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When "Discharge to Home" is Not an Option

Over the years, St. Jude has worked to find solutions to help homeless individuals who are discharged from the hospital, but need additional follow-up care. Those who have just had surgery or suffer from chronic conditions that require ongoing treatment often end up back in the emergency department (ED) or readmitted due to unsafe and unstable living conditions. In fact, the homeless population is nearly six times more likely to visit the ED than their housed counterparts and twice as likely to be readmitted to the hospital. This disparity in utilization and complication rates impacts their health and well-being, while reducing available hospital resources to care for the broader community.

Our social workers and dedicated community care navigators provide resources and support to homeless individuals discharged from St. Jude and they continue to significantly impact these patients' lives. But as the homeless population grows, it has become clear we need to find additional solutions. The 2019 Point in Time Count recorded a staggering 6,860 homeless individuals in Orange County and experts believe this number is low. Additionally, 207 homeless individuals including men, women and children died on Orange County streets.

After careful consideration, we have decided to support the Illumination Foundation (IF) efforts to open a women's medical recuperative care facility onsite at St. Jude. Medical recuperative care has shown it can improve outcomes and reduce unnecessary ED visits and hospitalizations; however, there is a significant shortage of such programs—especially those dedicated to women who are frail, have complex needs or who may be facing end-of-life.

This decision was not made lightly. After much discussion and a formal discernment process that included board members, Sisters and physicians, we agreed that we have a moral, ethical and legal responsibility to help create a solution that allows homeless women to fully recover. The Sisters were enthusiastic about the decision and it seems very appropriate to use the former convent to meet the needs of one of Orange County's most disadvantaged populations.

We are one of the first hospitals in the nation to help create a women's medical recuperative care facility onsite and while this is new to us, in many ways, it is simply a continuation of St. Jude's unique 62-year ministry of caring for those who need our help.

The IF is the country's largest recuperative care program with nearly 200 beds in facilities across Orange, Los Angeles and San Bernardino Counties. They have a proven track record of success in not only reducing readmission rates by 50 percent, but in helping break the cycle of homelessness through "wrap-around" services such as behavioral health counseling, case management and housing navigation.

This new 20-bed program, will open Q1 2020, and will be staffed and managed by IF. They will provide 24/7 support and services to homeless women who meet specific medical criteria, such as, recovering from surgery or injury or undergoing treatment for cancer or other chronic conditions. Clients will stay until their condition is stable. No walk-in clients will be accepted and priority will be given to homeless women discharged from or undergoing treatment at St. Jude. To help ease practical concerns, the facility will be fenced with a private exterior entrance. It will be completely self-contained and separate from medical center operations, with no interior access to the hospital.

This new use of the facility means that physicians and caregivers will no longer be able to enter the hospital through the former convent (the building closest to the Bastanchury Parking Structure). Instead, those who typically enter through the convent will need to enter through the Erickson Education Center, Valencia Mesa Lobby, Break Away Lounge or Northwest Tower.

To prepare the facility for IF to renovate, we will begin moving staff from the former convent. There is no doubt, that for some, this will be an inconvenience, but we believe the inconvenience will seem small when we see the reality of how lives are changed and dignity restored.

Our remarkable heritage and inspiring ministry continues today, calling us to serve the "Dear Neighbor" whether within the walls of the hospital or beyond our doors. We can take pride in knowing that our Mission, Vision, Values and Promise are not just pictures on the wall, but principles we live and practice every day.

If you have questions, suggestions or concerns about this direction, I would very much like to hear from you.

Sincerely,

Brian Helleland, CE

St. Jude Medical Center


Frequently Asked Questions Regarding Recuperative Care Program

What is medical recuperative care?

It is post-acute medical care for homeless individuals who are too ill or frail to recover from a physical illness or injury on the street or in a shelter, but are not ill enough to stay in a hospital. By providing medical coordination and education, case management, and other support services, medical recuperative care is an important alternative when discharge home is not possible. The short-term care—up to 90 days—is designed to provide a bridge to a more successful recovery.

Will St. Jude be involved in the day-to-day operations of the new facility?

No. The facility will be managed and staffed by the Illumination Foundation (IF) of Orange County and will be completely separate from hospital operations. We are simply providing a setting for the non-profit IF to continue its important work.

The IF has been very successful in helping acutely ill homeless patients recover their health while also connecting them to resources for housing, job training and counseling. Their ultimate goal is get the women back on their feet and off the street.

What patients will the medical recuperative care facility accept?

The 20-bed program will offer 24/7 care and monitoring for women with chronic or acute medical needs until they are stable. Conditions will range from active cancer treatment to recovery from surgery or injury. The facility will also provide for women facing end-of-life. This facility will not treat individuals for acute psychiatric diagnosis or addiction.

Why are we doing this?

We are a non-profit, faith-based organization, our heritage and Mission calls us to serve the entire community, not just those who come to our hospital. It is imperative to think beyond traditional healthcare to ensure the health, well-being and safety of the community we serve. Creating solutions for the issues facing our community is literally in St. Jude's DNA. It's why the Sisters built the hospital and an essential part of our ministry. The women who will be staying in the medical recuperative care program are seriously ill and without resources. We have a moral, ethical and legal responsibility to help them receive the care they need.

The homeless population visits the ED six times more often than their housed peers, are twice as likely to be readmitted to the hospital, and once admitted, have significantly longer average lengths of stay. By providing monitoring and support, the IF reduces the "revolving-door" use of local emergency departments and the resulting strain on available resources. In fact, recuperative care has been shown to reduce ER visits and

readmissions by 50 percent, while also promoting a more successful recovery, fewer complications and a higher quality of life.

Will this encourage the homeless to come to St. Jude?

Walk-in patients will not be accepted at the medical recuperative care center, only patients referred by St. Jude or another hospital and screened by the IF. The recuperative care facility will not be visible from the street, nor will it have any exterior signage. It will have its own private entrance and the IF will work closely with hospital security to ensure the safety of caregivers and the hospital grounds.

Won't this be an inconvenience for physicians and caregivers who use the former convent entrance to access the hospital?

For some it will require using a different entrance. Those who typically enter through the convent (the building closest to the Bastanchury Parking Structure) will now need to go through the Erickson Education Center, Valencia Mesa Lobby, Break Away Lounge or Northwest Tower.

Some of our patients might have questions. What should we do if asked?

If a patient or family member has questions please help him or her understand that we are a non-profit, faith-based organization and our heritage and mission calls us to serve the entire community. The women who will be staying in this small 20-bed medical recuperative care program, staffed and managed by the IF, are seriously ill and without resources. We have a moral, ethical and legal responsibility to help them receive the care they need.

There is a significant shortage of medical recuperative care programs dedicated to women who are frail, have complex health needs or who are facing end-of-life, and that need is growing. By giving these women a place to recover their health and dignity, we are ultimately reducing the number of homeless in our ED, in our hospital and in our community. The facility will have no hospital access and will be a completely separate entity. Clients and visitors will be screened. The IF will work with our security team to ensure a safe and secure environment.

When will it open?

The goal is to open sometime in the first quarter of 2020. We will keep you updated about the progress.

Will parking be impacted?

The IF has requested only six to eight parking spaces for staff, typically their clients do not have cars. Individuals visiting medical recuperative care will park in our parking lots and pay like any other visitor.

Will the recuperative care clients be allowed to walk in and around the hospital?

Only for scheduled treatment or medical appointment, such as lab or imaging. All recuperative care clients will be escorted to appointments by an IF staff member. Clients will not be permitted to enter St. Jude Medical Center unescorted.

What is their visitation policy?

The IF is the nation's largest recuperative care provider and has successfully run these types of facilities since 2009. Illumination Foundation operates six recuperative care facilities with approximately 200 beds across Orange, Los Angeles and San Bernardino counties. Illumination Foundation has a strict visitation policy to secure the safety of their clients and staff. Visitation is restricted between 10 a.m. and 5 p.m., seven days a week. Visitors must sign in and go through a security check, which includes a metal detector and storing any bags, purses, etc. in lockers. The recuperative care center will be staffed 24/7 by IF staff.

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