The announcement in the news recently about the City of Los Angeles suing Kaiser Permanente was huge and certainly makes a gallant statement. Not having viewed the entire body of evidence, it seems to be the right thing to do.
Dropping people off in Skid Row has been going on for long time. The key is the direct connection. We (social service providers) have no qualm with serving people brought to us; that is why we are here. But as matter of process and for the sake of the patient/client's well-being, we need to know who they are.
Recently, a local association of social service providers, the Los Angeles Central Providers Collaborative has been working closely with local hospitals through the Hospital Association of Southern California to develop a community-based solution to the issue of "dumping" patients. Comprised of the larger direct-service providers in Skid Row and the surrounding communities, the Providers Collaborative includes the agencies most commonly cited in news reports on the subject. The Hospital Association represents over 95 percent of the hospitals in the Southern California area.
Together, we have put into place correct actions that will address the problem. The pilot program is scheduled to start within the next month or so.
We found that hospital social workers didn't always connect with intake personnel at the service providers, and program capacities often changed. This can lead to communication breakdowns and a faulty service delivery.
The fix for this is elegant and clean. The two associations have created a universal intake form that will ensure the correct match is made. A phone call from the hospital to the service provider confirms the availability of service, the form is completed and signed by the discharge planner and faxed to the provider. They will in turn review and sign the document agreeing to accept the client and fax it back to the hospital. This all happens before the patient is released.
The next correction in the process involves transportation. The now infamous Carol Reyes video (over which the City Attorney's Office filed suit against a Kaiser Permanente hospital) shows a taxicab stopping in front of the Union Rescue Mission making a U-turn and disappearing, leaving Reyes to wander about until a mission staff member makes contact with her. Should the driver have made sure that the passenger made it inside the facility? I don't know. And let's face it: These folks are in the business of transporting people from one location to another, and close is often good enough for able-bodied persons who know where they going.
Members of the Providers Collaborative have agreed to take over that aspect of the process. Providers are familiar with the population served and the provider network in place to deliver the services. The venerable Volunteers of America has agreed to head up that portion of the solution. The discharge planner now would call on that organization to pick up and transport the patient to the receiving agency. Ambulance service would still be used when medically necessary.
At about 6 p.m., the night before the press conference announcing the city's decision to sue Kaiser, I was called down to our front desk area by our security personnel, because someone had been "dumped" in front of our location. After meeting with the patient, reviewing her physical condition and discharge papers it became clear that she was in the wrong place. The intake office of the provider, to which she was transported to, was closed. We made the patient comfortable for the night and transported her across the street to proper program the next morning. Case closed, right? Well no.
Further investigation showed that while the patient was medically ready for discharge, the aftercare plan suggested a recuperative care bed.
Recuperative care shelters provide medical care follow-up for sick and recovering homeless people. There was not a bed available that night. I am told that in this case the patient had a voucher for another housing program and requested to be released immediately, in lieu of waiting for a recuperative care bed to open. Hence her journey began.
There are not enough of the specialized recuperative care beds. The Hospital Association, the Providers Collaborative and other organizations are working to change that. This is a correct action.
The homeless service continuum of care deserves our focus and resources. The recent announcement by the mayor that additional money will be directed toward homeless services, particularly emergency services demonstrates the correct response to this and other capacity problems.
Lawmakers and law enforcement must continue to do the right thing, but community-based actions are the way to correct our social problems.
Orlando Ward is director of public affairs for the Midnight Mission, which provides services to the homeless in Skid Row.
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