As former Waikiki hotel manager Daniel Hoover rode the bus past the bench he used to sleep on at the crossroads of Kalakaua and Kuhio avenues, he had a surreal moment.
“When my world came crashing down, even when I think about it now, I can’t even believe that was me,” said Hoover, who had lived in a Waikiki apartment before finding himself on the streets in deteriorating health. He was plagued by chronic infections from wounds on his legs, and up until last month he also was living with a painful broken hip from a fall.
Between 2017 and 2018, Hoover estimates he was in and out of the hospital roughly eight to 10 times — and taken by ambulance at least seven times — for a variety of conditions specifically caused by living in unsanitary conditions outdoors.
“I stayed at Queen’s (Medical Center) more than anyone should ever have to,” he said. “I was one of the homeless people using the ER because I didn’t have a primary care provider and no other option for medical care. I hated going to Queen’s because I didn’t want to be taking advantage of the system, but there isn’t any other system to use. That was the system.”
Hoover is among a growing number of patients with social needs adding to the hospital’s costs for uncompensated care, which totals $10 million to $12 million annually. The critical gap between clinical care and social services is prompting health care providers, medical insurers and other payers to look at ways to solve the problem.
A $4.5 million grant from the Centers for Medicare and Medicaid Services and another $6.4 million from UnitedHealthcare is funding a new program to reduce the costs of uncompensated care and help patients like Hoover get back on their feet and out of the system.
Hoover, 65, had been an assistant manager at the Royal Hawaiian and most recently worked in the VIP lounge, but has been homeless for the past two years after being stricken with colon cancer in 2013 and having complications from a colectomy. Consequently, he lost his health benefits after not working for six months while in treatment and was later fired from the job and evicted in 2016.
In poor health on the streets, his life would get even worse.
Late last year, he found himself at his lowest point — admitted into the psychiatric ward at Queen’s after threatening to kill himself.
“I didn’t know where to turn to or who to turn to. I just lost all hope and didn’t see any point in surviving anymore,” he said. “I had given up.”
That’s when he met David Mamae, a so-called patient community navigator at Queen’s who is assigned to connect those in need of basic necessities with community resources.
Launched in October, the program funds about a dozen navigators that help Medicare and Medicaid patients find social services — including those that provide food, housing, transportation and jobs — in an effort to improve health outcomes and reduce skyrocketing medical costs, particularly in the emergency room.
The five-year grant is administered by medical insurer UnitedHealthcare, which is also funding navigators at Kalihi-Palama Health Center and the Waianae Coast Comprehensive Health Center.
“Social barriers, such as housing instability and quality, food insecurity, personal safety, and lack of transportation and affordable utilities affect people’s ability to maintain their health and well-being,” said Katherine Keir, UnitedHealthcare Hawaii state director.
Nearly 80 percent of the things that influence health is related to non-medical issues, the insurer said.
Hoover added that it’s nearly impossible to get social services while living on the streets, where robberies are commonplace and it is difficult for agencies to find and keep in contact with people.
Typically upon discharge, Hoover returned to the streets. But Mamae got him into a shelter and even bought him an airbed when he found out Hoover was sleeping on the floor.
“He’s gone to doctor’s appointments. When we met we had coffee together,” Hoover said. “They’re trying to turn things around where the ER isn’t a revolving door for homeless. They’re following up trying to direct them to other places.”
Since connecting with a navigator, Hoover, who moved to Hawaii from Washington state in the 1970s when he was 20 years old, was able to get Medicaid, the government health insurance program for low-income residents, and have hip surgery. He receives about $1,200 a month in Social Security. Social services agencies contact Mamae if they can’t reach him.
On Christmas Eve, Mamae helped him get into an emergency shelter, then a temporary boarding house in Kalihi, while working to get him into his “forever home.”
“Typically when a patient gets discharged from the hospital that’s it,” Mamae said, adding that through this program he will work with Hoover until “all his needs are met and even beyond that.”
Since the program began, roughly 10,400 patients have been screened to determine if they qualify for a navigator. The goal is to reach 75,000 screenings annually. Patients who have had two or more ER visits within the last 12 months and are in need of certain social services are eligible. They do not need to be a UnitedHealthcare member.
“Before a patient becomes a ‘hyperuser’ — the ones constantly coming into the ER multiple times a month — our program sort of tries to catch them before they get to that point,” Mamae said. “We try to address the needs before it gets severe. It may seem little but it makes a difference to finally get them out of that spinning wheel.”
Getting help at the most desperate time of his life is another surreal moment that Hoover said has restored his hope and outlook for the future.
“Before I was just existing. When I was on the street I didn’t feel like I was living. I had nothing to look forward to,” Hoover said. “Just to have hope is like unbelievable.”