Sonoma County is doubling the number of shelter beds available for homeless people who are discharged from hospitals but remain too sick or frail to recover from an illness on the streets.
Project Nightingale, based at Brookwood Health Center in Santa Rosa, recently received a $1.35 million boost to expand the number of beds available for homeless patients who don’t qualify for long-term hospital care or around-the-clock nursing assistance.
Under the program, which will grow from 13 to 26 beds, people are provided three meals a day and bed rest in a safe environment while receiving medical care and other supportive services, such as access to mental health treatment and housing assistance.
The Sonoma County Board of Supervisors this month signed off on a two-year contract with Catholic Charities, which oversees the program, to fund its expansion. It marks the latest move by county officials in a broader effort to invest in safety-net services aimed at reducing homelessness.
“Most of us have never really thought about what it’s like to be discharged from a hospital and be homeless and incredibly sick; then suddenly you’re out on the street again,” said Supervisor Shirlee Zane, who helped push to expand the scope of the program. “If we don’t provide this access to respite care and comprehensive case management for our most vulnerable citizens, we’re going to end up paying a lot more money in the end.”
Catholic Charities received funds from the county and a trio of private local hospitals — Kaiser Permanente, St. Joseph Health Sonoma County and Sutter Santa Rosa Regional Medical Center. The county’s share, approved by supervisors last week, is $60,000 for the first year, with the hospitals chipping in $615,000. A similar funding mix is expected during the second year.
Health officials believe the upfront costs to expand shelter beds will pay off in the long run by saving taxpayer money and reducing long-term costs associated with delivering care. When homeless people are hospitalized and have nowhere to go, they often stay in the hospital for longer periods of time, officials said.
After being discharged back to the streets, homeless people have higher rates of readmission, increased use of the emergency room — widely recognized as the most expensive form of care — and their illnesses grow more acute, officials said.
“This is really important because it helps ensure hospital resources are dedicated to patients who truly have acute needs,” said Todd Salnas, president of St. Joseph, which includes Santa Rosa Memorial Hospital, Queen of the Valley Medical Center and Petaluma Valley Hospital. “And it helps patients get the resources they need outside of the hospital so they can get better, without bouncing back and forth to the emergency room.”
Brian Barnard, who has lived on the streets in Sonoma County for years, has participated in Project Nightingale for the past six months. He entered the program after being admitted to Petaluma Valley Hospital following a series of seizures.
Barnard, 54, requires a walker to get around because he has suffered from two strokes in the past year. Prior to Project Nightingale, he slept where he could — some nights in a truck, others in a motel room he rented with his disability assistance money.
He credits the free shelter bed with significantly improving his health and giving him a future that might include walking unassisted again.
“I don’t know where I’d be without this place,” Barnard said. “This gives me everything I need.”
At Project Nightingale, he gets three meals a day, medications, a primary care doctor, access to specialty care and a place to do laundry.
“Right now, I’m all about trying to get better and back on my feet again,” he said. “I’m feeling good … because of my medications and physical therapy.”
Catholic Charities, which started the program in 2011, has been working with the participating hospitals to track the illnesses of homeless people who use the shelter beds, and their medical costs associated with long-term hospitalizations.
From December 2011 to December 2014, it would have cost hospitals $15.4 million to keep people in hospital beds instead of at the 13-bed shelter, according to Jennielynn Holmes, director of shelter and housing for Catholic Charities.
Shelter costs came to $840,000 over the same time period, for a total savings of more than $14.5 million.
“That’s a pretty incredible return on investment,” Holmes said. “That’s why we’ve been able to get the support to increase funding and beds, and now we’re able to serve people with a higher level of acuity.”
Under the expansion, Catholic Charities also is boosting the services it provides to homeless people. The nonprofit group will be able to serve people with more serious illnesses who previously would have been turned away.
Health professionals will be available for the clients 24 hours a day, and case workers will have a larger budget for helping people into transitional housing.
Half of the beds will remain at Brookwood Health Center and the others will be located at Sam Jones Hall, a homeless shelter in Santa Rosa. As patients recover, they will transition from the health center to a bed at Sam Jones, Holmes said.
“So many of the people we see need a higher level of care, and they can’t get better if they’re left to heal out on the streets,” Holmes said. “So we’re able to help people who have gotten amputations from being out in the cold or from diabetes, and we can give people with other chronic conditions or terminal illnesses a safe place to sleep for as long as they need it.”
Chronically homeless people have higher rates of mental illness and addictive disorders than other segments of Sonoma County’s population, Holmes said. They also report more crippling health issues, which can send them to the hospital more often.
County health officials are working with Catholic Charities and the three private hospitals to gather data on the costs and effectiveness of the program over the next two years. Officials plan to share the data with poverty and health care researchers at the University of Notre Dame.
Catholic Charities was selected to participate in the university’s research study that tracks costs and benefits of long-term care for the homeless.
“We’re hoping this can be developed into a model that can be replicated throughout the country,” Holmes said.