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AHH and APLA Health have joined forces!
March 22, 2021by admin
Alliance for Housing and Healing and APLA Health have joined forces, as of July 1, 2021 we are merging the two agencies. We will now be able to provide housing, food and world class health care to LGBTQ+ and HIV+ people throughout Los Angeles County. Since 1983 the organizations have been working together to care for some of the most marginalized and vulnerable members of our community. Both organizations started in the 1980’s in response to the AIDS epidemic and since that time have grown with needs of our community. Although HIV/AIDS is no longer a death sentence, the need for culturally competent health care and safe, affordable housing remain huge issues for our community. The merger of our two agencies affirms our commitment to bringing long overdue equity to the LGBTQ+ community.
We look forward to sharing more news as we embark on a very exciting time for the board of directors and staff of both Alliance and APLA Health.
We to thank you for your many years of support. We look forward to a bright, safe and prosperous future for the people we serve.
Our legendary fundraiser is back, and our audition call is officially here.
Are you ready to claim your crown?
AUDITIONS BY APPOINTMENT ONLY
Participate in one of LA’s most heart-filled fundraisers in October 2021, benefitting Alliance for Housing and Healing. All contestants must prepare an introduction of their character (name and state you are representing), share costume ideas, and prepare one minute of talent. Self taped audition videos due by April 12th, 2021.
Email Jeffrey Drew with questions or to request an audition: jdrewla@hotmail.com
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HOPWA Subcontractors
October 30, 2020by admin
Alliance is seeking qualified subcontractors who can provide crisis beds, housing specialist services, legal services and related services to HOPWA clients. Subcontractor must have at least five years of experience. Please include details of your current HOPWA contract (if applicable) including programs, staffing, and performance. Please submit information by November 15th to Terry Goddard II at tgoddard@alliancehh.org.
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Alliance for Housing Healing and 600+ LGBTQ Organizations Release Letter Condemning Racial Violence
June 9, 2020by admin
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COVID-19 Update
March 19, 2020by admin
As we continue to monitor the latest updates and guidance from the LA County Department of Public Health, the California State Government and the Centers for Disease Control and Prevention (CDC) regarding COVID-19, we are making some changes to ensure the top safety of our clients, team and community.
Here are the changes that our clients can currently expect from AHH.
OFFICES CLOSED:
Our Long Beach and West Hollywood offices are not currently open to the public or accepting walk-ins until further notice.
YOU CAN STILL REACH US:
Our Housing Support Services team is still here to assist you via phone and electronic communication during regular business hours: 8:00am – 5:00pm
Phone
Eagle Rock / LA Office Phone: (323) 344-4888
West Hollywood Office Phone: 323-656-1107
Long Beach Office Phone: 562-294-5500
or
Online
Complete this questionnaire to have someone from our team reach out to you to address your present needs: https://alliancehh.org/help/
WORKING REMOTELY
In an effort to protect our team, clients, and the community, our normal operations have been modified as recommended by the CDC. Effective Monday, March 16, 2020 until further notice, our Permanent Supportive Housing team will be providing services remotely. These services include:
Case management
Community referrals
Assessment of service needs
Life skills training
Housing related services
Supportive Service Coordinators will also work with clients remotely to complete any documents needed to maintain programmatic requirements. This may include the following:
Quarterly Paperwork (e.g., budgets, individual service plans, service participation log, etc.)
Annual Assessments
Income Update Forms
Diagnosis Forms
WHAT IS THE CORONA VIRUS?
COVID-19 (coronavirus) is a respiratory illness that can spread from person to person.
On March 15, the CDC said individuals and organizations should reschedule events with 50 or more people for the next eight weeks. Both Governor Gavin Newsom and Mayor Eric Garcetti have released statements and new recommendations or requirements. Governor Newsom called for home isolation for all people 65 and older and those with chronic health conditions. Mayor Garcetti announced an emergency action to close bars, nightclubs, restaurants (with the exception of takeout and delivery), entertainment venues, and gyms and fitness centers. Mayor Garcetti’s emergency action took effect at midnight on Monday, March 16.
For the latest information, please visit the CDC website or Los Angeles Department of Public Health website or contact your health care provider.
The Number-One Barrier to Ending HIV in U.S. Cities Is a Housing Crisis
January 27, 2020by admin
Throughout 2019, TheBody interviewed top providers at nearly 50 agencies nationwide as part of our Eyes on the End series, probing how close various hard-hit localities were to effectively ending their HIV epidemic—and what barriers stood in the way. Despite the fact that Housing Opportunities for Persons With AIDS (HOPWA), the longstanding federal funding stream for housing for low-income people living with HIV, has been consistently up-funded by Congress—most recently, to $410 million, a level that had been requested by the Democratic-led House of Representatives—providers say that, in their often rapidly gentrifying cities, the need for free or affordable units for their low-income clients almost always exceeds what’s available via their HOPWA allocations.
Those stories are backed up by Lauren Banks Killelea at the National AIDS Housing Coalition in D.C., who notes that HOPWA funding, while important, is small compared to funds that flow down for HIV services through the Ryan White CARE Act (which was funded at $2.34 billion in fiscal year 2018), and that HOPWA currently serves about 60,000 households nationwide, while it’s estimated that half of the 1.1 million Americans living with HIV will at one point face a need for housing.
“Housing continues to be one of the hardest resources to come by in almost every city in America where working a minimum-wage job isn’t enough to afford a decent living space,” says Killelea, who estimates that HOPWA would have to be funded at $1 billion to fully close the HIV housing gap. “Having a place to live is a fundamental of achieving viral suppression.” (Her remark reflects ample research showing that a safe and steady place to live is key to HIV-positive people being able to access, store, and take their meds daily, hence keeping HIV in their bloodstream suppressed to levels undetectable on labs.)
“It’s hard to thrive when you’re constantly worried where you’re going to sleep,” says Killelea.
A Problem Everywhere
And service providers nationwide say that worry is still far too common among their clients. At AIDS Center of Queens County in New York City, executive director Rosemary Lopez said, “We get HOPWA money, but everything here is getting gentrified and rents are sky-high. We housed 70% of our clients 15 years ago—now we’re lucky if we can house 30%. We have to move people to the [cheaper] Bronx, but then they lose services from us.”
At PALSS in Columbia, South Carolina, CEO Carmen Julious said, “We … haven’t been able to provide better access to housing for clients. Many of us [staffers] go home every night to a house, but we drive past clients who are walking to the shelter. Housing is a major issue in our community for all people with limited resources, not just those living with HIV.”
At BEBASHI in Philadelphia, executive director Gary Bell said that, for his clients, housing is “the number-one issue. It’s very hard to climb out of poverty if you don’t have a stable place to live. There’s some limited housing in Philly dedicated to people living with HIV, also some scatter-site housing, but the waiting lists are long, and not just for housing for people with HIV. Section 8 here has an 8-to-10-year waiting list. It’s very hard to get people into those systems. So in the meantime, you do what you can do to find a room for people. With gentrification, there’s less [affordable] housing available. There’s a lot of abandoned housing around the city, and I wish we could come up with more creative ways of making it available.”
And at AIDS Services of Austin, Texas, executive director Paul Scott said, “There’s a terrible housing shortfall in Austin. Getting all our clients housed is a challenge. Five or 10 years ago, the average one-bedroom rent was probably $800, and now it’s $1,350. It’s even a challenge for our employees.”
At RAIN in Charlotte, North Carolina, Chelsea Gulden said, “Transportation and housing come up the most in everyone’s needs assessment. Rent is high; an average one-bedroom is $900 to $1,100 a month. You have to make $20 an hour to make a living wage. We have so many people working 1.5 jobs who still can’t afford an apartment without a roommate. I live check-to-check and I’m a VP of operations. We need subsidies to pick up about half of people’s rent for those who are struggling. There’s been a HOPWA and Section 8 waitlist for 10 years.”
The stories like that go on and on. And if they’re not about how HOPWA funding doesn’t meet the need, they’re about some of the challenges of HOPWA. At FoundCare in Florida’s Palm Beach County, CEO Yolette Bonnet said, “We don’t take HOPWA funding anymore. It became a hardship. We were always waiting for them to reimburse us, but there was a huge lag. The housing we do is through Ryan White—short-term transitional housing for people coming out of prison or substance treatment, limited to six months but usually 90 days. It’s often hotels, and we pay the bill.” (Some Ryan White funding can be used for housing needs.)
Creating Solutions
All of this is not to say that HIV service providers haven’t found often ingenious ways to get or keep clients housed. One major trend is the growing number of service agencies that, rather than merely using HOPWA or other funds for rental assistance for clients in various apartments around a city, either build, buy, or rent their own congregate or scattered units and then rent directly to clients.
The most luxurious example of this may be Desert AIDS Project in Palm Springs, California, a generally affluent gay and HIV retirement mecca in the California desert east of Los Angeles. DAP has its own sleek, sprawling 11-acre campus, bought largely with money from the widow of McDonald’s founder Ray Kroc, which holds not only medical primary care but 80 units of housing—with 60 more on the way—as well as perks like yoga, massage, and reiki healing. And whereas many HIV agencies get by on public funds, DAP benefits from generous private donations—$2 million from its annual gala alone.
Says DAP CEO David Brinkman: “When I give people tours of our campus, which includes housing, medical clinics, dental and acupuncture clinics, a gym, a farmer’s market, and a food depot, people will ask, ‘How have you created this utopia?’ I say it has to do with the courage of Steve and the generosity of the Krocs, who were otherwise very conservative.”
Of course, not all agency-owned housing is this plush. More typical examples might be the four houses for homeless gay and bisexual men of color, complete with supportive services, managed by Brothers Health Collective in Chicago. “We make sure they’re provided with 90-day transitional housing, then we work with partner organizations to help get clients into permanent housing,” says the agency’s Ariq Cabbler. Or, in Las Vegas, the agency AFAN’s 20-unit permanent housing project for medically fragile clients who can’t work, “that’s always packed,” says AFAN’s Antioco Carrillo.
Or, in Cincinnati, the agency Caracole’s site-based housing, started in 2018. “The majority of clients who’ve come to live with us are actively using substances, particularly heroin, but there’s no requirement to seek treatment,” says Caracole’s Brent Hartke, reflecting the “housing first” ethos, which holds that people need to be stably housed before they effectively address their health issues. “We’ve had one person so far go for inpatient treatment. We do encourage harm-reduction practices. We have a case manager on site who’s available to provide transportation to syringe-exchange services, 12-step groups, medical appointments,” Hartke explains.
Also, like FoundCare in West Palm Beach, many service providers tap into Ryan White funding to meeting housing needs. But Killelea points out that this is more likely in states that, under Obamacare, expanded income eligibility for Medicaid, which moved many low-income people with HIV who relied on Ryan White for medical care onto Medicaid—thus freeing up Ryan White funds for other uses.
In the 14 states that have thus far chosen not to expand Medicaid eligibility, “often their Ryan White funds are stretched thin and they can’t use it for housing,” she says.
Yet another source of housing funds many agencies have turned to is revenues from their 340B pharmacies. This is a complicated government program in which agencies that become federally qualified health centers (as many have in recent years, often to stay alive), complete with in-house pharmacies, are allowed by law to buy prescription medications at slashed prices but still get reimbursed by insurers at the full (often astronomical) sticker price.
They are then allowed to use the overage as they please—including for housing, which is the case at AIDS Alabama. “They realized,” said Killelea, “that housing was their number-one need” when it came to a use for extra dollars.
One thing’s certain: To echo Killelea, there’s no keeping people with HIV on their meds, healthy, virally suppressed, and hence unable to transmit the virus—in other words, there’s no ending any city’s HIV epidemic—without keeping or getting low-income people with HIV stably housed. At FoundCare in West Palm Beach, chief operating officer Rik Pavlescak, Ph.D., tells of a client, more than a decade ago, in the agency’s housing program.
“Our housing director at the time wanted to discharge her because she was noncompliant with her lease, a variety of infractions,” he recalls. “I said, no, we need to meet her first. When I saw her, my heart broke. She weighed all of 80 pounds, very frail, substance-abusing, clearly not well. I said to my directors, ‘No, this is the type of person we’re here to serve—we’re not throwing her out on the street.’”
Recently, he says, he saw the client. “She’s in recovery, stably housed, and virally suppressed. She gave me a big hug and told me she’s one of the biggest advocates for the services we provide.”
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Program Manager
January 16, 2020by admin
POSITION SUMMARY:
The Program Manager has a lead role in the oversight of client data collection, managing data input and ensuring reporting requirements are met according to contractual obligations. S/he assists with staff supervision and training, coordinates resident meetings, and may provide supportive services to individuals living in scattered-site permanent supportive housing programs located throughout LA County. S/he will assist staff with clinical interventions and working with high acuity clients. S/he will assist Director in contract monitoring and compliance.
Principal Duties and Responsibilities:
· Supervise Supportive Service Coordinators. Coordinate case conferences, trainings, and in-services in collaboration with the Director.
· Provide guidance and direction to Supportive Service Coordinators.
· Assist Director with budget monitoring and development for PSH programs.
· Assist Director with staff recruitment and retention activities.
· Ensure compliance with contract expectations and manage contract reporting schedule; participate in internal and external program monitoring and audits.
· Monitor program outcomes and develop systematic ways to track data.
· Facilitation of quarterly resident meetings.
· Assist with the implementation of quality improvement process related to program evaluation and service delivery model.
· Develop, facilitate, and coordinate staff trainings to support the professional development of staff and the use of best practices in service provision.
· Participate in development of program policies, implementation, and evaluation.
· Assist in the development of program operation manual.
· Assist with implementation and maintenance of the PSH team’s policies and procedures.
· Manage a small caseload as assigned by the Director, conduct home visits, and provide supportive services to ensure housing retention and improvement of health and well-being
· In collaboration with the Director, oversee the intake and enrollment process for new clients.
· Work with matchers and housing specialists and/or case managers to fill vacancies.
· Collaborate with external service providers as needed to enhance service coordination and advocate on client’s behalf.
· Participate in outreach efforts to identify clients, as well as expand service knowledge.
Qualifications:
· Minimum of 3 years’ experience as a service coordinator or in a case manager role.
· Master’s degree in Social Work preferred; Bachelor’s degree in Social Work/related field required.
· Strong supervision and leadership abilities to strengthen team cohesion.
· Knowledge of community resources in Los Angeles County.
· Strong knowledge of the complexity of HIV/AIDS-related issues, chronic homelessness, and co- morbidities, including mental illness, trauma, substance abuse, aging, and chronic health issues.
· HMIS or other database management experience.
· Excellent active listening and crisis intervention skills with ability to model good judgment.
· Excellent interpersonal, written, and oral communication skills.
· Ability to manage multiple tasks and priorities, work independently as well as a member of a team.
· Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and Internet.
· Valid California driver’s license, reliable transportation, and valid insurance are required.
· Bilingual English/Spanish (preferred)
· Background check and annual TB screening required.
To apply for this role, please email your cover letter and resume to Jessica Johnson at jjohnson@alliancehh.org
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Predicting and Preventing Homelessness in Los Angeles
January 9, 2020by admin
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America’s Largest Health Insurer Is Giving Apartments to Homeless People
December 16, 2019by admin
*Article written by John Tozzi. Original article found bloomberg.com.
In 1986, Congress enacted a law to bar hospitals from turning away patients who are unable to pay. Any hospital with an emergency room that participates in federal health programs must evaluate and stabilize every patient who comes through the door, including those who are uninsured, indigent, addicted to drugs, or mentally ill.
No institution has a similar obligation to ensure that those people have a safe place to sleep. As a society, we’ve effectively decided that people shouldn’t die on the street, but it’s acceptable for them to live there. There are more than half a million homeless in the U.S., about a third of them unsheltered—that is, living on streets, under bridges, or in abandoned properties. When they need medical care or simply a bed and a meal, many go to the emergency room. That’s where America has drawn the line: We’ll pay for a hospital bed but not for a home, even when the home would be cheaper.
Jeffrey Brenner is trying to move that line. He’s a doctor who for more than 25 years has worked largely with the poor, many of them homeless. Recently, his place in the health-care system has shifted. After decades in shoestring clinics and nonprofits, he’s become an executive at UnitedHealth Group Inc., America’s largest health insurer. Brenner is expected to contribute to its bottom line. He plans to do it by giving people places to live.
The research and development lab for this experiment is a pair of apartment complexes in a down-at-the-heels corner of Phoenix called Maryvale. Here, Brenner is using UnitedHealth’s money to pay for housing and support services for roughly 60 formerly homeless recipients of Medicaid, the safety-net insurance program for low-income people. Most states outsource their Medicaid programs to private companies such as UnitedHealth, paying the insurer a per-head monthly fee—typically $500 to $1,000—to manage members’ care. The company’s 6 million Medicaid members produced $43 billion in 2018, almost 20% of total revenue.
It’s a profitable business overall. But the most expensive patients, who often present a complex blend of medical, mental health, and social challenges, cost UnitedHealth vastly more than it takes in to care for them. “Can you imagine people living on the street with these disorders? Heart failure, COPD. They’re rolling around with oxygen tanks, crazy stuff,” Brenner says. It isn’t hard to find people living in similar distress around Phoenix or any other American city. And despite their extreme costs, these patients often get poor care. “This is just sad. This is just stupid,” Brenner says. “Why do we let this go on?”
Sitting in a vacant studio apartment on the second floor of one of the complexes, Brenner shows me data on a patient named Steve, a 54-year-old with multiple sclerosis, cerebral palsy, heart disease, and diabetes. He was homeless before UnitedHealth got him into an apartment. In the 12 months prior to moving in, Steve went to the ER 81 times, spent 17 days hospitalized, and had medical costs, on average, of $12,945 per month. In the nine months since he got a roof over his head and health coaching from Brenner’s team, Steve’s average monthly medical expenses have dropped more than 80%, to $2,073.
After testing the idea in Phoenix, Milwaukee, and Las Vegas, UnitedHealth is expanding Brenner’s housing program, called MyConnections, to 30 markets by early 2020. It’s a business imperative. In January, after the company announced a $12 billion profit for 2018, Wall Street analysts pressed Chief Executive Officer Dave Wichmann on the performance of its Medicaid business. The return, he acknowledged, was “not at our target margin range of 3% to 5%.” Wichmann said it would hit the target next year.
Patients like Steve wind up in the ER because they don’t fit into the ways we deliver health care. The U.S. system is engineered to route billions of dollars to hospitals, clinics, pharmacies, and labs to diagnose and treat patients once they’re sick. It’s not set up to keep vulnerable people housed, clothed, and nourished so they’ll be less likely to get sick in the first place.
The U.S. spends 18% of its gross domestic product on health care, vs. 8.6% in the other 35 countries in the Organization for Economic Cooperation and Development. America’s outsize spending on health care contrasts with much paltrier investments in social support—housing, food, education, cash assistance, and care for children and the elderly. Other nations in the OECD spend $2 on social services for every $1 they spend on health care, according to The American Health Care Paradox, a 2013 book by Elizabeth Bradley and Lauren Taylor. In the U.S., each dollar of health spending is matched by only 60¢ of social support.
That a for-profit conglomerate like UnitedHealth is in the business of taking taxpayer money to care for poor people reflects the peculiarity of U.S. social policy. Medicaid was created in 1965 in tandem with Medicare—public insurance for older Americans. Congress has since expanded eligibility for Medicaid, most recently through the Affordable Care Act, and the program now insures 72 million people, more than 1 in 5 Americans. It pays for 42% of all births.
States split the cost of Medicaid with the federal government, but it takes up an ever-larger portion of their budgets—after education, it’s usually a state’s biggest expense. To keep down costs and avoid the difficulty of running a health-care system, most states contract with UnitedHealth and its competitors to establish what are called Medicaid managed-care programs. In 2017, $264 billion, almost 50¢ of every Medicaid dollar, went toward care for the 54 million people on private Medicaid plans.
Few entities outside the government exert as much influence over health care as UnitedHealth, based in Minnetonka, Minn. The company’s health-insurance unit, UnitedHealthcare, provides benefits to 43 million Americans. About 50,000 physicians work for its health-services unit, Optum Inc. UnitedHealth also owns pharmacies and a bank and Brazilian hospitals. Its revenue last year, $226 billion, surpassed that of all but five U.S. companies; it’s told shareholders to expect long-term earnings growth of 13% to 16% annually.
Brenner, a smiley and cerebral 50-year-old, is an unlikely insurance company man. He studied neuroscience at Robert Wood Johnson Medical School in New Brunswick, N.J., and anticipated a career in research. After a stint at a free student-run clinic that served homeless people and undocumented Central American refugees, he switched to the less prestigious field of family medicine. He did his residency in Seattle and then moved in 1998 to Camden, N.J., at the time the poorest city in the U.S. Brenner started at a small practice with three exam rooms and eventually split off to practice solo. Almost all his patients were on Medicaid. He’d get up in the middle of the night to deliver babies.
Brenner also treated victims of violent crime, which led to an interest in developing an accurate picture of Camden’s crime. It wasn’t going to come from the city government, he learned, because so many victims didn’t file police reports. He went to the hospitals instead.
The data he saw there illuminated a gross imbalance in health-care spending: A tiny sliver of patients accounted for a large part of spending. In Camden, 1% of patients made up 30% of the cost. Brenner spotted patients who went to the ER hundreds of times a year, including a handful of individuals who cost the system millions of dollars each. “Like, for 1% of the spending here, we could open up 10 primary-care offices all over the city,” Brenner says.
He had to shutter his solo practice when he was unable to sustain it on Medicaid’s payment rates. (Medicaid pays doctors and hospitals about 30% less than Medicare does; Medicare in turn pays significantly less than private insurers.) Meanwhile, hospitals were expanding. “The system had become so distorted that it felt like a microcosm of what was going on in America, which is if you don’t take good care of people, they’ll get sick,” Brenner says. “Then you’ll need more hospital beds and hospitals to take care of them.”
In 2002 he founded the nonprofit Camden Coalition of Healthcare Providers. The group used hospital claims data to identify outlier patients and hot spots of medical spending, then tried to help people before they landed in the most costly settings, ERs and hospital beds. That work brought Brenner national prominence, including a New Yorker profile by Atul Gawande, the surgeon and MacArthur “genius” grant recipient, in 2011. Two years later, Brenner received a MacArthur fellowship himself.
UnitedHealth supported the nonprofit and eventually approached Brenner about a job helping the company with its own strategy to address patients’ social needs. “I said no, and said no a couple of times,” he says. But in 2017, convinced that UnitedHealth’s commitment was serious, he joined to test his ideas on a vastly larger stage. The company has 80 times as many Medicaid members as Camden has people.
Brenner, whose title is senior vice president for clinical redesign, manages a staff of 65. The team was a bit larger before a recent broad round of company layoffs; UnitedHealth says the reduction won’t affect the housing program. By early next year the company expects to house 350 homeless Medicaid patients whose annual health-care spending, while they’re on the streets, exceeds $17 million. The goal is for them to “graduate” within a year to paying their own rent. (Most get a disability check; those who don’t get help from MyConnections to apply.)
Insurers, including UnitedHealth, generally try to reduce costs by restricting medical care. They require prior authorization for expensive procedures, deny claims for care deemed inappropriate, and limit the drugs available on prescription plans. This is partly why the industry has a bad reputation—the perception that insurers are middlemen that profit by withholding needed care without adding value. It’s behind the argument Senators Bernie Sanders and Elizabeth Warren make for replacing private insurance with “Medicare for All.”
Brenner aims to reduce expenses not by denying care, but by spending more on social interventions, starting with housing. How to do it is still largely uncharted. “I don’t think we’ve figured any of this out,” he says. “We’re at a hopeful moment of recognizing how deep the problem is.” A trip to any big-city ER reveals the magnitude of the challenge.
Kara Geren is trained to detect what’s about to kill you. The 40-year-old attending physician pulls eight-hour shifts in the emergency department at Valleywise Health Medical Center, a 325-bed public hospital north of the Phoenix airport. The unit has a low dropped ceiling, Formica countertops, and a motley collection of curtains that separate beds packed close together. Geren has the kind of calm yet focused demeanor you’d hope to encounter if you found yourself wheeled into the ER. She isn’t rushing, nor is she wasting any time.
“In emergency medicine you always assume the worst,” Geren says. “What’s going to kill this person in the next five minutes? What’s going to kill this person in the next hour?” Valleywise has two trauma bays and a landing pad for medevac helicopter ambulances. As a Level 1 trauma center, it has to be prepared for any unexpected medical crisis that might arrive at any hour of any day.
That vigilance makes it one of the most expensive places to get health care, and many patients who visit the Valleywise ER shouldn’t be there. Some are immigrants who don’t know how to navigate the U.S. system, so they walk into the hospital for routine treatment. Some are uninsured, so other doctors won’t see them. Some come to get out of the summer heat; temperatures in Phoenix can top 100F for weeks on end. The city’s growing homelessness crisis exacerbates the burden. The number of unsheltered homeless people in Maricopa County, which includes Phoenix and its suburbs, has almost doubled since 2016, to about 3,200.
Some patients are combative, especially if they come in drunk or high. Others are simply seeking shelter and a meal, and complaining of chest pain at an ER is a sure way to get both. Frequent flyers, as nurses and doctors call them, may visit a few times a week or daily. “Sometimes in the same shift, you’ll have a patient come back who you discharged a few hours earlier,” says Heather Jordan, Valleywise’s nursing director for emergency services. “They get a medical screening exam and maybe get a sandwich and a Powerade, and they go back out to where they started.”
Homeless patients have few good options when they’re ready for discharge. Sometimes the hospital pays to send them in taxis to city shelters, which are often full when they arrive. Some go to behavioral health centers for further treatment of mental illness or substance-use disorders. Others go to a respite center run by a nonprofit called Circle the City, where they get medical care along with a bed in a shared dormitory. There are never enough beds to meet demand.
Some people who no longer require hospital care stay at Valleywise simply because more appropriate quarters aren’t available. “There’s a couple of patients who live upstairs that have been here for months and months and months, because we can’t find a place, a safe place, to put them,” Jordan says.
The cost for their care—$3,825 a day—is paid by Medicaid or, for those with no insurance, absorbed by the public hospital and ultimately the taxpayers who fund it. “We could put them in a residence for a fraction of that, and then we can keep ourselves available for that burn patient, that ICU patient, the people, the patients that need us critically,” says Kris Gaw, chief operating officer for Valleywise Health.
Valleywise has been able to place a small handful of homeless patients with MyConnections in Maryvale. The developments were known for drugs and prostitution before UnitedHealth and its nonprofit partner, Chicanos Por La Causa, took them over a couple of years ago. The insurer gave the nonprofit a $21 million low-interest loan to purchase, rehab, and manage the 500 units. Fixing it up was a challenge. One property manager says she got death threats for evicting drug dealers. Eventually, the frequency of police calls dropped sharply, and kids started playing in the courtyards and using the pools.
Most of the apartments rent to the public at market rates, starting at $609 a month for a studio. But up to 100 units are set aside for formerly homeless UnitedHealth Medicaid members. One empty studio with new wood floors at the end of a row on the second story is an office for five “health coaches.” They serve as case managers, counselors, and companions who look after the patients in the program.
One of the coaches, Ray Torres, 50, used to work as a case manager at a county-run clinic for the homeless. Some of his current clients are people he knew from his old job. He’d refer them to services, but they’d frequently just disappear back onto the streets. “Here, we’re on-site, we connect them, we knock on doors,” he says. Torres keeps the medical appointments for his 18 clients in his calendar. He calls taxis for them and occasionally goes with them to the doctor. Sometimes a knock on the door is critical. The week before we spoke, one client had forgotten about an appointment for kidney dialysis. The man had no phone, and Torres’s check-in likely prevented him from going into kidney failure in his apartment.
Torres and his colleagues bring a reservoir of patience deeper than what the homeless typically encounter. Much of the U.S. social safety net conditions assistance on certain behaviors, in an effort to inspire or force people to change. In homeless shelters, people are often required to earn privileges such as a locker or a larger space, eventually to be rewarded with placement in a group home or further housing assistance. Many programs are predicated on first kicking drug habits or adhering to medication. If people act out, they may end up back on the streets. “It’s a little like playing Sorry,” Brenner says. “You go back to the beginning and start over again.”
Brenner, by contrast, advocates a model known as Housing First, which recognizes that getting off the streets is often a necessary first step for people to adhere to treatment for addiction or mental illness—not the other way around. Many of the patients he’s concerned with have experienced early trauma, which has lasting health consequences. Exposure to adverse childhood experiences is a strong predictor of problems such as chronic illness, obesity, smoking, substance abuse, and, not incidentally, health-care spending.
“There’s a whole thread in health care around personal responsibility that this work evokes in people. As though scolding them, they’re going to go, ‘Oh, you’re absolutely right,’ ” Brenner says. “All of these things that we talk about, you know, people not taking personal responsibility—things happen to people. And what we’ve learned is that if you’re very young and you’re exposed to toxic stress, that brain formation is very different. The way that you navigate the world is different. Literally some of your circuits are different.”
One of Brenner’s greatest challenges is deciding who should benefit from the program. Giving patients housing sounds beguilingly simple, but the economics are a high-wire act. Medicaid isn’t paying UnitedHealth anything directly for housing assistance. The company spends from $1,200 to $1,800 a month to house and support each member, so it must save at least that much to break even on Brenner’s program.
On average about 60 members are enrolled in the Phoenix sites at any given time. Once a week, Brenner and his team get on the phone to evaluate potential candidates—anywhere from 2 to 14 people whose names have surfaced in UnitedHealth’s data. They want patients who are homeless and whose medical spending exceeds $50,000 annually, with most of that coming from ER visits and inpatient stays. People living on the streets with less extreme medical costs may need a home just as much, but it doesn’t pay for UnitedHealth to give them one.
For patients above the $50,000 threshold, the reductions in medical costs should let the company at least break even on its investment in housing and services. But it’s not as simple as running the numbers. Brenner is looking for people who not only need help but are ready to accept it. “We want a storyline around, Why is the housing going to make a difference? What’s going on in there? And then what’s the exit strategy?”
It’s a difficult judgment, made more complicated by a statistical concept called reversion to the mean. Simply put, an outlier will tend to go back to the average over time. Some of the most expensive homeless patients spontaneously become less expensive. Maybe they move in with family or get help from another program; maybe they stop visiting hospitals after being mistreated. Brenner says that his team doesn’t fully understand the phenomenon and that the rate at which spending on high-cost patients declines is different in each city. Either way, the housing units he’s allocating are scarce resources, and he doesn’t want to give them to people who would have reduced spending on their own.
He also wants to make sure the program actually does help people reduce their hospital use, and it doesn’t work on everyone. Some people resist it and continue going to ERs even after UnitedHealth puts them in housing. Brenner shows me an analysis of the first 41 patients in Phoenix to get the intervention. The housing and support services proved cost-effective for the 25 most expensive patients, reducing their overall costs dramatically. For the other 16, total spending increased. “The return’s only going to work out if we target the right people,” Brenner says. That’s why UnitedHealth is starting with just 10 subsidized apartments in each new city where it’s introducing the program, even in places where there might be hundreds of homeless Medicaid members on its rolls.
Brenner’s bet is that he can break the cycle for people like Cathy, a 56-year-old who was homeless for several years. She remembers “moving around like a giant turtle,” with her belongings stuffed into bags latched to her electric wheelchair, which she’d plug in to charge overnight at the Sun Devil Auto repair shop in downtown Phoenix. For months, she visited ERs almost daily. One night she left St. Joseph’s Hospital after eight hours and went directly to another emergency department a few miles away. “I was going to keep going every day if I had to, because I was having pain in my chest, and they couldn’t tell me why,” says Cathy, who asked that her last name be withheld.
Her long list of ailments includes diabetes and asthma. A heart attack left her with a stent, and a series of infections almost claimed her foot. That’s on top of depression, post-traumatic stress disorder, and what she describes as “extreme anger issues.” Two years ago, Cathy moved into a subsidized apartment in Phoenix. Torres has witnessed her transformation. “She had that wall put in front of her,” he says. “She had no trust with anybody.” Now the two share wry jokes. “Ray kind of kept trying to be positive, be all sweet and nice, like he is,” Cathy says.
Housing hasn’t solved all her problems. She still has depression, and another heart attack left her hospitalized again earlier this year. But it’s made a profound difference. For one thing, she no longer makes a stop at the ER part of her regular routine. That’s good news for UnitedHealth. And then there’s this: “I feel human again,” she says. “Before, I didn’t.”
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World AIDS Day 2019
December 4, 2019by admin
Candlelight March
On Monday, December 2nd, Alliance for Housing and Healing organized the West Hollywood AIDS Memorial Walk to bring awareness to World AIDS Day, which was observed Sunday, December 1st with the laying of the roses on the memorial plaques along Santa Monica Blvd.
The march began at the Northwest corner of Santa Monica Blvd. and Crescent Heights and continued to West Hollywood Park where the Paul Starke Warrior Awards were given out to individuals providing HIV/AIDS and/or substance-abuse services or volunteer hours to support these services.
This year we honored Luis Camacho for his efforts in bringing a voice to HIV/AIDS in our community and for being a long-time volunteer of Alliance and The Best in Drag Show. Luis has helped raise hundreds of thousands of dollars to get homeless men, women, and children with HIV/AIDS into care and housing.
The Program Manager has a lead role in the oversight of client data collection, managing data input and ensuring reporting requirements are met according to contractual obligations. S/he assists with training of staff, coordinates resident meetings, and may provide supportive services to individualsliving in scattered-site permanent supportive housing programs located throughout LA County. S/he will assist staff with clinical interventions and working with high acuity clients. S/he will assist Director in contract monitoring and compliance.
Responsibilities:
Provide guidance and direction to Supportive Service Coordinators in collaboration with the Director.
Ensure compliance with contract expectations and manage contract reporting schedule; participate in internal and external program monitoring and audits.
Facilitation of quarterly resident meetings.
Develop, facilitate, and coordinate staff trainings to support the professional development of staff and the use of best prcatices in service provision.
Participate in development of program policies, program implementation, and evaluation.
Manage caseload as assigned by the Director, conduct home visits and provide supportive services to ensure housing retention and improvement of health and well-being.
Conduct intake and assessment of clients’ needs and goals.
Collaborate with external service providers as needed to enhance service coordination and advocate on clients’ behalf.
Qualifications:
Minimum of 3 years’ experience as a service coordinator or in a case manager role.
Master’s degree in Social Work preferred; Bachelor’s degree in Social Work/related field required.
Knowledge of community resources in Los Angeles County.
Strong knowledge of the complexity of HIV/Aids-related issues, chronic homelessness, and co-morbidities, including mental illness, trauma, substance abuse, aging, and chronic health issues.
HMIS or other database management experience.
Excellent active listening and crisis intervention skills with ability to model good judgement.
Excellent interpersonal, written and oral communication skills.
Ability to manage multiple tasks and priorities, work independently as well as a member of a team.
Proficiency in Microsoft OfficeSuite (Word, Excel, Outlook) and Internet.
Valid California driver’s license, must have access to a car with CA insurance and a good driving record.
Bilingual English/Spanish
Background check and annual TB screening required.
To apply, please send your resume and cover letter to Jessica Johnson at jjohnson@alliancehh.org.
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Housing Case Management Supervisor – West Hollywood
April 24, 2019by admin
Job description:
In coordination with the Metro West Regional Director of Housing Services, the Program Supervisor is responsible for staff supervision and program management in accordance with the organization’s policies and procedures.
Responsibilities:
Ensure program compliance with contract obligations.
Provide support and coordination to intake screening process for clients seeking housing services and assign clients to Housing Specialist/Case Manager.
Review Housing Specialist financial assistance applciations for accuracy and compliance.
Assists with coordinating administrative tasks and human resources activities.
Establish positive working relationships with local government offices and community-based organizations. Attend community meetings.
Make recommendations on Alliance programs and administrative policies to the Regional Office Director.
Prepare internal/external reports on client services activities to private and government funders.
Monitor program files, including audits, reviews, and quality assurance.
Required qualifications:
Bachelor’s degree in a social science discipline.
Two years’ minimum experience in a case management or similiar role.
Excellent verbal and written communication skills.
Great people skills and ability to work with a diverse population.
Well-organized and detail oriented with the ability to handle multiple tasks while meeting deadlines.
Ability to work both independently and as part of a team.
Working knowledge of Microsoft Office.
Must have access to a car; valid CA driver’s license and proof of auto insurance.
TB screening required annually.
Preferred qualifications:
Bilingual (Spanish/English).
Master’s Degree.
Supervisory experience.
Experience working with homeless and diverse populations.
Working knowledge of HIV/AIDS.
To apply, please send your resume and cover letter to Maria Aceves at maceves@alliancehh.org.