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Collective and California Senate Bill 1152: A Pragmatic Vision for Collaborative Support of the Homeless

It’s not news that homelessness in California—the dark side of an economy that continues to boom and that may be running out of people to hire—is a growing crisis of increasingly heart-breaking proportions. It’s widely believed to be the consequence of a housing crisis that shows no signs of slowing down. The result: Los Angeles County reported a 12 percent year-over-year increase in homelessness in the county—about 59,000 people on any given night are considered homeless, with other data indicating that about 68 percent are unsheltered. The two-year count numbers also surged by 30 to 40 percent in San Francisco, Silicon Valley, Orange County, and Kern County in the Central Valley.

For some people, homelessness is a brief transition after a lost job or when a mom and her kids leave a domestic violence situation. For others, particularly those struggling with psychiatric disorder, it can become chronic, which breeds illness, disease, and early death. There’s exposure to the elements and traumatizing violence. Many fall into pits of despair, loneliness and disconnection, and addiction. Many cluster in homeless encampments—under freeways and in river washes—that are increasingly characterized in terms such as ‘medieval’, with increasing outbreaks of infectious diseases such as typhus and hepatitis-A. Many are particularly hard to support because—despite their illnesses—they frequently visit hospitals and other facilities over city, county, and even regional boundaries, moving up and down the coast and Central Valley and even back and forth between Oregon, Nevada, and Arizona.

California hospitals, as well as first responders such as EMS and police, are on the front lines of the homeless crisis. California Senate Bill 1152, enacted in fall 2018, placed a range of new requirements on hospitals for homeless patients, including on-demand provision of meals and clothing, enhanced discharge plans, coordination with community providers, ‘safe’ discharges, and logging hospital encounters.

Collective Medical has mobilized to support our growing network of nearly 140 California hospitals in meeting key SB 1152 requirements. We’ve been thrilled to work with our provider community to develop an approach that pivots off statutory compliance into a pragmatic path toward a vision of regional and statewide collaboration around homeless individuals who frequently visit hospitals. By July 2019, we expect more than 30 California hospitals in the Collective Network to be uploading homeless discharge plans to the Collective Platform to kick off statewide collaboration, enabling other hospitals to identify homeless patients on registration in the emergency department and to leverage the discharge plans created by the first wave of participating hospitals.

We’re particularly grateful for the partnership of Glenn Raup, Executive Director of Nursing (Emergency/Behavioral/Observation Services Executive Director) at St. Joseph Orange Hospital, as well as Jeanine Loucks, Emergency Clinical Decision Unit Manager, and Melissa Ramirez, Director of Case Management. We’re grateful for the input we’ve had from a large number of practitioners across our network, including Ashley Pye of Hollywood Presbyterian Medical Center; Dr. Jason Greenspan of Emergency Medical Associates; Dr. Reb Close, Dr. Casey Grover, and Cara Allard of Community Hospital of the Monterey Peninsula; Brenda Brennan of Washington Hospital in Fremont, and a wide range of talented professionals at systems such as Prime Healthcare, Sutter Health, Providence St. Joseph Health, and Adventist Health. Finally, we’re grateful for the support and partnership of Whitney Ayres, Sharon Richards, Mark Gamble, Paul Young, and others from the Hospital Association of Southern California, and Jo Coffaro, Rebecca Rozen, and Bryan Bucklew, and the broader team  of the Hospital Council of Northern and Central California.

We’re proud to partner with all of these folks and many more amazing clinicians, case managers, social workers, and executives in hospitals, health plans, homeless services providers, and primary care and behavioral health practices in meeting the key health and public health challenges in California. We’re also really lucky to be part of a Collective team committed to meeting the challenge of homelessness in California and other parts of the US, and whose hearts break as much as ours do when we depict the mounting tragedy of homelessness in the Golden State.

Hospitals alone cannot fix homelessness in California. Hospital staff do what they can and more to meet the needs of the homeless who show up each day, and to move them where possible into outpatient care and increasingly robust programs that provide services such as respite care and transitional and supportive housing. What drives us at Collective each day is doing what we can to make the efforts of the providers we support more effective, and the difficult lives of the homeless patients who stream in and out of their doors each day at least a little better.

Suneel Ratan
General Manager, California

Melissa Morales, LCSW
Clinical Solutions Lead

Kyle Erb
Health Plan Relationship Manager

Gabe Waters
VP, Enterprise Sales, CA, TX, HI

Tory Neiwert
Product Director