New at-home health-care pilot debuts at Tenderloin SRO

A new pilot program will offer around-the-clock health care to residents of a single-room-occupancy hotel in the heart of the Tenderloin in an effort to provide more comprehensive support to those who’ve struggled with chronic homelessness and suffer from a variety of medical issues.

“We want to really make sure that we have all of the interventions that people need to live the best lives that they can in our system,” said Shireen McSpadden, the executive director of the San Francisco Department of Homelessness and Supportive Housing.

HSH is partnering with the Tenderloin Neighborhood Development Corporation and Cardera Health, an Oakland-based at-home health-care company that aims to provide an alternative for those who are elderly or “medically fragile” to having to go into nursing homes and similar facilities under the California Home and Community-Based Alternatives Waiver.

The waiver enables Medi-Cal recipients with sufficiently severe conditions to qualify for at-home care services to be provided as an alternative to a nursing home. Cardera has already worked under such a model in Oakland.

“The movement is really toward treating people at home,” McSpadden said. “People prefer to be at home.”

The pilot, which is set to run for 20 months, is being funded through a California Housing and Homelessness Incentive Program grant totaling up to $3.5 million, but the goal is to eventually have it funded through the Medi-Cal waiver system.

The program’s services include providing critical medications such as insulin and ensuring rooms are habitable for the residents of Kelly Cullen Community, a 172-unit SRO building at 220 Golden Gate Ave., who qualify for such care.

“As folks are coming through coordinated entry, there’s a special team with the Department of Public Health that will identify potential tenants — all with experiences of chronic homelessness, but also very complex medical and behavioral health needs,” said Katie Bouche, the support services manager for the SRO portfolio at TNDC. “Because of this population, we know the need is there.”

The team from Cardera Health consists of registered nurses, licensed vocational nurses, and caregivers who are primarily certified nursing assistants and largely certified as home health aides, said Catherine Hayes, Cardera’s director of clinical operations. There are also care coordinators acting as medical case managers and six TNDC social workers on site.

“They help people keep track of their appointments, make their appointments, follow up on referrals, follow up on refills, get refills, get transportation to their appointments,” she said. “Some of the things people have experienced with a lot of disorganization within the medical system.”

The team is available 24 hours a day, depending on individual needs, Hayes said. Services can be scaled up or down depending on changes in patients’ health, she said, and the only things that aren’t “baked in” to the pilot’s offerings are behavioral-health services.

“But we work really closely with behavioral-health teams that are already engaging with our clients,” she said. “Or we connect them with behavioral-health services in The City.”

Previously, the San Francisco Department of Public Health supplied staffers to handle the medical needs of the building’s tenants. Hayes said those workers operated outside of the waiver system, and the state program “allows you to do a lot of things in someone’s home that you wouldn’t necessarily be able to do under the DPH model.”

“It’s a way of using Medicaid funding to really provide for the needs that people are showing that they need, rather than a local city, for instance, having to take on all of those costs,” McSpadden said.

Residents at the Kelly Cullen Community range in age from their 20s to their 80s. Around 40 to 60 people have been identified as possible pilot participants based on their conditions.

Hayes said staff is trying to identify patients who are “medically frail,” suffering from “complex medical conditions,” or “something like a traumatic brain injury or a severe mental illness that’s untreated.” Workers are also looking for people who have been frequently hospitalized.

“We really are selecting for the sickest folks that have experienced chronic homelessness, not people who are able to live independently in a similar setting,” Hayes said.

Officials will determine the pilot’s success by measuring a variety of factors, including tracking whether fewer tenants need to leave the building because they are too ill and the frequency of emergency-room and hospital visits. They will also track tenants’ reception.

“We just wrapped up a pretty robust survey of how people feel supported at the [Kelly Cullen Community] around their medical needs, their behavioral-health needs, their safety needs,” Hayes said. “That was pretty interesting, and we’re going to aggregate that out by some racial and age demographics and then redo the survey probably in six months to a year.”

HSH has not yet identified other potential facilities that this model could also be applied to, but officials said other permanent-supportive-housing providers have expressed interest.

“We’re seeing people with more and more complex needs, and we definitely need to be able to respond to that,” McSpadden said. “We need to be able to scale the support in permanent supportive housing in a way that really makes sense for folks.”