Help homeless stay out of ERs

In the multi-pronged hunt for homelessness solutions, the newly proposed “H4” project sounds right on target. The idea — to create a hub in Iwilei for homeless people also dealing with chronic ailments — is a welcome private-public effort to provide medical services, respite and a path toward housing. As aptly put by a city spokesman: “It would certainly be a game changer on how we deal with the high cost of homeless health care.”

H4 — for hygiene, health, housing and humanitarian — is a needed initiative in a time of both rising homelessness and health-care costs. It targets chronic homeless overusers of Hawaii’s hospitals — the costly emergency rooms — to try to divert them to more appropriate, less-expensive treatment.

At the core of the homeless health care center is a group of private-sector leaders, including The Queen’s Medical Center and Hawaii Medical Service Association, who plan to raise $5 million to open the facility in 2018.

It’s an encouraging community step-up that meshes well with city plans to convert a building at 431 Kuwili St. into a prototype all-in-one space to help the homeless. The city’s Hygiene Center would be on the first floor; 24-hour urgent care and medical providers would be on the second story; the third floor would have 21 housing units for complex medical care and hospital discharges; and 21 units on the fourth floor would be for longer-term homeless with complex medical and behavioral health needs.

The focus on medical intervention would include a rapid detox and wound care center. All this promises to be an innovative solution for improving health among homeless while also bringing down medical costs.

And those costs are staggering. Consider that $92,000 yearly is spent on the average high-utilizer hospital patient. Consider that the city Emergency Medical Services’s top homeless user called for an ambulance an astounding 157 times last year. And consider that one homeless man’s woes totaled about 18 months in hospital stays — an estimated $1 million for his chronic diseases, conditions arising from drug abuse, malnutrition and living on the street.

The increasing strain, on both funding and providers, is evident. Hospitals here treated homeless patients 15,900 times in 2015, up from about 14,900 the previous year, said the Hawaii Health Information Corp.

The Queen’s Medical Center emergency room, which handles nearly 64 percent of the state’s homeless hospital encounters, knows only too well the medical and financial demands. Of the 2015 total, 10,126 were treated at Queen’s, with nearly 80 percent of them diagnosed with behavioral or substance abuse issues. The medical center provides about $10.5 million annually in unreimbursed care to the chronic homeless community.

More time on the streets exacerbates health problems, creating a vicious cycle of deterioration and repeated, intensive health care. And it is expensive for us all: about $1.2 billion of Hawaii’s annual Medicaid spending goes to just 3.61 percent (13,000 people) of beneficiaries here, including chronically homeless people.

In a study released in July, University of Hawaii public-health researchers linked homelessness and inadequate housing to unnecessary hospitalizations. In talking to 90 patients, a quarter of them cited housing issues as a major factor in their hospitalization; 12 were homeless.

With the H4 program, by diverting away from costly ERs, there is potential to save $30 million to $50 million annually in health costs statewide.

Doing emergency triage on problems leaves little time or focus for deeper treatment, let alone prevention. H4 has real potential to stem the epidemic of homeless overuse of ambulances and hospital ERs, and redirect them to suitable and less-expensive medical help. For some, that better path just might lead to the best outcome: a healing way out of homelessness.