Pilot Program Provides Apartments to Homeless Emergency Department Patients

Barnes-Jewish Hospital and St. Patrick Center are partners in an innovative pilot program that provides apartments to homeless patients who frequently seek shelter in the hospital’s emergency department (ED). The aim of the program is to move vulnerable individuals into stable, long-term housing along with the critical social and health care services they need, while at the same time reducing hospital costs.

The program, called Hospital to Housing (H2H), was launched on May 1, 2019, with a two-year grant from The Foundation for Barnes-Jewish Hospital. Early metrics show encouraging results with a significant decline in participants’ ED visits.  

“It’s a huge success in a health care area where we never thought we’d see success,” says Randy Jotte, MD, the H2H physician advisor and associate professor of emergency medicine at Washington University School of Medicine. “It’s one of those rare win wins in which everyone steps forward depending on the need.”

The St. Louis program is based on a successfully implemented model started by the University of Illinois Chicago Medical Center in 2016. At the end of the first year, 90 percent of the Chicago participants remained in stable housing and had improved health outcomes.

To be considered for the St. Louis program, patients must lack a permanent nighttime address, be frequent emergency room users and have a substance use problem and/or mental illness. The combination of these conditions means that they suffer from a complex set of social and medical issues that can often lead to difficult personalities and behavioral problems.

“These are people who everybody gave up on. Their cases are so challenging. It takes a lot of organization and resources,” Dr. Jotte says. “They are very socially isolated, most are single and when asked to list emergency contacts, they either list nobody or their case manager.

“You have people who come to the ED because they need safe shelter, they need food,” he says. “And then you have a subset who need socialization. They don’t have anyone else and they are so thirsty for human contact.”

To determine candidates for the program, patients are screened by the Barnes-Jewish Hospital’s ED medical staff and Case Management Services social workers. Individuals who agree to participate are referred to St. Patrick Center, which provides them with housing, food and other important services.

The first phase of the program is set up to handle about 20 patients, with 10 enrolling in May 2019 and another 10 in September. Those patients primarily range in age from 50 to 64 and most are men with both cognitive impairments and substance abuse issues. While participants averaged almost 50 ED visits per year at Barnes-Jewish Hospital before enrolling in the program, metrics for the first six months for the May enrollees showed that these patients’ ED visits were cut by more than half after receiving permanent housing. Inpatient days dropped 65 percent and readmissions to the hospital fell 60 percent. 

“Once placed, the patients are closely case managed so that their outpatient needs are being addressed in a timelier manner than if they went to the ED,” says Diane Howard, MSW, LCSW,  who supervises the emergency room social workers.

St. Patrick Center has a long history of providing help to the homeless in the St. Louis area. With its network of more than 200 landlords, it has been able to find apartments for the H2H participants in a matter of days.

“The quick turnaround is unheard of in the social services field, where two months placement would be considered lightning speed,” says Howard. “It blows me away and I’ve been doing this for 20 years.”

While the program is still in its early stage, Dr. Jotte said he is optimistic about the results from a full-year of tracking that will be compiled in the fall.  

“Is this program worth the effort or not? It clearly is,” he says.

For information about the Foundation for Barnes-Jewish Hospital, please visit foundationbarnesjewish.org.