication between the agency and the hospitals about people’s health status and expected discharge dates for timely transition to housing options
  • Operating systems: CARES, Home, Street Smart needs more study
  • Diversion Plan: The Committee thought it best to further seek further perspectives from enforcement (particularly from the Transit Dept. as they issue the summonses), courts, social services, and civilians (those who receive the summonses)
  • Income Savings (ISP) Mandate: We’re waiting for your supportive or contrary comments (pro or con) and saving options for the Objections and Suggestions proposal
  • Medical Respite Bed Facility: execute Advocacy Plan
  • Non Medical Respite Bed Policy Recommendations:Cassie Dessalines (BronxWorks) and Reggie Miller (NYDIS/ESN) are preparing another draft to discuss with the principal respite bed providers
  • Oversight
  • Shelter Policies
  • Social Workers embedded: School, Hospitals
  • Affordable Housing / AirBnB / Deregulation 
  • Vouchers: The committee’s researching and taking testimonials. 
  • The committee wants to hear from independent landlords about barrier and reluctance to the voucher program
  • Outreach / social workers embedded in the hospital emergency room (good), and to a much lesser degree during a patient’s respite period (not so good)
  • Mapping medical pathways from recovery to stable housing
  • Workshops development
  • Hotel participation: Allen Oster, CB4 and MSCC, to organize a meeting with the hotel industry to discuss how they may participate
  • Erica (CUCS)/MTS: follow up with outreach in the 8th Avenue (between 34th and 35th Street)
  • Erik Botcher, NYC Councilman Corey Johnson’s office, suggests having a conversation between the person who was hampered by bureaucratic systems and DHS/HRA to troubleshoot and find where the breakdown occurred. Others with similar problems could be invited too (SUS’s client)
  • Erin suggests watching for legislation and budgeting (that may not cover enough programs/assistance) to come from Albany: Liz Kruger’s Housing Stability bill, supporting increases of City and State voucher participation, and assistance for undocumented citizens (Federal provides only emergency assistance)
  • Medical Respite follow up with: Communilife, Rosa M. Gil, DSW Founder, President and CEO; Mount Sinai, Dr. Andy Coyle; Metroplus, hospital emergency supervisors; David Munson, Medical Director of Respite Programs at Boston Health Care for the Homeless; Human Rights Commissioner, Landlords…

ADDENDUM B: POLICY COMMITTEE’S RECAP

(Sub-committee of Homeless & Housing Committee) 

When: Tuesday, July 7, 2020 

Time: 8:30 am-9:30am

CHAIR PERSON(S): Sharon Jasprizza, MSCC

RECAP OF 8:30 POLICY MEETING

William Arboleda, Chelsea Ryan Clinic, gave an update of their medical facility progress during COVID. The week of July 6th, 202, the clinic was operating at 85% of normal capacity (includes tele health). Staff who were sent to Mt. Sinai during COVID is now returning to the clinic. People are feeling more comfortable to come into the clinic. All PPE is up to par, except gowns. The clinic is talking to NYC Council Corey Johnson, Senator Brad Hoyman’s office, Councilman Kieth Powers, and Julia Chambers of Shower Power for the use of the Ryan Chelsea Medical Mobile Health Unit for locations in need.

DHS AND NONPROFIT SHELTER POLICIES

We’re seeking to have an understanding and evaluate current policies, and their implementation. Britt says DHS could provide contact list of non-profit shelter management. 

HOTELS TO HOUSING

  • Discussion was about funding, space, development, operations, support for Medical Respite, supportive and affordable housing

Half of all department stores in malls cross the USA will be gone by 2021. Developments are converting Alderwood Mall outside of Seattle into housing, a 300 apartment complex with underground parking, with 90,000 square feet of retail. Adaptive reuse of Alderwood Mall which  is in progress suggests such transformation could bring malls to the ‘Village Square” concept initially envisioned. Link to article here.

ADVOCATING FOR MEDICAL RESPITE BEDS

  • Sharon: The financials of three medical facilities were sent to the accountant for the comparative study
  • Waiting for info from NYLAG

ASSESSING THE PRODUCTIVITY OF THE MEETINGS

  • Suggestions were requested and discussed how to: increase efficiency, assess productivity, effective actions, encourage involvement, and structure of meetings
  • Thuy Pham will speak to Chelsea Block association about joining us
  • Thuy suggest to use chat bar to triage  
  • William will discuss with Daniel Pichinson regarding this topic
  • Andrew said we need to target and focus topics, suggest bi-monthly meeting to cover two big issues
    • Andrew gave an example of extreme hot water issue with a client, who’s complaint is not being responded to after several calls
  • Sharon suggested to resolve this issue in a streamline effect way that will take care of future similar issues
  • Sharon suggested sending agenda items or concerns in advance to allow enough time on the agenda to triage

ACTION

  • Plan for meeting agenda to include Brookfield properties (Alderwood Mall) , Property developer in Seattle 866-207-3713; Hudson Companies Inc. Sarah Pizer; Local Initiative Support Corp, LISC, Grace Chung
  • Contact list of shelter non-profit management
  • Thuy Pham to follow up with Chelsea Block association
  • John Mudd to ask Maria Ortiz, CB4, to the Policy meetings
  • Figure how to provide time and focus to triage specific issues more thoroughly
  • John Mudd will make contact will DOB to intervene in Department building issues
  • Adding the ask for items of particular to the recap for triaging
  • Follow up Chelsea Ryan Clinics Gown needs
  • Thuy’s follow up question is unanswered: I learned through my network that there is a nurse who says that some homeless people have been placed in nursing homes.  Can this please be confirmed with the homeless coalitions, whether this is true?  The source is in Brooklyn, but not sure if it is happening in Manhattan, too
  • John to talks about an SOI speaker

ADDENDUM C: COVID-19 HOTEL PROGRAM

See below for notes on the webinar today. In short, registration is no longer required for use of Covid-19 Hotel program – just call 844-692-4692 (844-NYC-4NYC) and make the referral for isolation or quarantine, selecting the borough for services (1 for Manhattan). The patient should be called back within an hour. Expectation is that referring provider will continue to provide follow up services to the patient during their stay, as needed. See below for details.

COVID Hotel Isolation/Quarantine Beds

  • Test – Trace – Take Care
    • Carlos Devia, Senior Clinical Quality Manager for DOHMH
      • Overview of Test and Trace Corps
        • This program will run hotel program
          • June 1st – 20000 tests per day across 100 locations
          • June 1st – 1000 tracers screen Hotel, food, Meds, informs on mental health and family violence
          • June 1st – 1200 hotel rooms – Nicole Jordan Martin in charge 
          • Inability to self-isolate includes: cannot maintain 6 feet distance, do not have separate bathroom or cannot clean and disinfect after each use, shared kitchen that cannot clean touches surfaces after each use
          • Hampton Inn Times Square 851 8th Ave
          • Aloft Hotel 100-15 Ditmars Boulevard
          • LaGuardia Plaza – not fast enough for the address
  • COVID-19 Hotel Program by H&HC
    • Referral process: Call 844-692-4692 (844-NYC-4NYC)
    • NO REGISTRATION NECESSARY
    • No paper work or online forms
    • Contact center will call directly and screen patient and decide
    • H+HC will transport patient to room if needed
    • 3 meals/day
    • Children can be with parents
    • Wellness checks provided
    • Provides pajamas, wi-fi, TV
    • 24 hour nursing for emergencies (and ADLs?!)
    • Pharmacy services for regular meds, delivered to room
  • Guests should bring:
    • Photo ID
    • 14-day supply of medications
    • No alcohol or recreational drugs 
    • Items of necessity: clothes, shoes, toiletries, dentures, prostheses, personal electronic devices, small amount of cash or debit/credit card
    • Recent discharge paperwork/medication list
  • Maintaining continuity of care:
    • PCP is expected to continue providing whatever care – follow up calls, or televisits or in-person visits
    • If patient has home care, coordinate with them to transfer to hotel
    • Patient’s PCP expected to coordinate in-home supportive services
    • PCP or referring clinician welcome to do a visit at hotel, please provide your own PPE
    • Guests receive guidance to call 911 if they have medical emergency
  • LOS
    • Isolating: after 10 days of onset of symptoms and absence of symptoms for 3 days and overall improvement in symptoms
    • Quarantine: 14 days or if home situation changes so that they can isolate at home
    • Any issues with referrals: Assistant VP Dr. Aaron Miller: aaron.miller@nychhc.org
    • Hotels are free
    • Patients will be contacted within an hour of referral
    • What if patient doesn’t have a phone? TBD – maybe Ryan considers keeping patient on site and gives a direct call back to the center

I made two attempts to call into this line – it’s a general line for H&HC Covid services. I was able to get through to the right place for the Covid Hotel Program within 5 minutes on my second attempt. They stated ancillary staff should be able to make these calls, but providers should be able to make the referral within a visit as well.

Sara Sansone, MS, MPH, RN (she, her)

Chronic Care Manager | Population Health

P: 212.484.5860 M: 646-927-9609

F: 212.265.6565

Ryan-Chelsea Clinton Community Health Center

ADDENDUM D: MEDICAL RESPITE ADVOCACY PLAN FOR NYC

There is no question that we need medical respite beds in New York City. Many of our service providers will attest to this. People suffering homelessness are deprived of complete recovery alternatives after leaving an emergency room. People are mostly cared for by family or visiting nurses after returning home to ensure successful recovery. People who are homeless do hot have access to aftercare, and hospitals are reluctant to house people beyond their needed emergency care. As one Mount Sinai doctor said, “We’re not a Holiday Inn.” 

A medical respite bed facility can be a pipeline from the hospitals to health, medical, social, and other services, which can lead to housing opportunities. 

This four-step plan is to encourage the development of medical respite beds in NYC. This is a plan in progress, not without flexibility, and is open to suggestions.

Step #1 (Began November 2019) Mission:

Describes our mission (the encouragement of medical respite beds) and suggests the following pathways to complete that mission:

  • Encourage medical respite bed funding through the city budget
  • Ask the city to fund a pilot project to study the financial and clinical outcomes
  • Encourage the network of providers to develop medical respite beds

A press release describing the committees’ intentions, emphasizing the forthcoming presentations, and encouraging attendance could be prudent.

Step #2 (March 2020) Information Gathering:

This step requires a tremendous amount of information gathering affirming the necessity, sustainability, and capital to develop a respite bed facility. Fortunately there are successful examples and developers who are willing to guide this endeavor. The information gathering should include, but not be limited to:  

  • Statistics outlining success in other states
  • Costs difference between emergency care and respite bed facilities
  • Developmental and operational cost analysis
    • Daniel Muwamba, Deputy Chief Financial Officer, Boston Health Care for the Homeless Program is already working on financial details of the Barbara McInnes House and Stacey KirkPatrick facilities
  • Short documentaries and testimonials speaking to medical respite needs
  • Video and PowerPoint presentations affirming the medical respite beds necessity and benefits:
    • Andy Coyle, M.D., Assistant Professor of Medicine and Medical Education, Associate Program Director for Ambulatory Care, Internal Medicine Residency Program, Icahn School of Medicine at Mount Sinai, has shared a great deal of knowledge during a conference call and with his PowerPoint presentation, using data from March 2019, and he is willing to further support our endeavors: 

I can pull updated data if there is an opportunity to speak to a group…I can also share more of our outcomes data for the respite as we have it.

  • Comunilife’s Rosa Gil, DSW, President and CEO, has contracts with Monte, Bronx Lab and a few Medicaid Managed Care plans for medical respite bed care
  • David Munson, Barbara McInnes House, has shared details of his operation and as with Dr. Coyle, is willing to support our endeavors
  • BronxWorks, is partnering with One City Respite Program, to lower the cost of emergency room use, to provide longer care for persons without a residence, and to enable a pathway to better health and housing stability (an interim step towards medical respite beds?)
  • Insurance Companies: Health First, United Healthcare, MetroPlus, Amida Care
  • DHS, Outreach services, and NYDIS: How can medical respite beds benefit?

The video presentations should educate, speak to the need, and empower others to advocate for medical respite facilities. 

Step #3 (July, August 2020) Administrative, Proposal Development, and Marketing: 

This step collates the work from Steps 1 & 2, fills in the gaps, and tailors it to the needs of client and state for a finalized proposal to encourage the development of medical respite beds. This step serves the final presentation and marketing needs, and also encourages support and participation. 

Step #4 (September, October 2020) Advocating for Development:

This is the culmination of discussions, meetings, research, discoveries, proposals and presentations to gather the support from nonprofits, city agencies, governing bodies, medical institutions, and humanitarian developers to realize the building of medical respite beds.

This is the culmination of discussions, meetings, research, discoveries, proposals and presentations to gather the support from nonprofits, city agencies, governing bodies, medical institutions, and humanitarian developers to realize the building of medical respite beds.