Friday, July 17, 2009
Homelessness and alcoholism often go together. And that's a big problem for California hospitals. Homeless alcoholics tend to be frequent users of emergency rooms, at considerable expense. San Diego is one city that's trying to do something about it.
SAN DIEGO Homelessness and alcoholism often go together. And that's a big problem for California hospitals. Homeless alcoholics tend to be frequent users of emergency rooms, at considerable expense. San Diego is one city that's trying to do something about it.
It's another busy afternoon in the emergency room at UCSD Medical Center.
Linda Beach is the ER case manager. She says a small group of patients get the majority of the care here. Most of them are homeless alcoholics.
"And on any given day," Beach says, "our 22 beds may be occupied by four or five, so you know, roughly a quarter of our capacity is tied up with a chronically intoxicated person."
Beach says she's getting all too familiar with some of these people.
"I've had a guy who's been here three dozen times since the middle of January," Beach sighs. "He's unfunded, so the hospital gets no reimbursement for that care. Always brought in by medics. So it's a high cost to health care, because it's always an ER which is expensive, and medics, which is an ambulance transport."
A UCSD study of homeless alcoholics found 15 of them each racked up an average of $100,000 in hospital charges.
And they take up a lot of police and paramedics' time.
The San Diego Police Department is trying a new approach.
"Do you want to go to a rehab program?...What is a rehab program?"
On a street in downtown San Diego, Police officer Timothy Burns tries to interest a man in getting sober.
Burns is with the department's Homeless Outreach Team, HOT. Each HOT team has a police officer, a clinician, and a county benefits worker. They drive up and down the streets in an old black and white van.
Their mission: to contact chronic alcoholics on the street, and urge them to go into treatment.
Sergeant Rick Schnell oversees the program. He says 50 percent of police calls in the downtown area are homeless related. And he says HOT teams get a lot of calls directly from hospitals.
"The hospitals will say hey we've got a guy coming and going out of the emergency room every day, sometimes twice a day, but he's not listening to what we have to say," says Burns. "Can you guys find them on the street and try to intervene with them on the street? So if we can intervene with a person on the street and keep them from going to the hospital, that's a huge amount of savings to the hospital and the community, plus it's better for the client."
One of the HOT teams has convinced a man named Joe to try treatment.
"I'm drunk 24/7. I'm drunk right now," mumbles Joe. "It's really a hard life, man. I've been thinking of killing myself many times, I'd thought I'd try this one more time before I kill myself."
The HOT teams interface with people before they get arrested.
San Diego Police also run something called the Serial Inebriate Program (SIP). . SIP helps chronic abusers who have run afoul of the law.
Clients have to have multiple arrests for being drunk in public. They must have been taken by police to a detox center five times within 30 days.
Police give them a choice: jail or treatment.
Of course, getting someone into treatment is one thing. Getting them to complete it and stay sober is another.
Gary Garren used to live on the San Diego streets. Paramedics were called 36 times on his behalf in one three-month period.
Garrren says he had his doubts about the SIP program.
"Even the day that they came and picked me up from jail," recalls Garren. "I was ready to leave St. Vincent's when they took us there for the checkup and all. And I could have run out of there and I thought about it. I wanted a cigarette and I wanted a drink real bad."
But he's been clean and sober for two years.
"I've been in Orange County, LA County, Riverside, San Bernardino and San Diego County, as a drunk, and to me, this is ideal," Garren says. "It's working for me, and I've seen it work for others."
And it looks like it's working for hospitals, too. An evaluation of the SIP program found for people who entered treatment, their average use of medical services decreased by at least 50 percent.