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Homeless & Housing Meeting Recap for November 5, 2019

(MSCC) John Mudd, Posted December 15, 2019

TO: Committee Members and General Public

FROM: Matt Green, Councilman Corey Johnson’s Office; John Mudd and Sharon Jasprizza, Midtown South Community Council

SUBJECT: Homeless and Housing Committee Meeting recap for Tuesday, November 5, 2019 at 9:30am, plus upcoming meeting reminder and announcements

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

We covered a wide range of topics during our meeting on November 5, 2019: Boston’s Barbara McInnis House, Medical Respite Bed and the Non-Medical Respite Bed Policy Draft, were the headliners. We have a lot of unfinished business surrounding the vouchers, which will be explored in the coming December Homeless and Housing Meeting.

We’ve reached another milestone with our committee; we’ve added more medical professionals to our network! Thank you Daniel Pichinson for bringing Mt. Sinai’s Dr. Andrew Coyle, and Comunilife’s Rosa Cifre, LCSW Chief Program Officer into our circle. And thank you Cassie Dessalines for developing a relationship with Barbara McInnis House’s Dr. David Munson, and organizing the Boston trip to meet with him. The Non-Medical Respite Bed Policy recommendations are progressing!

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 (November 5, 2019 meeting):Sharon Jasprizza MSCC

POLICY COMMITTEE’S REPORT FOR NOVEMBER 5, 2019

The prior 8:30am Policy meeting’s hour was spent discussing the second draft of our Non-Medical Respite Bed Policy Recommendations.

SPEAKER(S): Homeless and Housing Committees’s John Mudd and Sharon Jasprizza, MSCC; Cassie Dessalines and others, BronxWorks; Reggie Miller, NYDIS; Sharmistha Mohapatra and Sara Sansone, Ryan’s Chelsea Health clinic (spoke about their trip to Boston’s Barbara McInnis House medical respite facility).

MEDICAL RESPITE BEDS

Homeless and Housing Committees’s representatives traveled to Boston’s Barbara McInnis House medical respite facility on Thursday October 24, 2019. The team included: MSCC’s John Mudd and Sharon Jasprizza; Bronx Works’s Cassie Dessalines, Mariam Alami, Martha Zabetta, Miliano, Sarah Zammiello, Juan Rivera; Reggie Miller, NYDIS; Ryan Chelsea Health clinic’s Sharmistha Mohapatra and Sara Samson.

Cassie organized the October 24, 2019 trip to Boston’s Barbara McInnis House medical respite facility to meet David Munson and his department heads to give us an overview of their facility. The goals were to understand the center’s: 

  • Policies
  • Programs
  • Goals/Mission
  • Operation
  • Budgeting
  • Proof of Savings through Services
  • Funding
  • Efficiency
  • Benefits (social, individual, health and human services)
    • Increase in safe discharge plans
    • Decrease Against Medical Advise (AMA)
    • Decrease length of hospital stay and recidivism
    • How are the dependent drug users supported
    • How are they connecting people with stable housing

Summary: We were looking for any metrics that prove the center’s efficiencies and net worth. 

See Addendum H for detailed findings of the trip.

HOSPITAL AND RESPITE CARE

Cassie discussed Bronx Works’ staff being embedded in the hospital emergency room (good), and to a much lesser degree during a patient’s respite period (not so good). This is limiting. A case manager needs time to develop a pathway to housing for their client. Embedded social services during the respite period would be advantageous.

Comunilife’s Beverly Raudales spoke about their respite service. They have two respite beds for recovering patients (not medically step-down, but medically discharged). Comunilife works to fulfill care obligations and beyond by securing stable housing. Comunilife is interested in establishing relationships with other homeless services, particularly Urban Pathways. 

Pathways from recovery to stable housing are advantageous and somewhat less complicated than other pipelines; the obvious being, it eliminates street outreach and on-site for better communications.

ADLs / PRIORITIZING CARE

Paul Feuerstein, of Barriers Free Living, tells us that nursing homes are discharging people with poor Activities of Daily Living (ADLs). Where do people with poor ADLs go? Nursing homes make their money off people with physical therapeutic needs, and do not cater to individuals’ other needs. 

NON-MEDICAL RESPITE BED

NYDIS/ESN: The merging of NYDIS and ESN was detailed in the August recap (see MSCC’s web link). NYDIS/ESN is a network of (mostly) congregations, which provide overnight stays for people who are homeless. There is a lack of rules and policy coherence among the respite bed facilities, clients, volunteers, and homeless service providers.

Drafting Policy Recommendations: Policy recommendations for the respite bed providers, social services, volunteers, and clients, could help solve many issues, if mutually agreed upon. 

During the July 2019 meeting, the committee agreed to develop Non-Medical Respite Bed Policy Recommendations. Cassie Dessalines’ (Bronx Works) first draft of the policy recommendations and Reggie Miller’s (NYDIS/ESN) input were merged together for a second draft (see addendum E). The third draft should be ready, and we’ll likely have updates for December’s meeting.

Training and retaining: How do we educate, train and retain volunteers without burdening them? Below are highlights from Cassie’s policy recommendations draft, and added suggestion from our committee members:

  • Webinars for educational updates
  • Short videos on locations
  • Short orientations on location
  • Accessible (24hrs) contact from the admitting organization
  • Basic Narcan or Opioid overdose training, which can save lives
  • Regular meetings

Losing volunteers due to safety risks or disregarding their comfort levels would be unacceptable. Reggie says we run the risk of not having volunteers if they do not feel comfortable. Volunteers assume and should be assured that clients are screened and pose no threat.

Clients Concerns:

Peter, Gudaitis, Executive Director, New York Disaster Interfaith Services, NYDIS, says we need to balance volunteers’ training, needs and comfort, along with client needs. 

People being housed overnight within the network have to abide by strict rules and timetables for travel. Filling the beds means more people are being served. To make the respite beds attractive for use and serve our purposes of bringing people in off the streets, an expanded threshold of tolerance is needed. Below are highlighted suggestions that were discussed from our Non-Medical Respite Bed Policy Recommendationsdraft:

  • Respite bed facilities should have a designated place to smoke, to ensure smokers are welcome
  • Poor ADL’s may be offensive but are non-threatening,: Access to showers will allow people with poor ADLs shelter opportunities without discrimination, and it will also enable our volunteers to work in a clean environment
  • Pet care needs to be discussed further

Side note: Nick Urban, Breaking Ground: 14th Street shelter needs improvements

MTA ENFORCEMENT INITIATIVE

In June, the City announced a new “diversion pilot” policy: Police officers would issue summonses to homeless people sleeping in the subways, which would be cleared if the ticketed person agreed to meet with outreach. No one had any additional information or knowledge of the proposal’s outcomes.

INCOME SAVINGS PROPOSAL (ISP)

DHS’s proposal to mandate (generally) 30% of shelter residents’ earnings to be put into a savings account effective date is December 15th  (see Addendum G and link below). The proposal was briefly discussed and will be tabled for February or March’s meeting agenda. Nancy Pascal was very familiar with the proposal and was asked to moderate the discussion. 

For additional information on this proposed new rule please see: NYC Rules https://rules.cityofnewyork.us/content/income-savings-plan-program (and also Addendum G).

WORKSHOPS

Current workshop updates: The four workshop pilot programs developed with Metro Baptist Church went well. Charisma and Nicole are working on an outline for an additional workshop, “Navigating the Shelter System.”

PUBLIC BATHROOM

No updates from the public bathrooms development and planning group: Allen Oster, CB4; Julie Chou, Renee Kinsella, Joseph Greely, CB5; Luke Szabados, CB5; Boyeong Hong; Kevin Gurly; John Mudd, MSCC

PUBLIC CONCERNS / POLICE AND COMMUNITY

Anthony Mahepath is MTS Precinct’s new NYPD Homeless Outreach contact. There were no public police concerns

ACTION LIST

  • No actions were committed (see Addendum A)
  • Laundry and daycare needs (see Josephine Ishmon’s email Addendum F)

ANNOUNCEMENTS

  • West Side Tenants Conference, Saturday, December 7th, 2019, 9:30-4pm, at the Fordham University School of Law (see flyer attached)
  • Port Authority Tree planting: There are nine trees placed with guard rails
  • Urban Farm Updates: Look out for our Urban Farm GoFundMe campaign to come!
  • Laundry For Kids – Update: raised close to $4,546 and served 293 kids
  • Please support our GoFundMe campaigns: Laundry for Kids and Street Sheets

ADDENDUM A: DISCOVERIES / ACTIONABLE ITEMS

Below are discoveries from previous discussions, and pertinent points for further discussions

DHS

Turning Tide: TurningtheTideNYC is DHS’s comprehensive vision for addressing homelessness. Download “Turning the Tide on Homelessness, Neighborhood by Neighborhood”

  • DHS is emphasizing the closing of commercial hotel shelters (cluster units) and have plans to replace them with 90 new shelters with proper wrap-around social services to reduce long-term homelessness: investing high quality of social service on-site, and implementing many unique best practices are of high priority to address trauma
  • The services are preventative: Many children in the shelter system will return as adults

NON-MEDICAL RESPITE BEDS

The non-medical respite beds are provided by ESN—a coalition of congregations—to DHS to house people overnight.

Problems

  • Sleeping in chairs is bad for health and causes long-term problems
  • Not enough cots for women
  • Some cots sit low and are difficult for people to get in and out of: The users are less mobile, larger in size, older, and less able
  • ADLs (Activities of Daily Living) are not good with the chronic homeless, and as a result, they are often unable to access respite beds (also due to poor mental health etc.) 
  • Emergency Shelter Network (ESN) require good mental capacity, drug-free, ADLs; too stringent for some clientele with hygiene problems (such as smelly feet)
  • One clientele was turned away because he smelled of alcohol as a result of his long-term alcohol abuse (he was sober)
  • Rules inconsistent amongst the various respite sites

Solutions

  • Uniform policy will alleviate many challenges with respite bed sites
  • Training for respite bed volunteers (e.g., de-escalation, Thrive/Narcan training kits on-site)
  • Add cots with appropriate height
  • List training recommendations, oversight

ADDENDUM B: POLICY COMMITTEE’S RECAP 11.5.19

(Sub-committee of Homeless and Housing Committee) 

November 5, 2019 Policy Meeting Recap

Location: Urban Pathways, 575 8th Avenue, 16 floor (between 38th and 39th Street)

Date: Tuesday, November 5, 2019

Time: 8:30am-9:30am

MEMBERS PRESENT

John Mudd, Sharon Jasprizza, MSCC; Dan Pichinson and Sharmistha Mohopatra, Chelsea Ryan Clinic; Cassie Desellines, BronxWorks; Andrew Bonfrancesco, Housing Works; Reggie Miller, NYDIS

COMMITTEE’S PURPOSE

Review policies and their oversight, determine actions, suggest and lobby for change!

TOPICS

The 8:30am Policy meeting’s hour was spent discussing the second draft of our Non-Medical Respite Bed Policy Recommendations.

FURTHER PLANNING

  • Adding policies concerning chronicity to our task list
  • Andrew: psychosocial and psychiatric evaluation policies in order to enter respite sites *Add-on
  • Review voucher policies and oversight

ADDENDUM C: BOSTON MASSACHUSETTS MEDICAL RESPITE BED

MASSACHUSETTS / Barbara McInnis House 

Agency: Boston Health Care for the Homeless

Program
Address: Jean Yawkey Place, 780 Albany Street, Boston, MA 02118 Contact: Sarah Ciambrone, Executive Director, Barbara McInnis House Phone: (857) 654-1701
E-mail: sciambrone@bhchp.org / Website: www.bhchp.org 

Description / Established 1993

Since 1988, medical respite care has been an essential component of the continuum of healthcare services provided by the Boston Health Care for the Homeless Program (BHCHP). Originating as shelter-based medical beds, medical respite care for men and women is now provided in one freestanding facility, the 104-bed Barbara McInnis House which is housed in the top three floors of Jean Yawkey Place on Albany Street in Boston and located across the street from Boston Medical Center. 

Jean Yawkey Place is home not only to the medical respite program but also the dental program, a busy pharmacy and ambulatory clinic, and administration for Boston Health Care for the Homeless Program. 

The McInnis House provides care to men and to women, and provides comprehensive medical, nursing, behavioral, dental, and case management services in an environment sensitive to the needs of homeless adults. 

The McInnis House offers three meals per day that are served in the dining room. Patients recuperate in private, semi-private or two to six bedrooms. The program admits patients 24 hours per day, seven days a week from hospitals, shelters, emergency departments, outpatient clinics, and directly from the street by referral from the BHCHP Street Team. 

Operating agency: Boston Health Care for the Homeless Program (HCH) 

Facility type: Stand-alone  / Number of respite beds: 104

Hours of operation: Admissions office – Monday thru Friday, 8am-4:30pm Average length of stay: approx. 12 days 

Admission Criteria 

• Primary medical problem 

• Psychiatrically stable 

• Independent in Activities of Daily Living 

• In need of short-term recuperative care 

• If on methadone, must be enrolled in methadone maintenance program 

• Disclosure of known communicable disease, including TB, VRE and MRSA

ADDENDUM D: COMMUNILIFE BROCHURE

About Comunilife 

Founded in 1989, Comunilife is a not-for-profit health and human services agency providing comprehensive mental health, social services and housing. Our mission is to provide vulnerable communities with housing and culturally sensitive support services. 

Services are provided to homeless persons living with mental illness, addictive disorders and HIV/AIDS to enable them to live independently in their community. In addition, we provide affordable housing for persons with low income. 

Comunilife programs employ our Multicultural Relational Approach for Diverse PopulationsTM which emphasizes respect for people’s cultural differences while mobilizing an individual’s strengths and resources of the community. Comunilife currently serves some 3,500 New York City residents throughout the Bronx, Queens, Brooklyn, and Manhattan. 

To make a tax deductible donation please visit www.comunilife.org/donation/. Donations may also be made by mail. For more information contact the development office at (212) 219-1618 ext. 6166 or ikaplan@comunilife.org 

Board of Directors: Raquel Ayala, Chairperson Veronica Kelleher, Vice Chairperson Jason P. Torres, Treasurer Frances Pandolfi, Secretary Carolina Buzzetti Gary Calnek Ruben Cardona Amarylis Cortijo, MD Steve Dyott Hazelien Featherstone James Geraghty Pamela J. Maraldo, PhD Carlos R. Piñeiro, Esq Miguel Sanchez, MD Ann Sullivan Marlene Zurack.

Rosa M. Gil, DSW Founder, President and CEO 

For more information or to discuss medical respite care services contracts, contact: Rosa Cifre, LCSW Chief Program Officer Comunilife, Inc. 462 Seventh Avenue New York, NY 10018 T: (718) 617-1978 info@comunilife.org www.comunilife.org 

Comunilife healthy living in community 

SOCIAL/MEDICAL RESPITE CARE 8/2015 

Admission criteria: Social/medical respite care programs will serve persons who: 

  • Lack suitable housing 
  • Have acute or post-acute medical illness which requires short-term resolution and/or care 
  • Need an environment in which to prepare for, or recover from, medical procedures such as surgery, chemotherapy, radiation, endoscopy, etc. 
  • Are independent in activities of daily living (ADL) with the ability to dress, bathe, transfer and ambulate independently, or with mechanical assistance such as a wheelchair, crutches or cane 
  • Are psychiatrically stable enough to accept and receive care and not interrupt the care of others 
  • Are sick enough to need more than an emergency shelter bed for the night 
  • Are not sick enough to require hospital level care or other medical care (nursing home, psychiatric in-patient care, rehabilitation hospital) 
  • Have a condition with an identifiable end point of care for discharge.
    (Patients requiring IV hydration will be assessed on an individual basis.) 

What is social/medical respite care? 

Social/medical respite care is acute and post-acute medical care for persons who are too ill or frail to recover from a physical illness or injury but who are not ill enough to be hospitalized. These individuals may be homeless, or may simply not have a family member or friend to care for them. 

Unlike “respite” for caregivers, “social/ medical respite” is short-term residential care that allows individuals the opportunity to rest and recover in a safe environment while accessing medical care and other supportive services. For homeless patients, staff help secure permanent housing prior to discharge from the program. Challenges such as obtaining food, clothing and shelter, or achieving or maintaining sobriety can compromise adherence to medications, physician instructions and follow-up appointments, thus increasing the probability of future hospitalizations. 

Social/medical respite care closes the gap between acute medical services provided in hospitals and the need for appropriate housing. It is an essential component of the continuum of health care services for the elderly and the homeless. 

Our medical respite care is offered in existing transitional housing. 

Why is social/medical respite care needed? 

It is not uncommon for persons who live alone and have been hospitalized to be temporarily unable to care for themselves following hospital discharge. In the absence of an available caregiver, social/medical respite care can avoid costly and traumatizing external and unnecessary hospitalization. 

For the particularly at-risk homeless population, living on the streets exacerbates health problems, complicates treatment, and disrupts the continuity of care. These people tend to have high rates of physical and mental illness, increased mortality, and frequent hospitalizations. 

Research shows that patients who participate in social/medical respite programs are 50 percent less likely to be readmitted to a hospital at three months and twelve months post-hospital discharge. 

Social/medical respite care generates significant savings for hospitals and communities, avoiding costly discharge delays as well as reducing hospital readmissions.

 ADDENDUM E: NON-MEDICAL RESPITE POLICY RECOMMENDATION

Respite Bed Suggested Policy

DRAFT 11/1/19 Cassie Dessalines with Reggie Miller’s added comments

Respite Bed Suggested Policy

Definition:

Drop-In Center– A Drop-In Center is a location in NYC where anyone can walk in and receive emergency shelter services. This may include a meal, shower, laundry and basic referral and assessment. If found to be chronically street homeless an individual could be placed on caseload where they could receive case management services to achieve an end goal of permanent housing. Drop-In Centers have no beds and clients sleep in chairs.

Chronically Street Homeless– To meet eligibility for caseload, a person must be able to prove they have lived on the street for 9+ months. This is often proved through a street outreach team (1 per borough) or through a social service agency that has engaged this person on the street.

Respite Beds– (aka Congregation Beds) Community agencies, including churches, community centers, synagogues, etc. will partner with Drop-In centers and allow clients to come and sleep in their facilities overnight. The social service agency will provide supplies such as beds, linens, care kits etc., and the community agency will provide the space and a volunteer to supervise clients overnight.   

Who Can Utilize Respite Bed Sites:

In order to meet eligibility criteria to utilize a respite bed, clients will need to hit a certain level of functioning. Administrative staff will be heavily involved in who will be eligible to attend. This eligibility will be determined by the following:

  • Clients will be on caseload. If a client is on an extended temp stay and is vulnerable, they may be sent, however, this decision will be on a case-by-case basis and will need approval from either PD or Clinical Coordinator.
  • Clients will need to be able to tolerate being in a different, less supervised, setting than the Living Room. They will need to be calm and peaceful while there.
    • Reggie: Please elaborate. Historically this meant that guests were not under the influence of alcohol or drugs, did not pose a threat to themselves or others, and if they had active mental health or substance abuse issues they were stabilized on whatever medications or other treatment plans were necessary. They also needed to be in relatively good health (not obviously unwell and/or infectious) and demonstrate relatively good hygienic practices. Is this no longer the case? Or is this an attempt to shift this (excluding the ADL’s which I know and understand there is a desire to shift)?
    • Cassie: This is an attempt to state that even though a client may have untreated mental health issues they should not be excluded as long as they can reasonably tolerate the environment.  
  • Clients need to be sober. Clients who need to smoke will be given an area to do so, however, abstinence from drugs or alcohol will be expected while staying at the respite site.
    • Reggie: This not always possible to do based on where within the building the shelter space is located, and maintain the integrity of the shelter space, especially after lights out.
    • Cassie: Understood. Just wanted to highlight that when clients are able to smoke they are more likely to attend.
    • Reggie: At the risk of being pedantic about semantics, this is a requirement. Granted, some volunteers are more flexible than others about whether a guest can stay if they arrive under the influence, I’m not aware of any who will look the other way at active use on site.
    • Cassie: Agreed

**It is my suggestion that ADL requirements be lifted from the policy already in place. Chronically street homeless individuals often struggle with ADL’s. Poor ADL’s do not pose any danger to other individuals, therefore should not preclude someone from accessing a bed.

  • Reggie: While I agree with the sentiment, this is going to be a hard sell for a number of reasons. Someone with poor ADL’s do not pose a danger in the same fashion as someone with active untreated psychosis, for example, but there are health and sanitation concerns and more often than not shelter spaces are shared spaces. This is certainly a topic worth further discussion, but expect a great deal of pushback.  
  • Cassie: Push back is fine, however, we need to be clear that the majority of street clients cannot be expected to have good ADLs.

Requirements for Respite Sites

  • Respite site will provide the agency with a space for clients to sleep.  
  • Provide a contact or liaison to discuss day-to-day needs or issues.  
    • Reggie: Drop-Ins should have information for an overall point of contact for each shelter. I know this can create a game of telephone when it’s necessary to reach the volunteer on duty on a given evening, but presently that is the most stable/reliable way to reach someone and to reach someone who has a reasonable idea of what’s going on. Not all shelter spaces have phones or reliable phone service. The conversation about a burner phone is one worth continuing, though we’d have to work out who and how it was being paid for.
    • Cassie: We have gotten approval for the Trac phone and plan to implement soon.
  • Provide a number to reach the volunteer with issues, i.e. lateness/cancellation.
    • Reggie: See above. Shelters should also have contact information for overnight Drop-In Center staff to reach out to with concerns.
    • Cassie: Trac phone will address this as well.
  • Volunteers will be present for the entirety of the clients’ stay.
    • Reggie: This is, or at least should be, standard procedure. I’m not aware of any circumstances in which at least one volunteer is not on premises for the duration of the guests stay.
    • Cassie: Is standard. Just included as a part of a complete policy.
  • Volunteers will attend an on-boarding session with the social service agency that is sending the clients.
    • Reggie: Agency Evening Shift Supervisors should also attend an orientation session at each shelter site.
    • Cassie: Agreed. Or perhaps a respite coordinator is available.
  • Volunteers will attend a Mental Health First Aid Training, Narcan Overdose Prevention, and Basic First Aid.
    • Reggie: NYDIS is working on expanding the scope of trainings available to shelter volunteers. This will be among the courses on offer.
    • Cassie: Great!
  • I would suggest a regular meeting with each church bed (monthly/bimonthly) to discuss any issues or concerns.  
    • Reggie: This is on my list of things to do.
    • Cassie: Great!
  • I would suggest that each site serve some sort of food/snack as able. (Many do this already)
    • Reggie: Generally speaking, those who have the facilities and the financial ability to do so, do so. This is also something on my list of things to figure out how to make happen.
    • Cassie: Understood
  • I would suggest that each site provide a space where clients could smoke. This could even be a time where the volunteer brings clients outside to smoke at a designated time. (Some already do this)
    • Reggie: As mentioned above, this is not always physically possible. I don’t know that this happens anymore, but this also used to be an area that created friction between host sites and their neighbors. To avoid problems with their neighbors, some nixed allowing guests to smoke period.
    • Cassie: Understood.

Requirements for Drop-In Center

  • Provide all necessary supplies including but not limited to cots, sheets, pillows, care kits, any additional personal supplies (adult diapers, feminine hygiene products)
  • Provide any and all trainings and materials for volunteers as needed.
    • Reggie: This should be a NYDIS task. We are happy to coordinate and work with Drop-In staff on trainings, but these should be standardized across all ESN sites.
    • Cassie: Great.  
  • Provide a 24-hour line for volunteers to call with issues.
    • Reggie: Complete with a name(s) to ask for.
    • Cassie: Agreed. Trac phone can be programmed with all appropriate contacts.
  • Provide transportation to and from site locations for clients at predetermined times. There should be a 15-minute grace period both for pick-ups and drop-offs.  
  • Provide line staff with a list of eligible clients that is updated daily. Line staff will conduct a superficial assessment of clients before they get on the van.
    • Reggie: Please define “superficial”.
    • Cassie: Meant to highlight that we are simply doing an informal assessment based on our best judgment.  This is not a perfect science and it must be understood that clients conditions may changed based on numerous variables.
  • If medication is needed and a client is on MMT, client will be packed out prior to leaving and will take needed doses independently at the site (**of note, this may include controlled substances such as Suboxone. This will be monitored and prescribed by an onsite doctor.)
    • Reggie: Volunteers will need to be apprised of this, without violating guests’ privacy. Volunteers don’t need to know what (exactly) or why a guest is taking something, but they will need to know that the guest will be taking something, what it looks like, how much, how often, and what effect they will have on the guest after they’ve been taken.
    • Cassie: Agreed.
  • Attend all conference meetings and respond to all requests within a reasonable amount of time.  
    • Reggie: Please define “reasonable amount of time”.
    • Cassie: Communication response should be within 24 hours.  We need to be clear that orders can sometimes take an extraordinarily long time.

ADDENDUM F: JOSEPHINE ISHMON’S EMAIL

The below email requests updates regarding laundry machines, day care needs to be added to the agenda, and more…

John, please add day care to the list.

Yesterday, I met briefly with Acacia (who oversees 7 midtown shelters) and they need more resources, specifically day care and laundry to handle the influx of homeless families from FEMA. Mothers cannot work without daycare for their children and they are having problems finding daycare centers that will take DHS vouchers. I asked them to try Hudson Guild and Polly Dodge Early Learning Center.

If anyone knows of other daycare centers in the midtown area, please advise.

They also asked for more laundry vouchers and I gave them what I could but need to keep a good portion in reserve for the start of the school year.

Matt, have we gotten a meeting with NYCHA on laundry machines for the smaller space?

Best,

Josephine

ADDENDUM G: DHS INCOME SAVINGS PLAN

Proposed Rules: Open to Comments (View Public Comments Received:2)

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Agency: Department of Homeless Services

Comment By:  Tuesday, September 24, 2019

Download Copy of Proposed Rule (.pdf): notice_of_hearing_on_dhs_rule_-_income_savings_plan_program.pdf

Section 352.35 of Title 18 of the New York Codes, Rules and Regulation, authorizes the New York City Department of Homeless Services (“DHS”) to make this proposed rule.

Following amendments to New York Social Services Law § 36-c, DHS proposes this rule for the Income Savings Plan Program, or “ISP” Program, whose purpose is to help clients exit DHS shelters by budgeting for and developing savings to facilitate their transition to permanent housing upon shelter exit. Under the ISP Program, certain households with earned income will be required to deposit a portion of their earned income (generally 30%) to a savings account. Deposited funds will be held by the New York City Department of Social Services and will be made available to program participants upon their exit from shelter.

The ISP Program will be implemented in phases for multiple populations. This rule establishes the first phase of this program, which will apply to employed residents of DHS shelters for single adults whose earned income makes them ineligible for Cash Assistance. DHS will amend the rule as it rolls out the program to additional populations with earned income, including families with children. Participation in the ISP Program plan will be a shelter program eligibility requirement pursuant to State regulation 18 NYCRR § 352.35(f) and will be subject to the application of the temporary discontinuance of shelter requirements of State regulation 18 NYCRR § 352.35, with a provision to immediately cure a violation.

Public Hearing

Subject: 

DHS Proposed Rule – Income Savings Plan Program

Public Hearing Date: 

Tuesday, September 24, 2019 –

2:00pm to 4:00pm

Contact: 

Kathleen Lee, DHSRules@dhs.nyc.gov or 929-221-6690

Location: 

2nd Floor Auditorium

125 Worth Street Enter at Lafayette Street

New York, NY 10013

ADDENDUM H: field visit to Boston Medical Respite

Notes by Ryan Chelsea Center’s Sharmistha Mahapatra, Population Health Manager, and Sara Sansone, Chronic Care Manager

We were welcomed by David Munson, Medical Director of Respite Programs at Boston Health Care for the Homeless. He is also the Chair of the Steering Committee of the Respite Care Providers Network through the National Health Care for the Homeless Council. We also met with the Deputy Chief Financial Officer, Director of Operations and Director of Nursing at Barbara McInnis House. The entire travel team discussed a number of issues with David, some highlights below.

Sites Visited

  • Large, main site: The Barbara McInnis House
  • 104-bed medical model, acute care oriented, short-stay to stabilize medical condition, and little case management (does not resolve or attempt to resolve housing issues)
  • Satellite, step-down site: The Stacy Kirkpatrick House 
  • More typical of a common respite site; more likely to be a model NYC would use
  • 20-bed nursing & operational staff run, transition medically frail homeless patients from low-risk care to long-term housing

Barbara McInnis House

  • Respite first started 30 years ago within a shelter, moved from what is now Stacy Kirkpatrick House. Current building (formerly pathology site, morgue) given to Boston HCH by the city for $1 (one dollar)
  • Capital funding used for major renovations
  • Primary care FQHC on the first floor
  • Also houses a SPOT (Supportive Place for Observation and Treatment) monitoring room for 8-10 individuals to be monitored while actively under the influence of a substance at high risk of overdose. This is not a safe injection site, however
  • Respite housed on 2nd – 4th floors
  • 2nd floor is a group area (cafeteria, laundry, activity room, large recreation area, outdoor space for smoking, some offices)
  • 3rd and 4th floors appear to be more likely an inpatient hospital
  • $16-18 million annual budget for the respite program
  • Approximately 2500 annual admissions (1200 or 1800* unique patients) 
  • 104 beds on 2 floors; most rooms 4-6 beds with TVs and headphones attached
  • 2 negative pressure rooms (for airborne isolation, but mainly used as isolation rooms for psychiatric separation)
  • Pharmacy on-site

Staffing

  • 24/7 nursing on-site
  • Daily visit with primary care + 3 nursing visits for each patient
  • 8 teams managing 13 patients
  • RN (daytime, 1 RN/team; nighttime, 1 RN/2 team), 
    • 1 case manager/2 teams
    • 2 medical assistants for every floor (52 beds)
    • 3.6 FTE social workers who focus on crisis intervention and milieu management
    • 0.7 FTE psychiatrist
    • Approximately 175 staff including per diem
    • Trauma-informed training for all staff, including contracted security agency
    • AmeriCorps members
    • Challenges for staff include:
      • Embracing harm reduction, especially allowing active drug use
      • Safety, particularly outside the building rather than inside the respite
      • Managing expectations that these are not typical patients
    • Trauma specialist rotates for staff/team self-care

Admissions and Patients Demographics

  • Criteria:
    • “Too sick for shelter, but not hospital”
    • “Imagine needing to discharge someone home with VNS, only they have no home to go to”
    • Includes activity-of-daily-living independence (can wash, bathe, transfer themselves)
    • Admissions can include from colonoscopy prep to full-on cancer care and in-between (e.g. hospice care, exacerbation of chronic respiratory disease, detox as secondary reason, DM/HTN or flu, surgical pre- and post-op)
  • Nursing oversees admissions
    • Respite staff Nurse Hospital Liaison embedded at hospitals constantly has to case review referrals for appropriateness because criteria is very particular
    • Liaisons are credentialed by hospitals
    • There is a referrals sheet with criteria
    • 10% daily turnover, 10-11 beds opened/day
    • 45% admissions from hospitals; 40% from outpatient (1st floor FQHC, 30-shelter based clinics, or street team); remaining from jails, detox, nursing homes. No self-referrals
    • Contract with Mass General for funding some bed-days for guaranteed access
    • On admission to program, patients have ‘benefit touch’ to enroll in insurance, etc.
    • More men than women, beds separated by sex/gender; transgendered assigned by self-identified gender
    • Approximately 80% of the population are active tobacco smokers
    • Approximately 80% of the population are active substance users (managing/treating withdrawal is secondary effort)
    • Barriers to admission can include hx [?] of sex offenses
    • Harm reduction model prevails
    • Orientation offered 2x/week for 1 hour, and run by Operations Director (required only once, so not done if patient is readmitted to the program)
    • No violence, confrontation, or racial remarks with other patients or staff is permitted 
    • Patients can’t come and go or bring in outside food
    • Escort or transportation provided to appointments (2 vans owned by respite)
    • Visiting hours allowed
    • Smoking limited to specific times and location
    • Option to attend groups run by SW or activities from external organizations
    • 2-week average length-of-stay (LOS); no mandatory end
    • Code Green ‘behavioral health response’ happens about 1/month; orientation and huddles have greatly mitigated this
    • 1/4 discharges are unplanned 
      • Some due to administrative reasons, patients leaving to get their benefits checks, substance users
      • Behavioral disturbance will be discharged but can come back on review of case 
    • Discharges planned by case managers and overseen by nursing to:
      • Street (can be followed by Street Team), shelter (most common), rest home, detox or sober homes, skilled nursing site, permanent housing support (rare and only if patients already in search process through the City)

Outcomes Data 

  • Not able to track all desired data due to disparate strength of relationship with 5 referring hospitals and lack of claims data
  • Boston Mass General (BMC) data supports that Medicaid in-patients are replaced with commercial/private pay, increasing hospital revenue by millions of dollars
  • Internal QI: Falls / medication errors / emergency events
  • External: 30 day readmit rates w/one hospital (BMC), 12-question patient satisfaction questionnaire, referral data
  • Hospital referrals average LOS: 16 days
  • Outpatients referrals average LOS: 12 days
  • Wish list for reports: Diagnoses, Disposition after discharge, Demographics
  • LOS meetings held every week; longer stays considered for step-down

Billing

  • Essential takeaway: that this is mainly funded through provider billing—RARE for a respite
  • Mainly dealing with one ACO, greatly simplifies agreements, contracts and payment, as compared to our NYC situation
  • Boston HCH: $60 million annual budget, Barbara McInnis $18 million (of that $60)
  • Recommendations from deputy CFO:
    • Have per diem contracts with ACOs negotiated at a percentage rate, not fixed $ amount
    • Send claims on a daily basis, not monthly
    • Make sure practice management system is sending automatic claims, hire detail-oriented staff if a lot of front end work needed, good idea to have a certified coder on staff
    • Manage payer mix
    • Each payor [payer?] coding preferences differ, ensure coding doesn’t look like an inpatient visit

Stacy Kirkpatrick House

A first-floor residential setting embedded with separately run supportive housing units, with space for case management, recreation room, and outdoor areas across the street from a large park.

  • Former nursing home site; current building shared with City’s supportive housing, but they are managed independently
  • $1.5 million annual budget operating at a loss due to higher proportion of undocumented patients [?] in the mix (as an independent site but ultimately beneficial, so other robustly funded areas of the Boston HCH make up for this)
  • 20-bed for low-risk care; 2-4 beds/room
  • 2 nurses/day, 14-hour/day 7 days/week nursing 
  • Case management staff 24/7, trained in CPR and vitals for overnight coverage
  • Once-a-week visit by PCP (12 hrs/week total provider time)
  • 60 or 40*-day average LOS, has been up to a year
  • Sex-mix similar to acute care site

Boston Healthcare for the Homeless

  • 30 outpatient clinics in shelters
  • Street Team with internist, nurse practitioner, psychiatrists, case managers
  • HCH-employed nurses embedded at most hospitals

Other Notes

  • They do code for homelessness (Z59 code)—increases risk score and reimbursement rate by ACO
  • Medicare subchapter 5 stipulates what you can bill in regards to split billing
  • David emphasized that every respite is unique, and that our model will be more like Stacey Kirkpatrick—getting to Barbara McInnis capacity would take years, but also would caution against that being a focus—David himself says that’s more like a small hospital and it doesn’t focus on linking folks to long-term solutions
  • The National Healthcare for the Homeless has a directory of respites and a number of resources accessible here: https://nhchc.org/clinical-practice/medical-respite-care/medical-respite-directory/
  • Those resources include Standards for Medical Respites & a Respite Toolkit
  • David says there will be a training in the next year specifically for folks opening respites and advises someone who is in the planning/operations stage to attend—no date yet but will be offered by NHCHC. Sara is on their mailing list. If anyone else wants to be, visit: https://nhchc.org/who-we-are/get-involved/

*Sara and Sharmistha have conflicting numbers on this