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APOLOGIZE FOR THE, FOR THE LONG DELAY TODAY.
THANK YOU ALL FOR STICKING WITH US.
UM, WE ARE GONNA GO AHEAD AND GET STARTED.
[CALL TO ORDER]
DO HAVE A QUORUM COUNCIL MEMBER, FUENTES, VICE CHAIR.FUENTES IS ON THE LINE AS WELL.
SO I WILL CALL THIS MEETING TO ORDER AND WE
[1. Approve the minutes of the Public Health Committee meeting on September 7, 2022.]
WILL START WITH AN APPROVAL OF THE MINUTES, PLEASE.UH, UH, VICE CHAIR, FRONT SECONDS.
IT ALL IN FAVOR? AND THAT'S UNANIMOUS ON THE DIAS.
MAYOR ADLER AND COUNCIL MEMBER HARPER MEDICINE ARE OFF THE DIAS.
[2. Briefing from Central Health on the Health Equity plan to include an update on services for unhoused, including respite care services.]
ITEM TODAY IS A BRIEFING FROM CENTRAL HEALTH.I KNOW YOU WORKED HARD TO, TO PULL THIS TOGETHER.
WE HAD SOME SCHEDULING ISSUES.
WE REALLY APPRECIATE YOU BEING HERE WITH US TODAY.
AND I'M GOING TO TURN IT OVER TO COUNCIL MEMBER KITCHEN TO INTRODUCE THIS.
WE REALLY APPRECIATE THE CHANCE FOR YOU TO, UM, BRING FORWARD, UM, WHAT YOU'RE DISCUSSING TODAY, THE, THE HEALTH EQUITY PLAN AS WELL AS THE RESPITE PROGRAM.
UM, I KNOW YOU ALL HAVE BEEN WORKING VERY HARD ON ALL OF THESE THINGS, AND THIS IS SOMETHING THAT FROM TIME TO TIME WE'VE TALKED ABOUT, WE FELT LIKE IT WAS REALLY HELPFUL AND IMPORTANT TO HAVE YOU ALL TALK WITH US HERE AT THE PUBLIC HEALTH COMMITTEE.
IT GIVES US A CHANCE TO HIGHLIGHT FOR THE PUBLIC, UH, THE PROGRAMS Y'ALL ARE WORKING ON, AND THEN JUST, YOU KNOW, GIVES US SOME TIME TO ASK QUESTIONS AND HAVE A CONVERSATION A LITTLE MORE DEPTH.
SO THANK YOU ALL FOR BEING HERE TODAY.
YES, THANK YOU ALL, UM, MEMBERS.
I'M MIKE GSON, PRESIDENT, CEO OF CENTRAL HEALTH, AND I'M JOINED BY CHIEF STRATEGY OFFICER MONICA CROWLEY, UM, AND OUR CHIEF MEDICAL OFFICER, ALAN SSHA.
AND SO IT IS, IS A PRIVILEGE TO BE HERE TODAY, AND WE'RE THANKFUL FOR THE TIME THAT YOU'VE GIVEN US.
AND, UM, WHAT WE'LL DO IS WE'LL SPEAK TO, UM, HEALTHCARE EQUITY, WHICH, AND YOU THINK ABOUT THIS, THIS IS THE FRAMEWORK UNDER WHICH OUR, THROUGH WHICH ALL OF OUR WORK IS GUIDED AND IT'S OUR NORTH STAR.
AND WHEN WE THINK ABOUT THE COMMUNITY NEEDS ASSESSMENT FOR THOSE THAT ARE LIVING BELOW 200% OF FEDERAL POVERTY LEVEL AND THE VOICES OF THE COMMUNITY THAT, UM, BRING CONTEXT AND TEXTURE TO WHAT WE SEE IN THE PATIENT DATA, THOSE TWO THINGS TRIANGULATE AND THAT APPOINTS THE DIRECTION IN WHICH WE'RE HEADED AS, AS AN ORGANIZATION THAT SERVES THOSE THAT ARE BELOW 200% OF FEDERAL POVERTY LEVEL AND WITHOUT INSURANCE, WOULD NOT HAVE ACCESS TO HEALTHCARE.
AND SO WE'LL TALK ABOUT HEALTHCARE EQUITY AND THEN WE WILL, UH, TRANSITION INTO RESPITE CARE, WHICH IS A VERY IMPORTANT PART OF THE CONTINUUM OF CARE, UH, FOR INDIVIDUALS, ESPECIALLY THOSE EXPERIENCING HOMELESSNESS.
AND, UH, YOU DO HAVE SOME MATERIALS THAT WE HANDED OUT TO, OF COURSE, YOU GOT THE HANDOUT FOR OUR PRESENTATION AND THEN THE NOTEBOOK THAT IS AT YOUR PLACES.
AND COUNCIL MEMBER FUENTES, I I THINK THIS IS, UH, AVAILABLE TO YOU AS WELL, BUT WE'LL, WE'LL GET YOU A HARD COPY TO YOUR OFFICE IF YOU NEED ONE.
UM, IS OUR HEALTHCARE EQUITY PLAN, WHICH HAS ALL OF THE INFORMATION AND DATA TABLES AND SO FORTH FOR YOUR REVIEW WITH THAT, DRS.
AND, UH, THANKS FOR THE OPPORTUNITY TO ENGAGE IN, IN DIALOGUE THIS MORNING.
UH, CENTRAL HEALTH AS A HOSPITAL DISTRICT HAS BEEN AROUND SINCE ABOUT 2004, BUT IT'S ONLY BEEN A COUPLE YEARS SINCE THE TEXAS LEGISLATURE.
CAN YOU ALL HEAR ME OKAY? CLOSER? YOU WOULD MAYBE BRING YOUR MIC A LITTLE CLOSER.
UM, IS THAT BETTER? ALL RIGHT, THANKS.
UH, BUT IT'S ONLY BEEN A COUPLE YEARS SINCE THE TEXAS LEGISLATURE AUTHORIZED THE HOSPITAL DISTRICT TO PRACTICE MEDICINE.
AND SO AS WE LOOK TO THE PAST FOR THE LESSONS THAT WE'VE LEARNED AND PREPARE FOR THE FUTURE, WE'RE LOOKING AT OBJECTIVE DATA, RIGHT? WHERE ARE THERE GAPS IN CARE? AND ALSO REACHING OUT TO THE COMMUNITIES THAT WE SERVE IN ORDER TO UNDERSTAND WHAT THEIR NEEDS ARE OR FROM THEIR PERSPECTIVE.
UM, AND OUR GOALS ARE REALLY TO BUILD BRIDGES WHERE THERE ARE GAPS IN CARE, CREATE THE ROAD AHEAD, UM, THAT HAS A MUCH BRIGHTER FUTURE FOR OUR PATIENTS BASED ON OUR, BASED ON OUR BUILD AND OUR INSTANT PRACTICE OF MEDICINE.
AND AS WE PREPARED, UH, OUR DIRECT PRACTICE OF MEDICINE, UM, WE NEEDED TO UNDERSTAND WHAT COMPONENTS OF A HIGH FUNCTIONING SYSTEM ARE AND HOW THAT RELATES TO THE ENVIRONMENT THAT WE SIT IN TODAY.
SO THIS IS OUR GRAPHIC OF OUR BASIC UNDERSTANDING OF COMPONENTS OF A HIGH FUNCTION FUNCTIONING SYSTEM.
AND WE KNOW THAT THERE ARE POTENTIALLY, POTENTIALLY ASPECTS THAT ARE MISSING OR THAT THEY COULD BE REARRANGED, BUT I THINK THE CRITICAL ASPECTS OF THIS ARE THAT FOR PATIENTS TO FLOURISH IN ANY SYSTEM, THE SYSTEM HAS TO INTERLOCK OR ENGAGE.
SO DISPAR ENVIRONMENTS HAVE TO WORK TOGETHER.
AND IF THEY ACTUALLY INTERLOCK AND WORK TOGETHER, PATIENTS,
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UH, FLOW MORE FLUIDLY THROUGH THAT SYSTEM AND HAVE A GREATER CHANCE TO SUCCEED.WHAT WE'VE PUT IN THAT CENTER COG ARE ITEMS THAT COULD POTENTIALLY, OR, UH, UM, ASPECTS OF CARE THAT COULD POTENTIALLY FAC FACILITATE CARE OR IMPEDE CARE.
AND SO WHETHER IT'S CARE COORDINATION, SHARING, ELECTRONIC HEALTH RECORD SYSTEM, UM, DATA SHARING, HAVING A UNIFORM FORMULARY, THESE ARE ALL ASPECTS THAT AFFECT THE HEALTHCARE WITHIN AUSTIN AND TRAVIS COUNTY NOW, AND ESPECIALLY FOR THOSE AT HIGHEST RISK.
UM, AND SO AS WE CONTINUE TO BUILD, THESE ARE ASPECTS THAT WE ARE PAYING SPECIAL ATTENTION TO, UM, IN ORDER TO INCREASE, YOU KNOW, THE CHANCE FOR SUCCESS OF OUR PATIENTS.
UM, AND I'LL TURN IT OVER TO MONICA, AND I'M GONNA STAY ON THIS SLIDE FOR JUST ONE SECOND BEFORE GOING TO THE NEXT ONE.
UM, BECAUSE THE THING THAT'S DIFFERENT ABOUT TAKING THIS PLANNING APPROACH, UH, STARTING AFTER THE LEGISLATURE, UM, YOU KNOW, PASSED THE LEGISLATION TO ALLOW CENTRAL HEALTH TO DIRECTLY, UH, PROVIDE CARE IN 2019 AS IN 2020, UH, THE BOARD TASK US, I THINK, HISTORICALLY WHEN CENTRAL HEALTH WAS CREATED.
UM, YOU KNOW, IN 2004, DURING THAT FIRST PERIOD FROM 2004 UNTIL 2012, UH, THE HOSPITAL DISTRICT REALLY FOCUSED ON THE PRIMARY CARE SYSTEM, THE HOSPITAL FOCUSED ON THE HOSPITAL SYSTEM.
WE FOCUSED ON BUILDING OUT PRIMARY CARE WITH COMMUNITY CARE, LONE STAR PEOPLES, YOU KNOW, OTHER COMMUNITY PROVIDERS, AND, YOU KNOW, BUILDING OUT THE MAP PROGRAM.
UM, DURING THAT TIME PERIOD FROM 2013 TO 2019, WITH THE 1115 WAIVER DELIVERY SYSTEM REFORM INCENTIVE PAYMENT PROJECTS, UH, D R UM, WE STARTED FOCUSING ON EXPANDING AMBULATORY SPECIALTY CARE, STARTING TO, YOU KNOW, WORK ON INTEGRATION.
AND THEN IN 2020, THIS IS REALLY THE FIRST TIME FROM THE SAFETY NET PERSPECTIVE.
AND, AND FROM THE COMMUNITY PERSPECTIVE, CENTRAL HEALTH REALLY STARTED TAKING THIS SYSTEMATIC COMPREHENSIVE VIEW OF ASSESSING THE NEEDS AND THE GAPS IN THE CAPABILITIES, UM, AND, AND STARTING TO PLAN, UH, ACROSS THIS ENTIRE, UH, SYSTEM.
SO IN FEBRUARY OF THIS YEAR, THE CENTRAL HEALTH BOARD ADOPTED OUR HEALTHCARE EQUITY PLAN, UM, AND THE HEALTHCARE EQUITY PLAN.
UH, I'M GONNA GET INTO THE METHODOLOGY A LITTLE BIT MORE IN THE NEXT SLIDE, BUT IN THIS SLIDE, UH, IT, UH, DEPICTS HOW THE HEALTHCARE EQUITY PLAN, UH, IS, UM, DRIVING OUR OPERATIONAL PLANNING, UH, AND THE FINANCIAL SUSTAINABILITY PLANNING OVER THIS TIME PERIOD.
AND THE HEALTHCARE EQUITY PLAN REALLY IDENTIFIED, UM, THE WHAT OF WHAT CENTRAL HEALTH AND WORKING WITH OUR COMMUNITY WE NEED TO BE DOING, UM, TO FILL THE CARE GAPS AND TO MEET, UH, THE COMMUNITY NEEDS THAT WERE IDENTIFIED IN THE PLAN.
AND THEN, RIGHT NOW WE ARE WORKING ON THE NEXT PHASE OF PLANNING, WHICH, UH, WILL BE PRETTY INTENSE UNTIL APRIL OR MAY OF NEXT YEAR.
THAT INCLUDES DEVELOPING, UH, OPERATIONAL IMPLEMENTATIONAL OPERATIONAL IMPLEMENTATION PLANS THAT, UH, ARE ONE TO THREE YEAR PLANS SEQUENCED OVER THE NEXT SEVEN TO 10 YEARS, WHERE WE'RE REALLY FOCUSING ON HOW AND WHERE AND WHEN WE ARE GOING TO BE TAKING ON SPECIFIC INITIATIVES TO ADDRESS THE NEEDS THAT WERE IDENTIFIED, UH, AND HOW THAT WILL BE PRIORITIZED.
AND THEN THE FINANCIAL SUSTAINABILITY PLAN, UM, AND, AND WHAT PARTNERS WILL WORK WITH.
AND THEN THE FINANCIAL SUSTAINABILITY PLAN, UH, IS REALLY A PLAN FOR HOW WE ARE GOING TO PAY FOR IT.
AND, UH, LIKE MIKE SAID, THIS HEALTHCARE EQUITY PLAN IS DRIVING, UM, WHAT CENTRAL HEALTH OPERATIONS ARE FOR THE NEXT SEVEN TO 10 YEARS.
UH, AND THIS IS ALSO JUST A LITTLE BIT MORE DETAIL INTO, UH, THE, THE INFORMATION THAT, UM, MIKE PROVIDED WHEN HE WAS TEEING THIS UP.
UH, WE REALLY STARTED WITH THE VOICE OF THE COMMUNITY, UM, AND TRYING TO, UH, OBTAIN INSIGHTS FROM PEOPLE'S LIVED EXPERIENCE ABOUT, UM, HOW DO THEY NEED TO, TO ACCESS CARE, WHAT BARRIERS THEY'RE EXPERIENCING IN, UH, CARE TODAY, AND HOW WE COULD BE MORE CULTURALLY AFFIRMING AS WE'RE DEVELOPING, UM, OUR PLANS.
UH, THEN WE LOOKED AT, UH, THE FIRST SAFETY NET FOCUSED COMMUNITY HEALTH NEEDS ASSESSMENT.
WE ARE STILL ACTIVE, UM, PARTICIPANTS, UH, ON, UH, ALL DIFFERENT LEVELS OF CENTRAL HEALTH IN THE CHA CHIP
[00:10:01]
PROCESS, FROM THE STEERING COMMITTEE TO THE, UH, CORE COORDINATING COMMITTEE TO ALL THE DIFFERENT WORK GROUPS.UM, BUT FOR CENTRAL HEALTH'S PLANS, UH, WE THOUGHT THAT WE NEEDED TO FOCUS ON THE NEEDS OF THE POPULATION THAT ARE LIVING WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LEVEL.
UH, AND, YOU KNOW, WE IDENTIFIED, UM, YOU KNOW, SOME DIFFERENT, UH, NEEDS THAN SHOW UP WHEN YOU'RE LOOKING, UH, ACROSS THE CARE OF THE ENTIRE COMMUNITY.
UH, WE ALSO LOOKED AT THE RESOURCES, UH, THAT ARE AVAILABLE IN THE CAPACITY FOR PROVIDING CARE TO THIS SPECIFIC POPULATION.
UH, AND WE LOOKED AT THE GAPS THAT, UH, EXIST TODAY, AND THEN ALSO LOOKING OUT INTO THE FUTURE OF WHAT, UH, ADDITIONAL GAPS ARE PROJECTED TO BE.
AND THIS, UH, SAFETY NET COMMUNITY HEALTH NEEDS ASSESSMENT, UH, CAPACITY AND GAP ANALYSIS COMBINED WITH THE INFORMATION THAT WE, UM, GATHER DIRECTLY FROM THE COMMUNITY IS WHAT LED TO THE HEALTHCARE EQUITY PLAN.
UH, THAT IS ALLOWING US TO BUILD A COMPREHENSIVE, HIGH FUNCTIONING HEALTHCARE SYSTEM THAT WILL IMPROVE THE HEALTH OF CENTRAL HEALTH'S PATIENTS, UH, AND OPTIMIZE THE USE OF OUR, UH, COMMUNITY RESOURCES FOR, UH, IMPROVING THE HEALTH OF THIS PATIENT POPULATION BY LOOKING AT STRATEGIC IMPERATIVES IN FOUR AREAS, WHICH INCLUDE ACCESS AND CAPACITY, CARE COORDINATION, MEMBER ENROLLMENT, AND ENGAGEMENT IN CARE AND SYSTEM OF CARE INFRASTRUCTURE.
ONE OF THE THINGS THAT WE REALLY FOCUSED ON IN THE SAFETY NET, UH, COMMUNITY HEALTH NEEDS ASSESSMENT, AND THAT'S IN, UM, THE, UH, BACKUP MATERIALS THAT YOU RECEIVED IS, UH, WE LOOKED AT THE POPULATION ON A CENSUS TRACK LEVEL IN 14 REGIONS ACROSS THREE FOCUS AREAS IN THE COMMUNITY THAT INCLUDED THE I 35 CORRIDOR, EAST TRAVIS COUNTY AND WEST TRAVIS COUNTY.
WE LOOKED AT SPECIFIC NEEDS OF POPULATIONS IN EACH OF THOSE, UH, AT 14 REGIONS, WE LOOKED AT THE SERVICES THAT WERE AVAILABLE TO CARE FOR THE LOW INCOME POPULATIONS IN THOSE, UH, AREAS, UH, WE LOOKED AT SPECIFIC BARRIERS TO CARE, UM, AND SOCIAL DETERMINANTS OF HEALTH IN THOSE AREAS.
AND I THINK THERE'S 144 PAGE, UH, COMMUNITY HEALTH NEEDS ASSESSMENT THAT HAS AN APPENDIX IN THE BACK OF IT, UH, THAT IS BROKEN OUT BY EACH OF THOSE 14 REGIONS THAT TALKS ABOUT WHO IS PROVIDING CARE THAT, UM, FOLKS WITH LOW INCOMES CAN ACCESS, UH, IN THOSE AREAS TODAY.
ONE OF THE THINGS THAT WE NOTED, UM, AND THAT IS STILL BEARING OUT AS WE LOOK AT THIS, WAS DONE WITH, UM, FIVE YEAR ESTIMATES FROM 20, UH, 19 IN THE ACS SURVEYS.
UH, WE ARE, UH, ALMOST COMPLETE IN OUR, UH, ANNUAL BIENNIAL DEMOGRAPHICS, UH, UPDATE THAT SHOULD BE COMPLETE BY THANKSGIVING.
THAT'S CHOOSING THE 2021 ACS ESTIMATE, UH, DATA FROM THE CENSUS.
UH, BUT WE'VE DISCOVERED THAT WHILE THERE IS WIDESPREAD POVERTY, UH, IN ALMOST ALL OF THE DIFFERENT CORNERS OF TRAVIS COUNTY, THAT, UH, THE GREATEST DENSITY OF PEOPLE THAT ARE LIVING WITH INCOMES THAT ARE BELOW 200% OF THE FEDERAL POVERTY LEVEL, UH, REMAINS IN THIS CORRIDOR, UH, ALONG BOTH, UM, SIDES OF I 35.
AND THAT ALTHOUGH WE ARE SEEING THAT THERE IS SUBURBANIZATION OF POVERTY, THAT THAT HAS NOT AMOUNTED TO A DE URBANIZATION OF POVERTY, UH, WITH 74% OF THE TOTAL POPULATION WITH INCOME BELOW, UH, 200% OF THE FEDERAL POVERTY LEVEL IN TRAVIS COUNTY, STILL BEING ALONG, UH, BOTH SIDES OF THE I 35 CORRIDOR.
UH, AND ACTUALLY 17% OF THIS POPULATION LIVE IN THE RUNDBERG, UH, AREA, AREA ALONE.
UM, ONE OF THE GOOD THINGS THAT WE'VE DISCOVERED BY, UM, LOOKING AT THESE DIFFERENT AREAS IS THAT WHEN WE FOCUS, UH, EFFORT IN ELIGIBILITY AND ENROLLMENT, THAT IT CAN HAVE AN IMPACT.
AND SO WE LOOK AT THE EFFORT THAT WE PUT INTO ENROLLING, UH, POPULATIONS, UH, THAT, THAT ARE POTENTIALLY ELIGIBLE FOR CENTRAL HEALTH IN THE EAST SIDE OF, UH, TRAVIS COUNTY.
AND, UM, ALTHOUGH FAM FAMILIES IN POVERTY IN THAT, UH, AREA FOCUS AREA,
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MAKE UP ABOUT 19% OF THE TOTAL FAMILIES IN POVERTY AND TRAVIS COUNTY, 28% OF THE ENROLLMENT AND MAP AND MAP BASIC, UH, COME FROM THOSE NEIGHBORHOODS.AND, AND I THINK THAT REFLECTS THE INTENSE EFFORT, UH, THAT WE PUT INTO TRYING TO ENROLL AS MANY PEOPLE AS WE POSSIBLY CAN.
UH, IN THIS KIND OF, UH, SEVERELY, UH, UNDERSERVED AREA OF TRAVIS COUNTY.
WE'VE PUT A LOT OF EFFORT INTO, UM, FOCUSING ENROLLMENT IN THOSE AREAS WHERE WE WILL HAVE CLINICS, UH, COMING ONLINE, AND WHERE A LOT OF OUR SERVICE EXPANSIONS, UM, ARE FOCUSED.
I THINK, UM, YOU KNOW, ONE OF THE KEY TAKEAWAYS THAT WE WANT YOU, UH, TO FOCUS ON BEFORE HAND IT BACK TO DR.
SHASHA TO REALLY TALK ABOUT, UM, THE UNMET NEEDS IS, UM, THAT CENTRAL HEALTH HASN'T BEEN DOING THIS WORK ALONE, AND WE DON'T INTEND, UH, TO DO THIS WORK ALONE.
WE'RE WORKING WITH, UH, THE PEOPLE THAT WE ARE CURRENTLY SERVING AND PEOPLE IN COMMUNITIES THAT WE ARE NOT YET SERVING, BUT THAT WE, WE WANT TO BRING INTO CARE AND THAT WE SHOULD BE ABLE TO CARE.
UM, AND WE'RE WORKING WITH, UH, PROVIDERS AND STAKEHOLDERS, UH, THAT WE CURRENTLY WORK WITH AND THAT WE WOULD LIKE TO WORK WITH IN, UM, DEVELOPING THE GAP ANALYSIS.
AND WE ARE CONTINUING, UH, TO WORK WITH THE COMMUNITIES TO WORK WITH OUR PROVIDER PARTNERS, UM, AND TO UPDATE, UH, THE DATA THAT WE'RE BRINGING IN AS WE ARE DEVELOPING, UM, DEVELOPING THE PROGRAMS TO MEET THE NEEDS THAT, UH, HAVE BEEN, HAVE BEEN IDENTIFIED.
THERE ARE CARE GAPS ACROSS THE CARE CONTINUUM.
THESE CARE GAPS ARE BROKEN DOWN INTO MODERATE GAPS AND SIGNIFICANT GAPS.
WHEN THERE'S A MODERATE GAP, IT MEANS THAT WE'RE MEETING 70% OR 70% OR LESS OF THE COMMUNITY NEED.
AND WHEN THERE'S A SIGNIFICANT GAP, IT MEANS WE'RE MEETING LESS THAN 50% OF THE COMMUNITY NEED.
UH, WE HAVE SIGNIFICANT WORK EFFORTS PLANNED FOR THE FUTURE THAT WILL ADDRESS ALL OF THESE AREAS.
BUT WHAT I'D LIKE TO DO IS JUST TOUCH ON A COUPLE OF THE SIGNIFICANT AREAS AND ACTUALLY ON BEHAVIORAL HEALTH AS WELL, WHICH IS A MODERATE GAP AREA.
UM, JUST GIVING AN EXAMPLE OF WORK THAT HAS BEEN UNDERWAY OVER THE PAST YEAR, AND THAT HAS ALREADY AFFECTED AND CHANGED AND IMPROVED LIVES, AND THEN END WITH RESPITE UNDER POST ACUTE.
UM, WHEN WE LOOK AT SPECIALTY CARE, I THINK I'VE BEEN IN AUSTIN ABOUT SIX YEARS, AND WHEN I FIRST GOT HERE, UM, AND I, I MET WITH THE CMOS OF THE HOSPITALS.
UM, THE NUMBER ONE CHALLENGE THAT THEY FACED THAT THEY COULDN'T AFFECT WAS WHAT WE CALL COMPASSIONATE DIALYSIS, WERE INDIVIDUALS EXPERIENCING HOMELESSNESS OR UNDER RESOURCED INDIVIDUALS THAT PRESENTED TO THE ED, UM, BECAUSE OF THEIR END STAGE RENAL DISEASE WHEN THEY WERE SO SICK THAT THEY COULDN'T FUNCTION ANYMORE.
AND WE CALL THAT IT'S A MISNOMER, RIGHT? WE CALL THAT COMPASSION DIALYSIS.
AND THEY WERE THEN DIALYZED TO WHERE THEY WERE HEALTHY ENOUGH TO BE DISCHARGED BACK TO THE STREET.
AND WE HADN'T BEEN ABLE TO SOLVE THAT PROBLEM, AND WE STILL HAVE A LOT OF WORK TO DO.
BUT ABOUT SIX OR SEVEN MONTHS AGO, CENTRAL HEALTH SET UP A PRO, UH, PROGRAM FOR TRANSITIONAL DIALYSIS IN WHICH, UM, IN WHICH CASE PATIENTS WITH END STAGE.
SO MATT, PATIENTS WITH END STAGE RENAL DISEASE NOW HAVE THE OPPORTUNITY TO HAVE A CHAIR IN A PREDICTABLE DIALYSIS SATELLITE CLINIC, UM, FOR UP TO A YEAR OR FOR UP TO A YEAR UNTIL WE TRANSITION THEM, UM, TO KIND OF AN INDEFINITE DIALYSIS PROGRAM.
TO DATE, 30 PATIENTS, UM, ARE RECEIVING OR ARE ON THAT LIST, 21 PATIENTS HAVE A SEAT AND ARE RECEIVING KIND OF THAT PREDICTABLE DIALYSIS, WHICH OBVIOUSLY IMPROVES QUALITY OF LIFE, UM, AND JUST DAY TO DAY FUNCTIONALITY.
SO THAT PROGRAM IS GOING WELL.
THE HOPE IS THAT PATIENTS THEN TRANSITION, UM, YOU KNOW, TO A PERMANENT DIALYSIS, AND THAT MAKES ROOM FOR ADDITIONAL PATIENTS.
UM, WHEN WE LOOK AT BEHAVIORAL HEALTH, THOUGH, STATED, YOU KNOW, THE OBJECTIVE INFORMATION OR THE OBJECTIVE DATA THAT WAS, UM, THAT WAS PULLED REALLY PUTS US IN THE MODERATE CATEGORY.
BUT WHEN WE LOOK AT ADDICTION DISORDERS, OPIOID, OPIOID ADDICTION DISORDERS, AND ALCOHOL ADDICTION DISORDERS, UM, THERE ARE SIGNIFICANT NEEDS HERE.
PRIOR TO THE PANDEMIC, TEXAS SAT BEHIND THE NATIONAL AVERAGE AS FAR AS OPIOID USE DISORDERS THROUGH THE PANDEMIC.
SO I THINK WE'RE ALL AWARE OF THAT, OF THE EPIDEMIC THAT SITS WITH WITHIN OUR MIDST.
UM, ABOUT FOUR TO FIVE YEARS AGO, CENTRAL HEALTH AND PARTNERSHIP WITH COMMUNITY
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CARE AND INTEGRAL CARE SET UP A MEDICAL ASSISTANCE PROGRAM, UM, WITH THE USE OF SUBOXONE.AND THAT PROGRAM OVER TIME HAS BEEN BUILT OUT WITH WRAPAROUND SERVICES, UM, YOU KNOW, INCREASING OVERTIME IN NUMBER OF PATIENTS, INCREASING OVER TIME.
UM, CURRENTLY ABOUT 600 PATIENTS ARE BEING SERVED THROUGH THAT PROGRAM.
AND THEN ABOUT FOUR OR FIVE MONTHS AGO, THE PROGRAM SPLIT TO WHERE, UH, COMMUNITY CARE IS CARING FOR PATIENTS THAT ARE APPROPRIATE IN A PRIMARY CARE SETTING WHERE THEY'RE EITHER STABLE OR THEY'VE GOT, UH, KIND OF A, A MENTAL HEALTH DIAGNOSIS THAT IS NOT AN SMI OR A SEVERE MENTAL ILLNESS, AND THEY ARE STABLE.
UM, THE GOAL OF THAT IS TO TRY TO DESTIGMATIZE, UM, THEIR, THEIR, THE, THE THERAPEUTIC APPROACH SO THAT IT CAN BE REALLY CATERED FOR IN A PRIMARY CARE ENVIRONMENT.
AND ALSO, IF OUR INTEGRAL CARE FRIENDS, UM, THEIR ESTIMATE IS ABOUT 80% OF THEIR PATIENTS HAVE BOTH AN SMI SO SEVERE MENTAL ILLNESS AND AN OPIOID USE DISORDER.
AND SO THE GOAL OF SPLITTING THAT PROGRAM IS SO THAT PSYCHIATRIC BASED ADDICTIONOLOGISTS CAN CARE FOR THE PATIENTS THAT ARE MORE COMPLEX OR ADVANCED IN THEIR DIAGNOSES AND THAT COMMUNITY CARE AND OUR OTHER FQHC PARTNERS CAN EXPAND THEIR CARE.
SO WE'RE MEETING MORE OF THE COMMUNITY NEED.
IN ADDITION, OVER THIS PAST YEAR, UM, WE HAVE PARTNERED WITH, UM, ONE ORGANIZATION AND ARE ABOUT TO PARTNER WITH ANOTHER, UM, TO CREATE ACCESS TO METHADONE, UM, INDIVIDUALS WITH OPIOID USE DISORDERS, UH, DO, UH, DO BETTER BASED ON THEIR OWN PHYSIOLOGY.
UM, YOU KNOW, SOME DO BETTER ON ONE MEDICATION AND THE OTHER, AND SOME ACTUALLY SWITCH.
AND SO I THINK THE MORE ACCESS THAT WE PROVIDE, THE BETTER FOR THESE PATIENTS IN ADDITION TO THOSE WRAPAROUND SERVICES.
AS RELATED TO DENTAL, WE'VE PROVIDED MORE SPECIALTY DENTAL AND MORE DENTAL CHAIRS.
UM, AND THEN TOUCHING ON, ON HOSPITAL CARE.
AND I REALLY WANNA FOCUS ON THE AMBULATORY SURGERY CENTER ACCESS THAT HAS BEEN PROVIDED OVER THIS PAST YEAR.
UM, WE HAVE STARTED TO BE ABLE TO PROVIDE ACCESS FOR TUBAL ALLEGATIONS FOR WOMEN WHO, WHO CHOOSE, UM, TO HAVE THEM.
AND WHAT THIS DOES IS IT, IT ALLOWS US AND PROVIDES AN OPPORTUNITY TO, UM, KEEP WOMEN OUT OF THE HOSPITAL, UM, WHERE THEY MAY BE EITHER, YOU KNOW, POLITICAL OR JUST, UM, ADMINISTRATIVE CHALLENGES TO GET TO THAT END POINT.
AND SO THEY CAN NOW HAVE THEIR TUB ALLEGATIONS IN AN AMBULATORY SETTING.
ACTUALLY, WE CAN GO ONE MORE PLEASE.
AND, UM, AS RELATED TO RESPITE, WE'VE HAD SOME, I THINK, BRIEF CONVERSATIONS RELATED TO RESPITE IN THE PAST WHEN WE WERE REALLY GEARING UP AND, AND STARTING THIS PROGRAM.
SO OUR RESPITE, I THINK THE, THE PROBLEM THAT EXISTS OR HAS EXISTED HERE IN AUSTIN, I KNOW YOU ALL ARE VERY AWARE, IS THAT INDIVIDUALS EXPERIENCING HOMELESSNESS, UM, AND OTHER UNDER-RESOURCED INDIVIDUALS, UM, ARE OFTEN DISCHARGED FROM A SKILLED NURSING FACILITY DIRECTLY TO THE STREET OR FROM THE HOSPITAL DIRECTLY TO THE STREET.
AND SO THERE WAS A CRITICAL NEED FOR A RESPITE ENVIRONMENT, UM, TO BE BUILT, UM, SO THAT PATIENTS, UH, COULD HEAL IN A SAFE ENVIRONMENT.
OUR PROGRAM HAS BEEN RUNNING, I THINK, ABOUT SIX MONTHS AS WELL.
AND IF WE THINK ABOUT RESPITE ON THE CARE CONTINUUM, UM, WITH THE RIGHT SIDE OF THE CONTINUUM BEING MORE COMPLEX CARE FOR ALMOST LIKE SKILLED NURSING FACILITIES AND, AND THAT, UH, KIND OF ENVIRONMENT.
AND ON THE LEFT SIDE OF THAT CARE CONTINUUM, UM, KIND OF RESIDENTIAL, RESIDENTIAL ROOMING WITH CASE MANAGEMENT AND SOCIAL SERVICES BEING PROVIDED, WE HAVE STARTED ON THE LEFT SIDE OF THAT CARE CONTINUUM, AND WE ACTUALLY CREATED A PHASED APPROACH AS WE, UH, THE, WITH THE ONSET OF THIS PROGRAM, UH, MORE SO, UH, TO WRAP THE CARE OF OUR PATIENTS, UM, TO ALLOW FOR THAT LEARNING CURVE, UM, AND TO, UH, CREATE BETTER END POINTS FOR THE INDIVIDUALS THAT WOULD BE WITHIN OUR RESPITE ENVIRONMENT.
SO THE FIRST PATIENTS THAT WE, UH, STARTED TAKING IN WERE INDIVIDUALS WHO WERE DISCHARGED FROM SKILLED NURSING FACILITIES.
AND I THINK WE STARTED WITH ABOUT FIVE BEDS.
UM, AND WE HAVE, WE TRANSITIONED, I THINK ABOUT THREE MONTHS AGO, UM, TO WORKING WITH INDIVIDUALS, UM, WHO WERE, WERE LIVING ON THE STREET, BUT WERE CARED FOR BY EITHER THE PARAMEDICS OR THE STREET AND MOBILE TEAMS. UM, AND WORKING WITH THOSE TEAMS WERE ABLE TO DIRECTLY ADMIT PEOPLE INTO RESPITE, UM, TO AVOID THEM NEEDING A HOSPITAL STAY, HOPEFULLY TO CATCH THEIR ILLNESS OR THEIR WOUND OR WHATEVER IT WAS EARLY, UM, SO THEY COULD THEN BE DISCHARGED BACK TO, TO THEIR ENVIRONMENT.
THE REASON THAT THE HOSPITAL, UM, UH, TRANSITIONS WERE NUMBER THREE IS JUST BASED ON THE SHEER NUMBER, UM, THAT
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THE CAPACITY AT FIRST WAS FIVE BEDS.WERE UP TO 10 BEDS NOW AND POTENTIALLY HAVE THE, THE CAPACITY WORKING WITH A NEW ENTRY, WHO IS OUR PARTNER IN THIS ENVIRONMENT, UM, TO INCREASE THE NUMBER OF BEDS.
UM, BUT THE FLOODGATES, THERE'S SUCH A CRITICAL NEED FOR RESPITE THAT, YOU KNOW, WE'RE AT 10 BEDS NOW, 20 BEDS IS NOT GONNA MEET THE NEED.
OUR ESTIMATE IS WE ACTUALLY HAVE A NEED BETWEEN 30 AND 50 FOR RESPITE CARE.
SO AS RELATED TO SOME OF THE, UH, THE DATA, THE, UM, UH, JUST THE, THE INFORMATION, THE, THE PATIENTS WHO'VE, WHO'VE WORKED THEIR WAY THROUGH RESPITE OVER THE PAST, UH, SEVEN MONTHS OR SO, UM, WE'VE HAD 29 PATIENTS.
UM, TWO THIRDS OF THOSE PATIENTS HAVE COME FROM SKILLED NURSING FACILITIES, UM, WITH, UH, WITH ABOUT 10 PATIENTS COMING FROM OUR STREET AND MOBILE TEAMS. UM, THE AVERAGE, UM, AGE IS ABOUT 47.
UM, THE MAJORITY OF THE PATIENTS HAVE BEEN MEN.
AND THEN YOU CAN SEE THE RACE AND ETHNICITY BREAKDOWN THERE.
UM, TOP DIAGNOSES, OBVIOUSLY THE DIAGNOSIS ARE GONNA CHANGE WHEN WE TRANSITION TO THE MAJORITY OF PATIENTS COMING FROM HOSPITALS, BUT COMING FROM A SKILLED NURSING FACILITY WHERE POTENTIALLY PHYSICAL THERAPY AND OTHER REHABS ARE PROVIDED, UM, UH, FRACTURES TEND TO BE THE NUMBER ONE DIAGNOSIS.
NOW, NOBODY THAT SITS IN THE RESPITE ENVIRONMENT HAS ONLY ONE DIAGNOSIS, RIGHT? SO THEY NORMALLY WILL HAVE A FRACTURE OR MULTIPLE FRACTURES WITH, YOU KNOW, ONE OR TWO COMPLEX DISEASE DIAGNOSES AS WELL.
AND SO THESE ARE COMPLICATED PATIENTS.
UM, AS RELATED TO THE DISPOSITION OF, OF THE, THE PATIENTS, ABOUT SEVEN PATIENTS, UM, HAVE EITHER, UH, BEEN PLACED IN TRANSITIONAL OR PERMANENT HOUSING, AND I'LL ACTUALLY, THERE ARE TWO PATIENTS I'LL TALK ABOUT AND TELL THEIR STORIES.
UM, AND IT REALLY SPEAKS TO THE SUCCESS OF RESPITE AND THE NEED FOR ADDITIONAL RESPITE.
UM, 40% OF PATIENTS CHOSE TO LEAVE A LITTLE SOONER THAT OUR THAN OUR TEAMS WOULD HAVE DISCHARGED THEM.
THEY WOULD'VE RECEIVED SOCIAL SERVICES, THEY WOULD'VE GONE TO VARIOUS APPOINTMENTS, BUT OUR TEAMS WOULD'VE LIKED THEM TO STAY IN THAT ENVIRONMENT TO HEAL AND PROGRESS AND CONNECT THEM TO MORE SOCIAL SERVICES.
BUT THIS IS A DIFFERENT ENVIRONMENT FOR PEOPLE THAT ARE, HAVE BEEN USED TO LIVING ON THE STREET, AND SOMETIMES IT JUST TAKES, IT TAKES MULTIPLE TRIES.
UM, SO THAT JUST THE CULTURAL CHANGE OF BEING IN THIS ENVIRONMENT, UM, TAKES A LITTLE BIT OF GETTING USED TO, UM, 20% OF PATIENTS, UH, ACTUALLY WERE READMITTED TO THE HOSPITAL.
AND THIS COULD BE LOOKED AT AS A NEGATIVE STATISTIC, BUT THESE ARE, ARE INDIVIDUALS WHO POTENTIALLY WOULD BE HA WOULD HAVE BEEN DISCHARGED BACK TO THE STREET AND WHETHER THEY WEREN'T READY AND WEREN'T APPROPRIATE TO GO TO RESPITE OR WHETHER THEY WERE SUDDENLY GETTING SICK AND RESPITE, AT LEAST THEY WEREN'T DISCHARGED BACK TO THE STREET WHERE THAT EITHER, UM, HAD A CHANCE OF DYING OR THEIR DISEASE PROCESSES PROGRESSING TO WHERE WHEN THEY FINALLY MADE IT INTO THE SYSTEM, THEY WERE MUCH MORE ADVANCED.
UM, AND THEN THERE WERE ABOUT 15% THAT HAD WHAT WE CALL AN ADMINISTRATIVE DISCHARGE.
SO THESE ARE FOLKS, UM, WHO HAVE AN ADDICTION DISORDER, AND WE'RE IN NEED OF ACUTE DETOX, AND WERE DECLINING ACTUALLY BEING TRANSPORTED TO ACUTE DETOX.
AND THERE'S A CRITICAL NEED FOR THAT, FOR THAT AS WELL.
THE AVERAGE LENGTH OF STAY IS ABOUT 23 DAYS.
AND THEN ONE OF THE BENEFITS IS ALL THE SOCIAL SERVICES THAT WE CAN BRING TO PATIENTS WHEN WE HAVE THEM IN ONE PLACE.
UM, AND SO THOSE ARE LISTED THERE.
UM, MR. P, HE WAS ACTUALLY OUR FIRST PATIENT.
SO MR. P IS 64 YEAR OLD MALE, UM, WHO'D BEEN EXPERIENCING HOMELESSNESS FOR ABOUT 15 YEARS.
UM, HE WAS HIT BY A CAR AND BROKE MULTIPLE BONES, SPENT ABOUT THREE MONTHS, UM, IN THE HOSPITAL AND IN SKILLED NURSING FACILITIES, UM, AND SPENT ANOTHER 50 DAYS WITH US WHILE WITH US.
UM, HE WAS SIGNED UP FOR QUITE A FEW SOCIAL SERVICES, UM, AND ACTUALLY, UM, WE WERE ABLE TO HOUSE HIM AT COMMUNITY FIRST.
THIS IS HIM STANDING VERY PROUDLY IN FRONT OF HIS TINY HOME.
UM, HIS LIFE HAS BEEN CHANGED, RIGHT? SO A HUGE SUCCESS STORY.
AND AGAIN, THIS WAS OUR VERY FIRST PATIENT, SO IT WAS A GREAT PRECEDENT TO SET.
UM, AND OUR, OUR TEAMS, UH, STILL SPEAK ABOUT MR. B.
SO, MR. W, UH, MR. W ENDED UP EXPERIENCING HOMELESSNESS.
UM, TRAGICALLY HE WAS IN A FIRE ABOUT A YEAR EARLIER, UH, AND HIS WIFE PASSED AWAY.
UM, HE FOUND HIS WAY TO ARCH AND THEY FOUND THAT HE REALLY COULDN'T SEE THAT HE HAD BILATERAL CATARACTS, SO HE HAD CATARACTS IN BOTH EYES, BUT BECAUSE HE WAS LIVING ON THE STREET, THERE WAS NO METHODOLOGY TO ACTUALLY PROVIDE THAT SURGERY AND THAT HEALING THAT NEEDED TO OCCUR POST SURGERY.
AND SO HE HAS NOW HAD ONE CATARACT REMOVED AND HAS GREAT VISION AND THAT EYE, AND THE SECOND CATARACT IS SCHEDULED,
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A CATARACT, SECOND CATARACT SURGERY IS SCHEDULED.UM, AND, UM, AND HE WILL GO FOR THAT SURGERY.
AND, UM, AND HOPEFULLY HE CAN PROGRESS FROM THAT POINT ON.
AND THEN, YOU KNOW, THERE ARE JUST MULTIPLE OTHER STORIES OF PEOPLE WHO HAVE DONE REALLY WELL IN RESPITE.
OUR PLAN THIS YEAR IS TO GO FROM THAT KIND OF LEFT OF THE CARE CONTINUUM PHASE, UM, TO HIRING A NURSE AND AN MA.
WE ROLLED OUT OUR ELECTRONIC HEALTH RECORD THIS WEEK.
AND SO WHILE WE WERE, UH, GIVEN THE AUTHORITY TO PRACTICE MEDICINE, IT TAKES A WHILE.
FIRST OF ALL, IT HAPPENED, YOU KNOW, RIGHT BEFORE THE PANDEMIC.
AND, UM, AND I WAS ACTUALLY WITH COMMUNITY CARE AT THAT POINT, AND OBVIOUSLY THE PANDEMIC WAS BUSY.
AND SO NOW WE HAVE BEEN BUILDING THE POLICIES, PROCEDURES, THE COMMITTEES, UM, FOR THE PRACTICE OF MEDICINE ROLLED OUT OUR ELECTRONIC HEALTH RECORD THIS WEEK.
AND SO WE'LL HAVE NURSING AND MA STAFF WITHIN THE RESPITE ENVIRONMENT WITHIN THE NEXT THREE MONTHS.
UM, AND WE'LL BE ABLE TO TAKE CARE OF MORE ADVANCED PATIENTS AT THAT POINT.
SOME OF THE ADVANTAGES, UM, AND THE UNIQUENESS OF OUR RESPITE ENVIRONMENT IS THAT IT'S NOT A UNILATERAL KIND OF REFERRAL, RIGHT? PATIENTS CAN BE REFERRED FROM PROVIDERS IN SO THEY CAN AVOID HOSPITAL STAYS.
THE PARAMEDICS AND STREET MOBILE TEAMS CAN REFER 'EM.
WE CAN TAKE PATIENTS FROM SKILLED NURSING FACILITIES AND FROM THE HOSPITAL.
AND OBVIOUSLY AS THIS BUILD, BUILD OUT, UM, YOU KNOW, WE'LL HAVE MORE ACCESS BECAUSE WE'VE PARTNERED WITH A NEW ENTRY.
INDIVIDUALS THAT DO HAVE AN ADDICTION DISORDER ARE ACTUALLY ABLE TO GET THE COUNSELING THAT THEY NEED.
AND SO THIS HAS WORKED OUT REALLY WELL, THOUGH THE PIECE OF THE ACUTE DETOX IS STILL MISSING.
UM, AND THEN MANY RESPITE, IF NOT THE MAJORITY OF RESPITE REALLY FOCUS ON CLINICAL CARE.
AND SO WHETHER THIS WAS, YOU KNOW, WHAT OUR CHOICE WOULD'VE BEEN, BECAUSE WE'RE STILL BUILDING THE ABILITY TO PRACTICE MEDICINE.
WE'VE BEEN FOCUSING ON THE SOCIAL SERVICES, WHICH AS WE PROGRESS WITH THE PRACTICE OF MEDICINE NOW, WE HAVE A REALLY WRAPPED CARE ENVIRONMENT WHERE HOPEFULLY FEW FEWER PATIENTS FALL THROUGH THE CRACKS AND MORE PROGRESS AND, AND DO WELL.
AND MIKE, I TURNED OVER TO YOU.
SO CHAIR TOVA AND MEMBERS, WE ARE THANKFUL THAT YOU'VE GIVEN US THIS OPPORTUNITY TO PRESENT.
WE'RE HERE TO ANSWER ANY QUESTIONS, UM, THAT YOU MAY HAVE.
AND, UM, JUST THANKFUL FOR THIS COMMITTEE'S FOCUS AND YOUR ADVOCACY AROUND HEALTH EQUITY.
AND ALSO THANK YOU TO THE, THE ROOM MEETING TEAM AND HELPING US GET THROUGH THE PRESENTATION.
THIS IS REALLY VERY VALUABLE INFORMATION.
UM, I'LL OPEN IT UP FOR QUESTIONS.
I KNOW I HAVE A FEW EVENTUALLY.
UM, COUNCIL MEMBER KITCHEN, WOULD YOU LIKE TO START US OFF? UM, I, I WILL START WITH ONE SET OF QUESTIONS AND UH, THEN, UM, PASS IT ALONG TO MY COLLEAGUES, THEN YOU CAN CIRCLE BACK AROUND.
SO, UM, UH, I'M GONNA ASK ABOUT ONE ASPECT OF THE RESPITE PROGRAM.
FIRST OFF, I WANNA SAY THANK YOU ALL FOR, UH, YOU KNOW, REALLY, UM, WORKING ON RESPITE, AND SOUNDS LIKE YOU'VE, UH, GOT A GOOD, GOOD PROGRESS GOING ON THAT.
AND YOU'VE GOT A, IT SOUNDS LIKE YOU HAVE A PATH.
SO I WANNA TALK A BIT ABOUT, UM, THE, I WANNA FOCUS IN ON WHAT YOU SAID ABOUT THE NEED.
UH, I THINK YOU SAID FROM 30 TO 50.
COULD YOU JUST TALK TO US A LITTLE BIT MORE ABOUT THAT? MY GUESS IS WHAT YOU'RE SEEING, YOU KNOW, TELL US WHAT THE DATA IS THAT YOU'RE SEEING, AND IF I HEARD YOU CORRECTLY, THAT THAT NEED IS, IS GONNA FALL PRIMARILY IN THE HOSPITAL DISCHARGE AREA, DO YOU THINK? OR IS IT REALLY ACROSS ALL THOSE THREE AREAS? JUST, UH, TALK TO US A LITTLE BIT MORE ABOUT WHAT YOU'RE SEEING FROM A NEED PERSPECTIVE, WHAT YOU'RE SEEING FROM A NEED PERSPECTIVE.
WHAT, WHAT PATH DOES CENTRAL HEALTH HAVE TO ADDRESS THAT NEED AND WHAT CHALLENGES? IN OTHER WORDS, HOW FAR CAN YOU GUYS GET, AND WHAT KIND OF, UH, PARTNERSHIP DO YOU NEED IN THE COMMUNITY TO IDEALLY GET TO A POINT WHERE WE ARE ADDRESSING THE, AT SOME POINT, THE 30 TO 50 NEED? A GREAT QUESTION, AND I THINK I'LL SHARE THE ANSWER WITH MY, WITH MY COLLEAGUES HERE, OKAY? MM-HMM.
BUT, UM, THE, UM, THE NUMBERS COME FROM THE FACT THAT ON ANY SPECIFIC DAY, WE HAVE BETWEEN 18 AND 26 PATIENTS IN A SKILLED NURSING FACILITY MM-HMM.
THEY NEED A CLINICAL RESPITE ENVIRONMENT.
AND SO WHEN YOU LOOK AT THAT AND YOU LOOK AT THE FACT THAT WE'RE MAXING OUT, YOU KNOW, AT 10 PATIENTS AND REALLY HOLDING, BECAUSE EVEN IF WE INCREASE IN THE WAY THAT WE ARE WORKING
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NOW TO 15 PATIENTS, WE STILL NEED NURSING CARE.WE STILL NEED MEDICAL ASSISTANT CARE AND POTENTIALLY A CLINICIAN.
AND SO IF YOU LOOK AT THE NUMBERS AND WE SAY, YOU KNOW, AND THIS IS JUST A VERY, VERY BASIC ESTIMATE, BUT YOU CAN TAKE 15 PATIENTS OR 18 PATIENTS FROM A SKILLED NURSING FACILITY, 10 PATIENTS THAT WERE CURRENTLY HOUSING RESPITE.
WE HAVEN'T TURNED ON THE HOSPITAL DISCHARGES YET MM-HMM.
AND SO THE ESTIMATE IS REALLY SOMEWHERE BETWEEN 30 AND 50 AS RELATED TO RESPITE.
SO THAT'S HOW WE GOT TO THOSE NUMBERS AS FAR AS PARTNERSHIP.
MONICA, HAPPY TO HAND THIS, THIS OFF TO YOU.
UM, THE, THE LESSONS THAT WE'VE LEARNED AND THE FUNCTIONALITY OF NEW ENTRY, YOU KNOW, WE ARE, WE'RE SO GRATEFUL THAT THEY WERE, UM, INTERESTED IN PARTNERING WITH US, AND THAT HAS BEEN A GODSEND BECAUSE OF THE ADDICTION DISORDERS THAT TEND TO ACCOMPANY HOMELESSNESS, UM, AND A LOT OF THE, UH, INDIVIDUALS THAT WE CARE FOR.
BUT THE DETOX, UM, ENVIRONMENT, THE ACUTE DETOX ENVIRONMENT IS PRETTY CHALLENGING.
AND THERE'S VERY LITTLE AND DIFFICULT ACCESS, YOU KNOW, FOR PATIENTS.
AND, YOU KNOW, WE FOCUS ON OPIOID USE DISORDERS, THAT ALCOHOL USE DISORDERS ARE EVEN BIGGER, AND WE'RE JUST STARTING TO LEAN IN TO SEE IS IT APPROPRIATE FOR CENTRAL HEALTH TO WORK IN THAT SPACE? MM-HMM.
AND THERE ARE MULTIPLE AGENCIES IN TOWN.
I THINK THE, THE ANSWER, AND I'M NOT AN EXPERT IN, IN, UM, ADDICTION USE DISORDERS, BUT THE THING YOU HEAR ALL THE TIME IS NO WRONG DOOR.
AND SO, WHETHER IT IS MENTAL HEALTH AND INSTANT ACCESS TO MENTAL HEALTH, UM, OR, UM, PROVIDING CARE FOR THE PATIENT WHERE THEY ARE, HOUSING IS CRITICAL BECAUSE UNLESS WE HOUSE THESE INDIVIDUALS, IT'S JUST A CYCLE THAT'S GONNA CONTINUE.
UH, YOU KNOW, BUT I THINK LOOKING AT PARTNERSHIPS WITH, UH, ORGANIZATIONS LIKE INTEGRAL CARE WITH, UM, THE CITY AND THE COUNTY IN FIGURING OUT THE, UH, THE PLACE WORKING WITH, UM, PRIVATE BUSINESSES, LIKE THE LARGE HOSPITAL SYSTEMS IN THE COMMUNITY, THAT IN MANY COMMUNITIES ARE, UM, YOU KNOW, LARGE FUNDERS OF, UM, YOU KNOW, RESPITE BUILD OUTS, UM, AND PRIVATE PHILANTHROPY WITH GROUPS, UM, LIKE COMMUNITY FIRST VILLAGE, UH, INTO OTHER, UH, PROVIDERS IN TOWN.
I THINK ONE OF THE THINGS THAT DR.
SSHA, YOU KNOW, TALKED ABOUT, UH, IS THIS KIND OF BACKING INTO A MODEL IN OUR COMMUNITY THAT ACTUALLY, UM, YOU KNOW, COULD BE VERY BENEFICIAL FOR THE PATIENTS IN THE SYSTEM BECAUSE WE'RE, WE'RE STARTING, YOU KNOW, HERE ON THE WRAPAROUND SERVICES PIECE WITH ORGANIZATIONS THAT HAVE BEEN, UM, YOU KNOW, HEAVILY SUPPORTED BY, UM, YOU KNOW, THE OTHER BY, BY THE CITY AND THE COUNTY AND PHILANTHROPY, AND BRINGING THE, THE MEDICAL KIND OF NURSING SOCIAL SERVICES PART TO THAT LEARNING, UM, WHAT PEOPLE NEED, WHAT GAPS ARE AS WE BUILD OUT TOWARDS.
SO SOMETHING THAT IS A MORE COMPREHENSIVE MEDICAL RESPITE TYPE FACILITY.
BEING ABLE TO TAKE THOSE, THOSE LEARNINGS, UM, YOU KNOW, BUT I THINK CONTINUING, UH, TO BUILD ON, UM, YOU KNOW, THE, THE LEARNINGS WORKING WITH, UM, YOU KNOW, THE, THE PRIVATE PARTNERS AND WORKING, UH, POTENTIALLY TOGETHER TO BUILD OUT THIS MORE, UM, YOU KNOW, MEDICAL, CLINICAL BASED, UM, FACILITY.
I THINK, I THINK WE'RE GONNA NEED IT ON ALL OF THE DIFFERENT LEVELS.
AND SO JUST MAKING SURE AS WE, YOU KNOW, KIND OF TURN TO THE NEXT PHASE THAT WE CONTINUE, YOU KNOW, TO SUPPORT, UH, ORGANIZATIONS LIKE A NEW ENTRY AND, UH, COMMUNITY FIRST VILLAGE AND SOME OF THE, THESE ORGANIZATIONS THAT HISTORICALLY HAVE, HAVE SERVED THE POPULATION THAT, THAT WE NEED TO BE WORKING WITH.
DO, DO YOU HAVE A TIMELINE IN MIND TO, TO OPEN IT UP TO DISCHARGES FROM HOSPITALS? SO I THINK WE'VE DONE THAT ON A VERY SMALL, I THINK WE HAVE ONE OR TWO THAT ARE NOT ON THESE METRICS.
UM, WE WILL DO THAT VERY SLOWLY, UM, AGAIN, FOR
[00:40:01]
THIS FISCAL YEAR THAT JUST BEGAN FOR US WITHIN OUR BUDGET, OR IS THE NURSING STAFF THAT IS THE NEXT PHASE.AND THE REALLY, THE CHALLENGE IS, UM, I THINK WE COULD INCREASE BY ONE BED, BUT IT'S THAT AS WE START INCREASING, THE COMPLEXITY WILL SIT THERE AND WE REALLY DO NEED NURSING STAFF.
AND SO IT WAS SETTING UP THE POLICIES AND PROCEDURES, THE HIGHER FOR THOSE INDIVIDUALS IS PLANNED FOR THIS FIRST QUARTER OF THIS FISCAL YEAR FOR US.
AND SO THE NEXT THREE TO SIX MONTHS, WE SHOULD NOT ONLY INCREASE THE NUMBER, BUT INC INCREASE OR CHANGE THE WAY THAT WE'RE CARING FOR INDIVIDUALS.
AND THEN JUST AS WE CONTINUE THE WORKER, THE THREE KIND OF BUBBLE VIN DIAGRAM THAT SHOWED THE, YOU KNOW, WHAT, HOW ARE WE GONNA MEET THESE NEEDS AND HOW ARE WE GONNA PAY FOR IT, UM, AS WE CONTINUE TO DEVELOP THAT PLAN FOR OPERATIONAL IMPLEMENTATION, UH, THEN WITHIN THE NEXT, YOU KNOW, PROBABLY SIX MONTHS OR SO, WE SHOULD HAVE A STRONGER, I THINK A MORE CLEAR DEFINITIVE TIMELINE FOR WHEN WE MIGHT BE ABLE TO, UH, YOU KNOW, INVEST IN, UH, A FACILITY THE SIZE OF THAT FACILITY AT HOW MUCH IT'S GONNA COST, WHAT ADDITIONAL RESOURCES, YOU KNOW, WE, WE MIGHT NEED FOR WORKING WITH PARTNERS AND, AND WHERE, UH, THE BEST LOCATION FOR THAT IS GONNA BE.
AND RESPITE CONTINUES TO RISE TO THE TOP.
SO I THINK THAT IS GOING TO BE SOMETHING THAT WILL BE ON, ON THE FRONT END.
YOU KNOW, THE, I I HATE TO SKIP AHEAD AS, AS A, YOU KNOW, PLANNER.
I DON'T WANNA SKIP AHEAD THROUGH THAT PROCESS.
UM, YOU KNOW, BUT, BUT I DO SEE THIS AS SOMETHING THAT IS RISING IT THAT CONTINUES TO RISE TO THE TOP OF THE, THE NEEDS THAT WE'RE SEEING.
I'LL, I'LL TURN IT BACK TO YOU GUYS AND THEN ASK MORE QUESTIONS.
AND THANK YOU FOR THIS PRESENTATION.
IT'S DEFINITELY VERY INFORMATIVE AND HELPFUL IN UNDERSTANDING THE HEALTH EQUITY PLAN AND THE GAPS THAT WE STILL HAVE IN SERVING OUR MOST VULNERABLE.
ONE IS AROUND REPRODUCTIVE HEALTH, AND THEN THE SECOND IS, UM, BETTER UNDERSTANDING WHAT PLANS ARE IN PLACE TO ADDRESS THE GAPS THAT YOU'VE, UM, RECOGNIZED.
UM, SO FOR THE REPRODUCTIVE HEALTH, YOU KNOW, YOU MENTIONED, UM, THANK YOU FOR MENTIONING THE TUB TUBAL TUBE.
IS IT TUBAL LATION
UM, WHAT, WHAT ARE WE DOING WITH IN AS FAR AS VASECTOMIES AND OTHER TYPES OF REPRODUCTIVE HEALTH, UH, SERVICES? UM, KNOWING THE STATE OF REPRODUCTIVE HEALTH AND THE STATE OF TEXAS, AND KNOWING THAT CENTRAL HEALTH IN OUR, IN OUR HEALTHCARE DISTRICT IS SET UP TO SERVE OUR MOST VULNERABLE AND THE DISPROPORTIONATE IMPACT THAT OUR COMMUNITIES WILL HAVE AS A RESULT OF, UM, RECENT, UM, RECENT LEGISLATIVE ACTION THAT, UM, THAT HAS HAPPENED.
SO COULD YOU TOUCH ON A LITTLE BIT MORE WHAT AL CENTRAL HEALTH HAS DONE WHEN IT COMES TO REPRODUCTIVE HEALTH SERVICES? THANKS.
UH, SO GREAT, GREAT QUESTIONS.
UM, I'M GONNA, I'M GONNA SHARE SOME OF WHAT WE'RE DOING.
I'M GONNA TELL YOU THAT THERE, IT'S GONNA, IT'S HARD TO COMBAT SOME OF THE LEAD, YOU KNOW, SOME OF WHAT'S HAPPENED IN OUR, IN OUR COMMUNITY AND ACROSS THE NATION.
UM, WE ARE IN THE PROCESS OF CONTRACTING FOR VASECTOMIES.
UM, THE, THEY WERE VARIOUS PROVIDERS WITHIN SOME OF OUR PRIMARY CARE PARTNERS, UM, THAT HAVE POTENTIALLY BEEN DOING THEM.
BUT, UM, THE NEED, I THINK HAS BEEN SO SPARSE OVER THE PAST FEW YEARS THAT, UM, WE REALLY HAVEN'T UTILIZED THOSE PROVIDERS.
AND SO THERE ARE UROLOGISTS WITHIN OUR COMMUNITY THAT ARE INTERESTED IN CONTRACTING WITH US, AND THAT IS THE DIRECTION THAT WE ARE PURSUING NOW.
UM, AND SPECIFICALLY THERE IS ADDITIONAL ENERGY BEHIND THAT BECAUSE OF EVERYTHING THAT, YOU KNOW, HAS GONE ON OVER THE PAST, YOU KNOW, THREE MONTHS OR SO.
IN ADDITION, WE'RE LOOKING AT OUR MOST VULNERABLE WITHIN THE VULNERABLE POPULATIONS.
AND SO THERE IS A DOULA PROGRAM THAT WAS JUST INITIATED, UM, WI WITHIN COMMUNITY CARE BECAUSE FOR AFRICAN AMERICAN MOMS, I THINK THE OUTCOMES, YOU KNOW, THERE ARE HUGE DISPARITIES AND OUTCOMES THERE.
AND, UM, AND THERE'S, THERE'S GOOD DATA THAT REALLY SHOWS THAT PARTNERING WITH DUAL IS AND CREATING UNIQUE ENVIRONMENTS FOR CARE AND MONITORING, UM, ACTUALLY, UM, INCREASE, UM, THE, THE CHANCE FOR POSITIVE OUTCOMES.
AND SO WE'RE TRYING TO FOCUS ON INDIVIDUAL COMMUNITIES, UM, AND CULTURES, UM, IN ORDER TO DO A LITTLE BIT MORE HAND HOLDING, UM, TO HELP OUR MOMS THROUGH, YOU KNOW, THROUGH THIS TOUGH TIME.
AND I THINK PROVIDING EDUCATION, EDUCATION INFORMATION.
AND, UM, AND IT'S BEEN CHALLENGING.
[00:45:01]
I MEAN, THERE IS, PROVIDERS ARE ANXIOUS, CARE TEAMS ARE ANXIOUS, WHAT CAN THEY SAY? WHAT CAN'T THEY SAY? UM, AND SO, UM, THIS IS A UNIQUE TIME TO BE A WOMEN'S HEALTH PROVIDER.UM, I THINK IN OUR COUNTRY, AND ESPECIALLY IN TEXAS, WE, WE HAVEN'T FIGURED IT ALL OUT, BUT WE, WE'VE PULLED, UM, SUBJECT MATTER EXPERTS TOGETHER AND WE'RE TALKING NOT ONLY IN THE STATE, BUT ALSO IN THE COUNTRY.
AND SO WE'RE STILL WORKING ON IT.
AND I'M CURIOUS, I KNOW CENTRAL HEALTH RECENTLY ADOPTED A BUDGET.
UM, DID THAT BUDGET INCLUDE ANY INCREASE IN, IN FUNDING FOR REPRODUCTIVE HEALTH SERVICES? OR EXCUSE ME, THE TRAVIS COUNTY RECENTLY ADOPTED, UH, CENTRAL HEALTH BUDGET? YES.
AND SO WE HAVE, UH, OVER A $90 MILLION INCREASE IN OUR HEALTHCARE DELIVERY SERVICES.
AND THAT'S THE FULL SPECTRUM OF CARE, UM, INCLUDING, UH, REPRODUCTIVE SERVICES AS WELL.
BUT WAS THERE ANY INCREASE THAT WENT TOWARD REPRODUCTIVE HEALTH? I'LL, YEAH, I'LL HAVE TO LOOK AT THE SPECIFIC LINE ITEMS AND GET BACK TO YOU ON THE PRECISE NUMBER.
UM, AND THEN THE OTHER QUESTION I HAD WAS AROUND, UM, YOU KNOW, Y'ALL LAID OUT THE, THE SIGNIFICANT GAPS, UM, AND THEY WERE PARTICULARLY ON, OR THEY WERE FOCUSED ON, UM, HOSPITAL ACCESS, DENTAL, POST-ACUTE AND SPECIALTY CARE.
UM, YOU KNOW, I HAVE LONG POINTED OUT THAT WE DON'T HAVE A FULL SERVICE HOSPITAL EAST OF 35 TO HELP OUR COMMUNITY HERE IN THE EASTERN CRESCENT.
UM, WHAT OTHER PLANS ARE IN PLACE NOW THAT WE KNOW THAT THIS IS A SIGNIFICANT GAP, WHAT ARE SOME OF THE STRATEGIES THAT CENTRAL HEALTH IS TAKING OR CONVERSATIONS THAT Y'ALL MIGHT BE HAVING, UM, TO HELP CLOSE THOSE GAPS? YES, THANK YOU.
AND FOR THE QUESTION, SO THERE'S REALLY TWO POINTS OF CONVERSATION, IF YOU WILL.
ONE IS IN OUR OPERATIONAL PLANNING THAT, UM, BOTH ALAN AND MONICA EXPOUND UPON, YOU KNOW, WHERE WE LOOK FORWARD ONE TO THREE YEARS, AND IT'S BASED ON THE COMMUNITY NEEDS ASSESSMENT.
HOW DO WE START OPERATIONALIZING TO BE ABLE TO FILL THOSE GAPS ON HEALTHCARE THAT YOU SAW ON THE CHART THAT DR.
SCHULS RECOVERED NOW AS A HEALTHCARE DISTRICT? INEX IS UNDER CHAPTER 2 81.
UM, THERE IS NO LIMITATION ON WHEN AND WHERE AND HOW YOU CONVERSE ABOUT WHAT ARE THE FUTURE HOSPITAL NEEDS FOR TRAVIS COUNTY.
AND THAT IS SOMETHING THAT IS AN ONGOING, UH, CONVERSATION AT THE BOARD LEVEL, NOT JUST AT THE STAFF LEVELS.
CAUSE WE HAVE BOARD MEMBERS THAT ARE ALSO, UM, LEADING THAT CONVERSATION.
THE SECOND CONVERSATION POINT IS IN A FIVE YEAR, UH, PERFORMANCE REVIEW, UH, THE COUNTY COMMISSIONER'S COURT ACTUALLY PASSED A PERFORMANCE AUDIT, BUT WITHIN THAT PERFORMANCE AUDIT FRAMEWORK, THAT IS ANOTHER PLACE WHERE WE CAN HAVE A DISCUSSION AROUND WHEN WE THINK ABOUT HOSPITAL NEEDS AND FILLING GAPS IN CARE.
YOU KNOW, WHAT DOES THAT LOOK LIKE GOING FORWARD? UM, IT'S, IT'S A LOT OF THE SAME TYPES OF, UM, ANALYSIS, IF YOU WILL.
BUT, YOU KNOW, AGAIN, GOING BACK TO OUR HEALTHCARE EQUITY APPROACH, STARTING WITH THE VOICES OF THE COMMUNITY AND LOOKING AT THE COMMUNITY NEEDS ASSESSMENT, AND THEN LOOKING WHAT THE CAPACITY IS CURRENTLY FOR THE DIFFERENT TYPES OF HOSPITAL CARE, AND THEN BACKING INTO, OKAY, THINKING FORWARD INTO THE FUTURE MULTIPLE YEARS, WHAT DOES THAT LOOK LIKE FOR TRAVIS COUNTY? AND SO THAT'S SOMETHING THAT IS, IT'S, I I WOULD CHARACTERIZE IT AS BEYOND IDEATION.
AND IT REALLY IS GETTING DOWN TO BRASS TAX TO SAY, OKAY, WHAT DO WE NEED, WHERE AND WHEN AND WHAT TIMEFRAME.
UM, I'M JUST GOING TO, I THINK, GIVE SOME NUTS AND BOLTS OF NEXT STEPS, BECAUSE THE EXAMPLES THAT I GAVE WERE, UM, WE'RE JUST A FEW EXAMPLES OF WORK THAT HAS BEEN DONE IN THE PAST FISCAL YEAR.
AND I THINK THERE WERE, THERE WERE 42, THERE WERE 42 CLINICAL INITIATIVES THAT WE WERE WORKING ON THAT WEREN'T JUST CONTRACTUAL, RIGHT? AND SO I THINK I, I CITED THREE OR FOUR OF THEM.
UM, MOVING FORWARD, WE'VE GOT, IF WE'RE LOOKING AT BUILDING OUT THE INFRASTRUCTURE, WHICH IS WHY WE SHOWED KIND OF THAT COG SLIDE.
SO WHAT ARE, WHAT ARE THE CRITICAL GAPS THAT WITHOUT BUILDING A HOSPITAL RIGHT NOW, THAT WE CAN START TO BUILD TOWARDS SO THAT WE, OUR PATIENTS DON'T FALL INTO THE CRACKS AND WHATEVER THE FUTURE HAS IN STORE, WHEREVER WE END UP, WE HAVE THAT, THAT INFRASTRUCTURE BUILT.
SPECIALTY CARE IS A CRITICAL NEED, RIGHT? SO WE'RE WORKING ON, UH, ROSEWOOD OSA, WHICH, YOU KNOW, WAS CRITICALLY USEFUL, UM, TO OUR COMMUNITIES, YOU KNOW, DURING THE, THE HEIGHT OF THE PANDEMIC, UM, THAT WILL BECOME A SPECIALTY CLINIC WITHIN THE NEXT YEAR.
AND THEY WILL BE SIX SPECIALTIES THAT WILL BE RUN OUT OF THAT CLINIC, PULMONARY, GI, NEPHROLOGY, NEUROLOGY, UH, PODIATRY AND CARDIOLOGY, RIGHT? AND THE REASON THAT
[00:50:01]
THOSE SPECIALTIES, WE ARE ADDING THOSE SPECIALTIES IS BECAUSE IF YOU LOOK AT THE WAIT TIMES FOR OUR PATIENTS, THE HIGHEST WAIT TIMES ARE FOR THOSE SPECIALTIES.IN ADDITION TO PROVIDING THOSE SPECIALTIES THERE, THERE WILL ALSO BE DIAGNOSTICS, WRAPAROUND CARE, EXPANDED HOURS.
SO ALL OF THE NEEDS THAT OUR PATIENTS HAVE THAT, YOU KNOW, WE'VE BEEN ABLE TO, UM, PROVIDE THROUGH CONTRACTUAL RELATIONSHIPS.
UM, BUT WHAT HAPPENS TOO OFTEN IS THAT, UM, ORGANIZATIONS THAT WE PARTNER WITH EITHER CHANGE THE STRATEGIC PLAN OR THEIR FUNDING AS WELL.
AND THE PATIENTS WHO ARE AFFECTED FIRST ARE OUR PATIENTS.
AND SO WE ARE TAKING, UM, PROFOUND STEPS TO REALLY FILL THOSE GAPS.
ANOTHER BUCKET OF TRANSITIONS OF CARE, THE MIDDLE COG, THAT BIG PURPLE COG, ALL OF THE, THOSE FACTORS, WE CAN CONTROL A LOT OF THAT.
AND SO IF WE CAN DO MORE HANDHOLDING IN TRANSITIONING OUR PATIENTS BETWEEN ONE CARE ENVIRONMENT, WE DON'T HAVE TO SET UP AN ELECTRONIC HEALTH RECORD FOR THAT.
WE DON'T HAVE TO BUILD A BUILDING FOR THAT.
WE COULD PUT, UH, WHAT WE CALL NURSE NAVIGATORS INTO HOSPITALS.
WE CAN START MANAGING OUR PATIENTS IN SKILLED NURSING FACILITIES.
WE CAN START TALKING TO EACH OTHER A LITTLE BIT MORE AND JUST MAKING SURE THAT PEOPLE DON'T FALL THROUGH THE CRACKS.
SO WE HAVE HIRED, I THINK ON THAT LAST SLIDE THAT WAS UP, ARE JUST WORK AREAS THAT WE ARE WORKING ON, BUT WE HAVE A MEDICAL EXECUTIVE BOARD SET UP THAT IS BASED ON HEALTH EQUITY.
UM, BUT WITHIN THAT HEALTH EQUITY, WE HAVE A DIRECTOR OF TRANSITIONS OF CARE, WHICH IS KIND OF A JOB TITLE THAT WE MADE UP, BUT WHAT WE THOUGHT WAS THE MOST CRITICAL, UM, ASPECT AND ENVIRONMENT THAT WE NEEDED TO CONCENTRATE ON, BECAUSE AGAIN, YOU DON'T HAVE TO WORRY ABOUT CAPITAL, CAPITAL INFRASTRUCTURE, RIGHT? YOU CAN JUST IMPROVE PATIENT HEALTH, RIGHT, RIGHT THEN AND THERE, UM, WHETHER IT'S ENROLLMENT AND ENGAGEMENT, I MEAN, FOR MANY OF OUR PATIENTS, THE ELECTRONIC ACCESS, UM, THE INTERNET IS DIFFICULT FOR OTHER PATIENTS.
IF THEY CAN MAINTAIN THEIR JOB AND THEY CAN ACTUALLY GET ON A VIDEO CALL OR ON A PHONE CALL, IT MEANS WE CAN ENGAGE THEM IN CARE.
SO NOT ONLY WHO ARE WE ENROLLING, BUT HOW ARE WE ENGAGING OUR PATIENTS, I THINK IS ANOTHER ASPECT.
AND SO WE, WE HAVE A STEPWISE APPROACH, UM, UH, THE RESPITE, UM, CARE AT HOME, AND IT'S NOT HOME HEALTH, BUT IT'S FOR MANY OF OUR PATIENTS, IF WE'RE LOOKING AT THAT CARE CONTINUUM FROM HOSPITALS TO SKILLED NURSING FACILITY TO RESPITE TO MOBILE AND STREET, THERE ARE PATIENTS THAT DON'T NEED TO BE AN ENVIRONMENT AND ACTUALLY DO HAVE A HOME.
AND IF WE CAN ACTUALLY PROVIDE EITHER SKILLED NURSING OR PROVIDER CARE FOR THOSE PATIENTS THAT MAY HAVE, YOU KNOW, CHALLENGED WITH TRANSPORTATION, UM, BUT JUST NEED EPISODIC VISITS, UM, THAT IS SOMETHING THAT I THINK IS SCHEDULED FOR THIRD QUARTER OF THIS NEXT FISCAL YEAR FOR US.
AND I, I WOULD LOVE TO SET UP A MEETING WITH Y'ALL TO GO OVER A LITTLE BIT MORE IN DEPTH THIS SPECIALTY CARE AREAS.
I KNOW THAT CENTRAL HEALTH IS IN THE PROCESS OF BUILDING OUT THE CLINICS IN DEL VALLEY AND HORNSBY BIN, SO I WOULD BE CURIOUS TO KNOW WHAT SPECIALTY CARE FOCUS AREAS ARE BEING CONSIDERED FOR THOSE TWO CLINICS AS THAT WILL BE CENTRALLY LOCATED IN OUR MOST EASTERN COMMUNITIES.
UM, ALSO WOULD LOVE TO TALK MORE ABOUT, UM, YOU KNOW, HOW WE COORDINATE BETWEEN THE CITY OF AUSTIN AND, AND CENTRAL HEALTH.
WE HAVE RECENTLY ADDED TELEHEALTH KIOSKS INTO SOME OF OUR PUBLIC HEALTH.
I MEAN, SOME OF OUR PUBLIC LIBRARIES.
UH, SO FOR EXAMPLE, THE SOUTHEAST BRANCH NOW HAS A, A, A TELEHEALTH KIOSK AVAILABLE FOR OUR COMMUNITY.
AND I WOULD LOVE TO TALK ABOUT HOW WE CAN SYNC THAT UP OR LINK THAT UP WITH CENTRAL HEALTH AND, UH, AND COMMUNITY CARE.
UH, AND THEN ALSO THE OTHER THING I WANNA MENTION, UM, IS OUR COMMUNITY HEALTH WORKERS PROGRAM.
WE JUST CERTIFIED AND GRADUATED OVER 30 INDIVIDUALS WHO ARE PRIMED AND READY, UH, TO HELP OUR COMMUNITY NAVIGATE THE HEALTHCARE SYSTEM AND SOCIAL SERVICES.
SO I THINK THAT'S ANOTHER OPPORTUNITY THAT WE CAN, UM, BETTER COLLABORATE ON AND SEE IF THERE'S ANY WAY, UM, IF CENTRAL HEALTH OR THROUGH YOUR PARTNERS, IF THERE'S OPPORTUNITIES TO LINK OUR GRADUATES, THOSE INDIVIDUALS WHO ARE GETTING CERTIFIED THROUGH OUR PROGRAM, UM, TO JOB PLACEMENT.
AND SO THERE'S A LOT MORE CONVERSATIONS I THINK THAT CAN BE HA THAT COULD BE HAD, AND IT'S EXCITING TIME FOR US BECAUSE WE ARE SEEING A, UH, A BETTER AND MORE ROBUST APPROACH TO HOW WE DELIVER, UH, PUBLIC HEALTH AND HEALTHCARE IN TRAVIS COUNTY.
AND, AND, UM, WOULD LOVE TO CONTINUE TO BE PART OF THAT.
SO THANK YOU CERTAINLY, AND WE WOULD WELCOME THOSE CONVERSATIONS AND, UH, YOU KNOW, JUST TO, UM, MAYBE HAVE A, A PARADIGM MOMENT HERE THAT WE ALL NEED TO BE THINKING ABOUT IN THIS, IN THIS COMMUNITY.
SCH ALSO SPOKE, HAS, CAN TALK ABOUT THIS MORE DETAIL THAN I, BUT WHEN YOU THINK ABOUT PROVIDERS PRACTICING AT THE TOP OF THEIR LICENSE AND REALLY COMPLETING THAT HIGH FUNCTIONING HEALTHCARE SYSTEM AND ALL THE PIECES THAT GO IN BETWEEN, THERE IS SO MUCH ABOUT OUR CURRENT THOUGHTS ABOUT HOW HEALTHCARE IS DELIVERED THAT ARE GOING TO CHANGE RAPIDLY OVER TIME, NOT OVER GENERATIONS, BUT IN
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A VERY SHORT PERIOD OF TIME, SUCH THAT AS WE'RE GETTING PEOPLE TO THE RIGHT CARE AT THE RIGHT PLACE AT THE RIGHT TIME, YOU KNOW, THE, THE OLD WILL GIVE AWAY TO THE NEW.AND THAT'S, THAT'S THE BEAUTY OF HEALTH EQUITY AS YOUR, AS YOUR FOCUS.
BECAUSE NOW YOU ARE, UM, DOING WHAT YOU NEED TO DO TO ELIMINATE DISEASE DISPARITIES AND SEEING THAT THE PROVIDER TEAMS ARE AS EFFECTIVE AS THEY CAN POSSIBLY BE, AND EMPOWERING THOSE TEAMS AND THE PATIENTS THAT RELATIONSHIP.
UM, SO ANYWAY, THAT'S JUST SOMETHING THAT'S, IT'S MORE FOR THOUGHT, UH, AT THIS POINT, BUT, UH, YOU'LL START TO SEE IT MANIFEST IN THE OPERATIONS, UH, IN THE COMING MONTHS.
YOU BROUGHT UP COMMUNITY HEALTH WORKERS.
UM, UH, SO COMMUNITY HEALTH WORKERS HAVE TO BE CENTRAL TO EVERYTHING WE DO.
UM, I CAN TELL YOU THE DIAL THE DIALYSIS PROGRAM IN PART PART OF THE SETUP WAS, UM, WAS ORGANIZED BY A COMMUNITY HEALTH WORKER AND A COMMUNITY HEALTH WORKER OVERSEES THAT HEART FAILURE PA PATIENTS AND THE MANAGEMENT OF A HEART FAILURE PATIENTS.
AND THAT PROGRAM MANAGED BY COMMUNITY HEALTH WORKER.
WE HAVE A TINY EDUCATION RESEARCH DEPARTMENT THAT WE JUST SET UP.
UM, WE HAVE TWO COMMUNITY HEALTH WORKERS WHO SIT IN THAT ENVIRONMENT TO PROVIDE EDUCATION AND NAVIGATION OF OUR PATIENTS THROUGH THE SYSTEM IS BEST DONE BY COMMUNITY HEALTH WORKERS.
AND SO I THINK THERE'S A LOT OF OPPORTUNITY.
WE JUST HAD A CONVERSATION THIS PAST WEEK ABOUT CREATING CAREER PATHS FOR COMMUNITY HEALTH WORKERS, ESPECIALLY THE ROCK STARS, YOU KNOW, THAT CAN LEARN AND THEN REINVEST THEIR KNOWLEDGE AND HELP, UM, EDUCATE OTHERS.
SO I THINK LOTS OF OPPORTUNITIES.
ANY OTHER QUESTIONS BEFORE WE MOVE BACK TO THE RESPITE CARE? UM, I HAVE SOME QUESTIONS RELATED TO THAT.
DO WE HAVE ANY OTHER QUESTIONS ABOUT THE HEALTH EQUITY PIECE OF THE PRESENTATION? UM, NO.
I HAVE RESPITE RESP, SO WHY DON'T YOU FINISH YOURS.
I'LL, I'LL KICK US OFF ON SOME ADDITIONAL RESPITE CARE.
UH, YOU KNOW, AND LOOKING THROUGH THIS CHART, WHICH IS REALLY VALUABLE, LOOKING AT, UH, THE, THE VARIOUS ELEMENTS AND PARTNERS AND, AND PIECES THAT YOU NEED OF A FUNCTIONING A HIGH, HIGH FUNCTIONING HEALTHCARE SYSTEM, IT STRIKES ME THAT IT WOULD BE VERY USEFUL TO, TO FILL IN SOME OF THE BLANKS ABOUT THE VARIOUS PARTNERS THROUGHOUT THE, THROUGHOUT OUR COMMUNITY THAT ARE, ARE HELPING TO FILL THIS.
I THINK THAT WOULD BE A REAL VISUAL, VERY VISUALLY USEFUL, UM, TO SEE WHERE SOME OF THE GAPS ARE.
AND YOU'VE IDENTIFI A FEW OF THEM HERE TODAY, RESPITE CARE, WHICH YOU'RE COMMITTED TO AND, AND WORKING ON.
UM, I DO HAVE ONE QUESTION THAT'S NOT RESPITE, IF YOU WANT ME TO GO CAFFEINE IN.
UM, ACUTE DETOX, WHICH WE'VE HEARD AGAIN AND AGAIN, ARE THERE OTHER OTHERS THAT I MISSED IN YOUR PRESENTATION ABOUT AREAS WITHIN THE HEALTHCARE SYSTEM THAT YOU FEEL AS A COMMUNITY WE NEED TO FOCUS ON ADDRESSING? UM, I, I, I THINK TO SAY NO WOULD JUST BE SILLY.
I THINK THERE'S, THERE'S SIGNIFICANT AREAS.
UM, YOU KNOW, I I THINK WHETHER IT'S CANCER CARE, WHETHER IT'S RADIATION, WHETHER IT'S THERE, THERE IS A, YOU KNOW, I THINK WE COULD FILL OUT A LONG LIST, RIGHT.
UM, I DON'T WANNA SHORTCUT THAT.
HA, VERY HAPPY TO GET SOME OF THAT INFORMATION BACK TO YOU.
YEAH, IT'D BE INTERESTING AND LOT.
THERE ARE MANY, MANY GAPS THROUGHOUT AND COUNCIL MEMBER FUENTES AS QUESTIONS I THINK ELIMINATED OR POINTED THE WAY TO SOME OF THOSE AS WELL, IT WOULD BE INTERESTING TO KNOW KIND OF WHAT ARE THE TOP FIVE, TOP FIVE TO 10, UH, NEEDS IN OUR COMMUNITY THAT WE NEED TO BE FOCUSED ON.
UM, COUNCIL MEMBER KITCHEN, AND THEN, AND THEN I HAVE SOME RESPITE QUESTIONS.
YEAH, JUST A VERY, VERY QUICK, UH, IN THE NON RESPITE AREA.
SO, UM, I'M ALSO INTRIGUED BY THE DATA THAT YOU HAVE PUT TOGETHER.
YOU KNOW, IT'S PART OF YOUR LISTENING TO THE COMMUNITY AS WELL AS YOUR COMMUNITY HEALTH NEEDS ASSESSMENT.
UM, I THINK IT'D BE INTERESTING, UM, TO, TO, UM, HAVE ACCESS TO THAT DATA DOWN TO THE NEIGHBORHOOD LEVEL, UH, FOR, FOR COUNCIL MEMBERS, UH, JUST TO, UH, AND, AND ACTUALLY THAT, YOU KNOW, THERE'S DATA AVAILABLE THROUGH OUR HEALTH DEPARTMENT, ALSO OUR PUBLIC HEALTH DEPARTMENT.
BUT, UM, WHAT CAME TO MIND FOR ME WAS ONE OF THE THINGS THAT WE DO ON THE CITY SIDE IS WE PARTNER WITH HOUSING WORKS TO, TO HAVE A SCORECARD ON A REGULAR BASIS OF HOW WE'RE DOING ON, ON HOUSING.
BUT IT WOULD BE VERY INTERESTING IF WE HAD SOMETHING SIMILAR ON HEALTH EQUITY THAT, UM, THAT'S, YOU KNOW, JUST SHORT AND ONE PAGE KIND OF TRACKING OF HOW WE'RE DOING ON HEALTH EQUITY ISSUES.
THAT'S A, THAT'S A BIG ASK AND IT'S JUST AN IDEA AT THIS POINT.
BUT, UM, AND IN THE MEANTIME, CAN YOU JUST TELL ME WHAT, WHAT LEVEL OF DETAIL DO YOU HAVE GEOGRAPHICALLY IN TERMS OF YOUR, OF YOUR, OF YOUR HEALTH NEEDS ASSESSMENTS? AND LET ME GET A LITTLE BIT MORE SPECIFIC THAN THAT.
SO YOU WERE, HAD TALKED EARLIER ABOUT LOW INCOME, UH, COMMUNITIES AND THAT THAT WAS ONE OF THE THINGS THAT YOU WERE TRACKING IN
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YOUR NEEDS ASSESSMENT.UM, AND I COULD SEE IN THE BACKGROUND, YOU HAVE SOME MAPS, BUT DO YOU HAVE MAPS DOWN TO THE NEIGHBORHOOD LEVEL OR THE CENSUS TRACK LEVEL, OR HOW, HOW GRANULAR ARE THE MAPS AVAILABLE? SO WE HAVE, UH, THE GRANULAR IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
THE INFORMATION THAT GOES INTO EACH REGION IS BASED ON, UH, CENSUS TRACKED LEVEL DATA.
AND, UM, WE HAVE THAT GRANULAR INFORMATION ABOUT THE NEEDS, THE DISPARITIES, THE SOCIAL DETERMINANTS, UM, IN, UH, FOR EACH REGION WE GROUPED THE REGIONS, UM, BY KIND OF AR AREA IS, UM, YOU KNOW, GEOGRAPHICALLY ARE, ARE THE, DO THE COMMUNITIES GO TO THE SAME GROCERY STORES? DO THEY USE THE SAME CLINIC? ARE THE ROADWAYS SURROUNDING OKAY.
UH, THE NEIGHBORHOODS, THINGS THAT FACILITATE OR CREATE BARRIERS.
UM, SO, YOU KNOW, WE WOULDN'T HAVE SOMETHING THAT CROSSES AN AREA.
SO THAT'S HOW WE KIND OF GROUPED, UH, THE CENSUS TRACKED AREAS INTO THE 14 REGIONS.
UM, I, WE ARE ALSO, AS WE'RE UPDATING OUR DEMOGRAPHIC REPORT THAT LOOK ON, THAT LOOKS AT, UH, HEALTH CONDITIONS, POVERTY, SOCIAL DETERMINANTS, THAT WILL BE, UM, UPDATED, UH, BY THANKSGIVING.
WE LOOK AT THAT ON A CENSUS TRACK LEVEL.
I THINK THEY'RE CARRYING IT OVER WITH THIS KIND OF 14, UM, YOU KNOW, 14 REGIONAL AREAS.
ALTHOUGH AS THE CENSUS, UH, CHANGES AND THE DIFFERENT, YOU KNOW, WE, THAT'S ONE OF THE REASONS THAT INSTEAD OF IT BEING DONE IN OCTOBER, IT'S, YOU KNOW, TAKING UNTIL NOVEMBER IS BECAUSE SINCE WE DID OUR LAST DEMOGRAPHIC REPORT AND THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE CENSUS RESULTS, UM, HAVE COME OUT.
AND OF COURSE, YOU KNOW, YOU LOOK IN COMMUNITIES LIKE, UH, FLICKERVILLE MM-HMM.
NOW I'VE BEEN SPLIT INTO TWO OR THREE CENSUS TRACKED AREAS.
SO, YOU KNOW, WE'LL PROBABLY HAVE TO HAVE SOME SORT OF KEY SO THAT, YOU KNOW, PEOPLE CAN MAP OVER TIME.
UH, YOU KNOW, WHAT YOU'RE TALKING ABOUT, YOU KNOW, AREA BY AREA.
UM, AND I THINK THE IDEA OF TRYING TO HAVE, YOU KNOW, A, I ALWAYS LIKE THE IDEA OF ONE PAGER, MAYBE FRONT AND BACK, ONE PAGE, YOU KNOW, BUT I KNOW IT'S ALWAYS DIFFICULT.
TRYING DOCUMENT WOULD BE GREAT.
AND COUNCIL MEMBER, IN RESPONSE TO YOUR QUESTION OF THE MATERIALS THAT, UH, ARE ON YOUR DESK AND COUNCIL MEMBER FUENTES, AGAIN, WE CAN GET, UM, THIS, THIS BIG NOTEBOOK HARD COPY TO YOUR OFFICE IF, IF YOU DON'T ALREADY HAVE ONE, BUT IF YOU GO TO TAB THREE AND STARTING ON PAGE 59, THAT SHOWS YOU THE SOCIAL VULNERABILITY SCORES, THAT'S THE JUMPING OFF POINT, IF YOU WILL.
AND IT BREAKS IT DOWN BY NEIGHBORHOOD, BUT THEN GOING INTO SECTION SEVEN, IT COVERS NOT ONLY, UM, SOCIAL ECONOMIC ISSUES, BUT THEN IT STARTS TO GET INTO THE TYPES OF FACILITIES, THE DISEASE, UM, AND HEALTH CONDITION BURDENS, UH, THAT PEOPLE BEAR.
AND SO IT'S, UH, AGAIN, IT'S NOT THE ONE PAGER.
UM, CUZ, BUT, BUT THAT'S, THAT'S, THAT'S GOOD.
BUT IT'S, IT'S VERY DETAILED INFORMATION THAT REALLY GETS TO THE POINT IN THE HEART OF YOUR QUESTION.
AND I, AND, UH, THANKS FOR POINTING US TO SOME OF THE AREAS IN THE BINDER WHERE WE CAN FIND THAT MORE DETAILED INFORMATION, YOU KNOW, AND LOOKING AT THE CAN DASHBOARD, I SEE THAT, YOU KNOW, THIS IS, UH, A HEALTHY COMMUNITY IS ONE OF THE AREAS WHERE THEY MEASURE AS WELL, AND IT, IT MIGHT BE GOOD FOR THOSE COUNCIL MEMBERS WHO SERVE ON THERE TO KIND OF REFLECT THIS BACK AS A REQUEST FOR THE DASHBOARD TO REALLY GET AT SOME OF THE, THE HEALTH EQUITY MEASURES, SOME MEASURES FOR HEALTH EQUITY AND, AND MAKE SURE THAT THOSE ARE STARTING TO BE REFLECTED ON THE DASHBOARD AS WELL.
UM, I HAD A COUPLE OF QUESTIONS ABOUT THE RESPITE.
WELL, MANY QUESTIONS, BUT I'LL START WITH A FEW.
SO CAN YOU HELP US UNDERSTAND WHAT DOES RESPITE CARE LOOK LIKE? YOU KNOW, WE TALK ABOUT IT A A LOT AND IT SOUNDS LIKE THERE ARE REAL RANGE.
THERE'S A REAL SPECTRUM OF THAT FROM NEEDING WHAT I WOULD GUESS WOULD BE AROUND THE CLOCK NURSING CARE TO MAYBE A LIGHTER, A LIGHTER MEDICAL APPROACH.
CAN YOU SHARE WITH US WHAT, WHAT THAT SPECTRUM LOOKS LIKE WHERE YOU ARE NOW? UM, AND THEN AS I UNDERSTAND YOUR HIRING SKILLED NURSES OR HIRING, HIRING THOSE NURSES THIS YEAR OR WITH THIS YEAR'S BUDGET, AND SO IT MIGHT LOOK DIFFERENT, BUT WHAT DOES IT LOOK LIKE NOW AND HOW IT WILL EVOLVE IN TERMS OF, UM, INDIVIDUAL PATIENT CARE? OKAY.
UH, WHAT, RIGHT NOW WE ARE, PEOPLE ARE HOUSED IN A SAFE ENVIRONMENT, AND WE
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ARE CASE MANAGING THOSE INDIVIDUALS AND PROVIDING THE SOCIAL SERVICES TO THEM.UM, THE FACT THAT WE ARE PARTNERING WITH A NEW ENTRY MEANS THE, YOU KNOW, THE ADDICTION DISORDER ASPECT.
A LOT OF TIMES WE CAN PROVIDE COUNSELING RIGHT THEN AND THERE.
SO I THINK THAT HAS BEEN A BONUS.
UM, THE NEXT PHASE FOR US IS REALLY GOING TO BE PROVIDING THE MA THE NURSING.
SO IT'S MED RECONCILIATION, WOUND CARE, PHYSICALS, UM, COMMUNICATION WITH PROVIDERS, UH, MORE APPROPRIATE TRIAGE, YOU KNOW, THAT CAN'T REALLY BEEN DONE, BE DONE WHERE YOU'RE NOT ACTIVELY PRACTICING MEDICINE.
I THINK ULTIMATELY WHERE WE WOULD, WHERE WE WOULD LIKE TO LIVE IS IF IT'S, IF THERE'S A SKILLED NURSING FACILITY NEED, WHICH, YOU KNOW, MEANS YOU'VE GOT A LOT MORE MONITORING, AND THAT, THAT'S PROBABLY NOT THE ENVIRONMENT WE'RE LOOKING AT ONE STEP SHORT OF THAT TO WHERE, UM, INDIVIDUALS CAN HOUSE, UM, FOR AS LONG AS THEY NEED TO HOUSE.
AND WE HAVE TEAMS, CLINICAL TEAMS THAT ROUND WHERE THERE'S ACCESS TO THERAPEUTIC APPROACHES.
UM, AND SO IS IT, YOU KNOW, DO THE PHYSICAL THERAPISTS, YOU KNOW, ACTUALLY COME AND, AND WORK WITH THE PATIENTS IN A RESPITE ENVIRON ENVIRONMENT? ABSOLUTELY.
COULD IT BE HOUSED IN AN AREA WHERE THERE'S ACCESS TO A CLINIC SO THE CLINICAL TEAM CAN ACTUALLY SEE PATIENTS, YOU KNOW, THE REST OF THE TIME POTENTIALLY MAINTAIN OR, OR HELP MANAGE THOSE INDIVIDUALS WHO ARE TRANSITIONING THROUGH RESPITE, UM, BUT ONLY UTILIZE THEIR SERVICES, YOU KNOW, IF NEED BE.
AND SO WE ARE NOT LOOKING AT THE HIGHEST ACUITY RESPITE, BUT SOMEWHERE IN BETWEEN WOUND CARE, UH, MED REC AND SKILLED NURSING FACILITY.
AND WE'VE, I THINK YOU ALL KNOW DR.
SHE OVERSEES, UH, THE CARE FOR HIGH RISK POPULATIONS BOTH AT COMMUNITY CARE, UM, AND, UH, SERVES ON OUR MEDICAL EXECUTIVE BOARD FOR, FOR THE HOSPITAL DISTRICT, AND DOES THE SAME THING IN OUR ENVIRONMENT.
SO MOST OF WHAT IRE CANTING, UM, COMES DIRECTLY FROM AUDREY.
AND HER SCOPE OF, OF KNOWLEDGE IS MUCH MORE BROAD THAN MINE.
AND SO, YOU KNOW, THAT FOLLOW UP VISIT FOR A DEEP DIVE INTO THE, THE NEXT STEP IN THE ENVIRONMENT IS PROBABLY MORE, PROBABLY WOULD WANT PULL AUDREY IN.
DO YOU HAVE A SENSE OF WHAT THAT MIDDLE LEVEL ACUITY CARE COSTS PER PATIENT? I DO NOT.
I THINK THAT IS PART OF THE WORK THAT WE ARE CURRENTLY, YOU KNOW, ENGAGED IN, UM, AT, AND PART OF IT IS THE CARE PART OF IT ARE, ARE ASPECTS THAT, YOU KNOW, WE MAY NOT THINK OF LIKE A CAFETERIA, RIGHT? AND SO THEY REALLY ARE WRAPAROUND SERVICES THAT ARE NEEDED WHEN YOU'RE THINKING ABOUT HOUSING INDIVIDUALS FOR AN EXTENDED PERIOD OF TIME.
AND, UM, THAT IS WHAT WE ARE CURRENTLY WORKING ON.
DO YOU HAVE A MODEL FROM ANOTHER COMMUNITY OR ANOTHER FEW COMMUNITIES THAT YOU'RE WORKING TOWARD? AND IF SO, WHAT COMMUNITIES? UM, SO THE, THE MODELS, AUDREY COMES FROM, UM, I THINK THE SAN JOSE AREA IN CALIFORNIA.
AND, YOU KNOW, SHE SPEAKS OF THE MODEL THAT I THINK THERE WAS A, THERE WAS A, UM, KIND OF A DENVER MODEL AS WELL.
BUT YOU KNOW, WITHIN SAN JOSE, I THINK ALL THE HOSPITALS ACTUALLY PARTNERED, UM, IN ORDER TO CREATE A RESPITE ENVIRONMENT.
UM, AND YOU KNOW, I CAN, I CAN ASK AUDREY AND WE CAN SHARE KIND OF WHAT THAT, WHAT THAT MODEL IS, BUT I THINK THAT IS MOST OF THAT, THAT'S THE DIRECTION THAT SHE'S MODELING THIS AFTER.
AND I ASSUME IF WE LOOKED, IF WE LOOKED TO THOSE TWO CITIES, WE WOULD GET A SENSE OF WHAT THE FACILITY LOOKS LIKE, YOU KNOW, AS WE'VE ABSOLUTELY, AS PEOPLE HAVE TALKED WITH US ABOUT THIS CONCEPT THROUGH THE YEARS.
UM, SOMETIMES THEY'VE SUGGESTED CITY BUILDINGS OR OTHER KINDS OF FACILITIES THAT MIGHT SERVE AND SOME, UM, THINKING TOWARD THAT TOO, YOU KNOW, WHAT, WHAT WOULD A, WHAT WOULD A FACILITY LOOK LIKE? ARE THESE, DO THESE TEND TO BE BUILT FROM THE GROUND UP? UM, ARE THEY BUILT ALONGSIDE SOMETHING ELSE, AS YOU DESCRIBED, ALONGSIDE A CLINIC? IS IT HOW ADAPT, WHAT KIND OF SPACE NEEDS MIGHT YOU HAVE? THOSE THOSE ARE ALL I GREAT QUESTIONS.
AND, AND THOSE ARE ALL CONSIDERATIONS.
I MEAN, ONE OF THE THOUGHTS WE'VE HAD IS IF YOU'RE LOOKING AT A SKILLED NURSING FACILITY, IS THERE A WING OF A SKILLED NURSING FACILITY SO THAT YOU CAN TRANSITION PATIENTS TO HIGHER, A LOWER ACUITY AS NEED BE, AND KIND OF HAVE A STEPWISE KIND OF DISCHARGE APPROACH AS MAY, MAY BE APPROPRIATE? IS THERE A, UH, A MEDICATION ASSISTANCE THERAPEUTIC, YOU KNOW, A MAT PROGRAM, UH, ACCESS TO SUBOXONE AND METHADONE? UM, CAN YOU BRING IN SPECIALTY CARE? UM, UH, COMMUNITY CARE HAS A, A CLINIC CALLED CARO, WHICH IS REALLY A COMPLEX CLINIC, UM, WHEREBY INDIVIDUALS WHO, UM, ARE DISCHARGED FROM THE HOSPITAL BUT REALLY NEED WRAPPED SERVICES, SPECIALTY CARE, HIGH SOCIAL NEED SERVICES, CAN GO TO ONE CLINIC AND RECEIVE KIND OF ALL OF THOSE SERVICES.
DO YOU LOCATE A CLINIC LIKE CARE CO IN AN ENVIRONMENT LIKE THAT? SO YOU CREATE A HUB,
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YOU KNOW, FOR CLINICIANS AND EVEN IF THEY, THERE'S A REMOTE CARE THAT PATIENTS ARE THERE AND ALL OF THE OTHER SERVICES EXIST.SO I THINK THERE ARE LOTS OF WAYS THIS WAYS THIS CAN BE DESIGNED.
UM, UH, TWO THINGS JUST TO, TO, UM, YOU KNOW, FOLLOW UP A BIT ON WHAT, WHAT YOU ASK, UH, COUNCIL MEMBER TOVO.
UM, I THINK IT'D BE INTERESTING AS, AS WE PROCEED WITH THIS TO, UH, TO HAVE CONVERSATIONS ABOUT, UM, PARTNERSHIPS WITH THE CITY, UH, IN TERMS OF FACILITIES.
SO FOR EXAMPLE, YOU KNOW, IF THE CITY HAS A BETTER IDEA OR, OR EARN THOSE DISCUSSIONS ABOUT WHAT IT, WHAT IT WOULD TAKE, WE COULD LOOK AT SOME PARTNERSHIPS.
SO FOR EXAMPLE, UM, IF THE CITY WERE TO PROVIDE A FACILITY OR TO PROVIDE SPACE IN A FACILITY THAT WE CURRENTLY HAVE, LIKE WE HAVE BRIDGE SHELTERS NOW, FOR EXAMPLE.
UM, WOULD THERE BE A POTENTIAL FOR A PARTNERSHIP WHERE CENTRAL HEALTH, UM, CONTRIBUTES THE, THE DOLLAR AMOUNTS THAT'S NECESSARY FOR, UM, THE MEDICAL CARE? UM, AND THE ACTUAL BRICKS AND MORTAR IS SOMETHING THAT THE CITY COULD CONTRIBUTE.
SO THAT'S JUST ONE POSSIBILITY.
AND I THINK THAT, UM, COUNCIL MEMBER TOVO WAS, WAS TALKING ABOUT THAT KIND OF THING AS WELL, YOU KNOW, IN TERMS OF IDENTIFYING WHAT THE FACILITIES ARE.
UM, SO I, I DON'T KNOW, I DON'T KNOW THAT ANY OF THOSE CONVERSATIONS ARE HAPPENING YET.
I WAS JUST GONNA SAY, I THINK IT WOULD BE HELPFUL TO HAVE CONVERSATIONS WITH OUR HOMELESS STRATEGY OFFICE, UM, ABOUT THE POTENTIAL FOR SOME PARTNERSHIP THERE.
CUZ IT SOUNDS TO ME LIKE THAT ONE OF YOUR CHALLENGES NOW AND WHAT YOU'RE THINKING ABOUT IS WHAT KIND OF FACILITY DO YOU NEED? YOU KNOW? UM, AND HOW DO YOU GET TO THAT POINT? SO I THINK EXPLORING, UH, PARTNERSHIPS WITH THE CITY WOULD BE USEFUL.
UM, THAT MAY NOT BE WHERE IT ENDS UP, BUT I THINK IT'D BE USEFUL TO HAVE THAT CONVERSATION.
S'S POINT IS WE BUILD UP THE PROGRAMS AND THE CAPACITY TO MAKE SURE THAT WHEN WE MAKE A COMMITMENT TO AN INDIVIDUAL THAT WE ARE GOING TO PROVIDE CARE FOR YOU IN THIS RESPITE ENVIRONMENT, THAT IT IS EVERYTHING THAT THAT INDIVIDUAL DESERVES.
I THINK, YOU KNOW, HE, HE MENTIONED EARLIER THE LEARNING CURVE, SO THERE'S A LOT THAT WE'RE LEARNING, INCLUDING HOW TO MEASURE AND, AND WHAT TO MEASURE.
THEN I THINK WE CAN FEED THAT INTO THOSE CONVERSATIONS, AND I THINK THAT'LL HELP INFORM WHEN AND WHERE AND HOW THOSE, UH, FACILITY PARTNERSHIPS MIGHT EVOLVE.
UM, THE OTHER THING TOO THAT I WOULD LIKE TO PAUSE IT WITH, UM, THIS COMMITTEE TO, TO THINK ABOUT AND IS THERE, IS, THERE'S A LOT OF OPPORTUNITIES WHEN IT COMES TO PROGRAMS AND ORDINANCES AND, AND OTHER, UM, CITY I, I THINK FUNDED PROGRAMS ARE CITY AFFECTED PROGRAMS WHERE IF WE'VE GOT A HEALTH AND WELLNESS CENTER THAT WE'RE CONSTRUCTING SOMEWHERE AND, YOU KNOW, DOES, IS IT, IS IT OKAY THAT IT'S IN THE E J THAT ARE THERE SOME OPPORTUNITIES THERE? AND SO I THINK LOOKING AT THE DIFFERENT THINGS THAT COME BEFORE THE COUNCIL TO, YOU KNOW, IF IT'S INVOLVES PEOPLE IN PLACE, WHICH IS A LOT OF, YOU KNOW, ALMOST, I THINK PROBABLY DESCRIBES 99% PERHAPS OF WHAT COMES BEFORE YOU.
BUT LOOKING AT IT THROUGH THE LENS OF, OKAY, WELL WE KNOW THAT THERE'S OTHER PROVIDER PARTNERS OUT THERE THAT, THAT HAVE THESE CARE PROGRAMS THAT THEY'RE BUILDING UP.
IS THERE SOMETHING HERE THAT WE CAN BRING FORWARD AND ACCELERATE, UM, TO BE ABLE TO GET THAT PHYSICAL SPACE, UM, AND HAVE IT PACE WITH, WITH THE PROGRAM.
SO I THINK ONE OF THE, UM, APPARELS THAT WE NEED TO TRY TO AVOID AS A COMMUNITY IN THE ANALOGY THAT WE USE IS, UH, SELLING A TICKET FOR AN AIRPLANE, BUT YOU DON'T HAVE A FULL CREW TO BE ABLE TO MAKE IT YEAH.
YOU KNOW, WE NEED TO MAKE SURE THAT THAT'S IN PLACE FIRST.
UM, BUT, BUT I WOULD, I'M JUST, AGAIN, 100% APPRECIATE YOUR CONVERSATION HERE AND THE, AND WE AGREE.
UM, JUST KIND OF PUTTING SOME FINER POINTS ABOUT, YOU KNOW, HOW THE PLANNING COULD OCCUR JOINTLY.
WELL, AND THIS MIGHT BE APPLICABLE TO MY NEXT, THAT MIGHT BE APPLICABLE TO MY NEXT COMMENT, YOU KNOW, THAT THE IDEA OF THE RESPITE CARE, AND I'M GONNA, UM, AGE MYSELF HAS BEEN IN THIS COMMUNITY FOR OVER 10 YEARS, UM, CLOSE TO 15 YEARS.
AND THERE ACTUALLY WAS A PROGRAM THAT WAS OPERATED, AND IT NEVER, IT NEVER GOT VERY FAR.
AND SO I KNOW THAT YOU ALL KNOW THAT.
AND SO I'M, I'M, I'M SURE YOU'RE, AND I WOULD WANNA MAKE SURE, WELL, I'M SURE YOU'RE DOING THIS, IS UNDERSTAND WHY THAT PROGRAM DIDN'T CONTINUE.
WHAT HAPPENED? WHAT WERE THE BARRIERS THERE? UM, I DON'T KNOW ALL THE DETAILS.
I WAS THERE WHEN IT LAUNCHED AND I WASN'T THERE FOR
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THE MIDDLE PART OF IT, SO I'M NOT SURE WHAT THE BARRIERS WERE.I SUSPECT THAT ONE OF THE BARRIERS HAD TO DO WITH, WELL, WHERE DO YOU LOCATE IT? CUZ I KNOW DURING SOME OF THAT TIME, THERE WERE CONTRACTS WITH SKILLED NURSING FACILITIES FOR BEDS, AND THAT WAS HOW THE RESPITE PROGRAM WAS WORKING.
THE OTHER THING THAT I WAS AWARE OF THAT NEVER GOT FULLY LAUNCHED WAS THE WHOLE CONTINUUM, LIKE YOU JUST MENTIONED.
IN OTHER WORDS, THERE WASN'T A PLACE WHEN SOMEONE WAS READY TO BE DISCHARGED FROM THAT RESPITE CARE THAT KEPT THEM FROM GOING BACK ON THE STREETS.
SO I JUST WANT, UM, I WANNA MAKE SURE, AND I'M A LITTLE, A LITTLE ANXIOUS AND A LITTLE BIT, UM, IMPATIENT, I GUESS
UM, AND, AND SO I FIND THAT FRUSTRATING, BUT I'M ALSO ENCOURAGED BECAUSE OF THE WAY YOU ALL ARE APPROACHING IT, YOU KNOW, IT REALLY SOUNDS TO ME LIKE YOU'VE THOUGHT THROUGH IT AND YOU'VE GOT, UH, YOU'RE OPERATING NOW AND YOU'RE THINKING ABOUT WHAT IT'S GONNA TAKE TO MAKE IT SUSTAINABLE.
SO, BUT I JUST
LET'S, LET'S MAKE SURE THAT THIS REALLY, REALLY GETS TO SCALE AND GETS TO SCALE IN A REASONABLE TIMELINE.
SO YES, I JUST WOULD PUT THAT CHALLENGE OUT FOR Y'ALL.
WELL, AND THAT'S, THAT'S ONE THAT WE EMBRACE WITH YOU.
AND I'LL CIRCLE BACK WITH YOU OFFLINE TO MAYBE GET A LITTLE BIT MORE, UM, ON THE, ON THE PRIOR RESPITE PROGRAM, BUT WE APPRECIATE THAT.
WAS THIS, DO YOU MIND ME ASKING, WAS THIS A CITY OR WAS IT A PRIVATE FOUNDATION RESPITE PROGRAM? I, I WAS HERE 15 YEARS AGO, SO I'M, I'M HAVING A, I THINK, IF I'M REMEMBERING CORRECTLY, IT WAS FRONT STEPS THAT OPERATED IT, BUT I THAT'S RIGHT.
YEAH, IT WAS, IT WAS LAUNCHED THROUGH THE ICC, THE INTEGRATED CARE COLLABORATION.
SO IT WAS A COLLABORATIVE EFFORT.
I KNOW THERE WERE FUNDING ISSUES AT THAT TIME.
UH, AND SO THERE WAS A PILOT, AND I DON'T KNOW HOW IT WAS FUNDED AFTER THAT.
THERE WAS ALSO SPACE QUESTIONS, WHERE WAS IT GONNA BE? RIGHT.
UM, BUT I DON'T KNOW WHAT FINALLY, I DON'T KNOW WHAT THE BIG BARRIERS WERE.
COUNCIL MEMBER KITCHEN, I THINK WE'VE BEEN TALKING ABOUT THIS FOR AS LONG AS, AS LONG AS THE TWO OF US HAVE SERVED, UM, HERE ON THE DIAS.
AND SO IT IS TO THE EXTENT THAT, UH, THAT WE CAN BE SUPPORTIVE IN THESE LAST COUPLE MONTHS AND, AND OUR COLLEAGUES, UM, AFTER OUR DEPARTURE.
I KNOW THAT THIS IS A REALLY HIGH PRIORITY FOR THE CITY COUNCIL TO MAKE SURE THAT THIS, UM, THAT WE LEND SUPPORT AS APPROPRIATE.
I'D LIKE TO LOOK AT TOGETHER AT THE PAGE THAT TALKS ABOUT OUTCOMES.
I KNOW YOU ADDRESSED, YOU ADDRESSED THIS IN YOUR PRESENTATION, BUT I WANNA CIRCLE BACK ON IT AND REALLY UNDERSTAND.
SO AS I'M LOOKING AT THE DISPOSITION OF THE CLIENTS THAT YOU SERVED, 25% MOVED ON TO TRANSITIONAL PERMANENT HOUSING.
IS THAT, AND I ASSUME YOU DID THAT IN WITH PARTNERS.
UM, AND MAYBE YOU CAN IDENTIFY WHICH PARTNERS THOSE ARE, BUT I'D LIKE TO TALK A LITTLE BIT ABOUT THE 40% WHO LEFT.
CAN YOU HELP US UNDERSTAND SOME OF WHAT, SOME OF WHAT THOSE CHALLENGES WERE? AND AGAIN, I THINK YOU ALLUDED TO SOME OF THOSE CHALLENGES IN YOUR EARLIER COMMENTS, BUT I'D LIKE TO, I'D LIKE TO MAKE SURE I UNDERSTOOD IT.
UH, WHERE TO START THE, SO FOR THE 40% WHO, WHO TRANSITIONED OUT, UM, I THINK THIS IS US REALLY SHOOTING FOR THE MOON AS WELL, BECAUSE POTENTIALLY WE COULD HAVE QUALIFIED, IF ANY, ANY OF THOSE INDIVIDUALS ACTUALLY HAD FOLLOW UP WITH THEIR PCP, ACTUALLY RECEIVED THEIR MEDS ACTUALLY WERE TIED INTO THE SYSTEM, UM, OR REGISTERED FOR HOUSING, WHATEVER, WE COULD HAVE COUNTED IT FOR SUCCESS.
THE ONLY WAY WE'RE COUNTING THE TOTAL VISIT AS A SUCCESS IS IF PEOPLE END UP HOUSED AND THEIR END POINTS IS KIND OF A TERMINAL SUCCESSFUL ENDPOINT.
AND SO FOR THOSE INDIVIDUALS, THEIR, THEIR SOCIAL SERVICES NEEDS WERE JUST NOT COMPLETELY WRAPPED AND MET.
UM, AND IT MAY HAVE BEEN THAT SOMEBODY HAD A DIAGNOSIS OF PNEUMONIA AND WAS STILL FEBRILE AND THE PATIENT, YOU KNOW, OR THE INDIVIDUAL, UM, UH, JUST WANTED, WANTED THE FREEDOM TO BE BACK, YOU KNOW, UM, ON THE STREETS AND WE WOULD'VE LIKED TO SEE NO FEVER, YOU KNOW, AND JUST SOMEBODY DOING MUCH BETTER.
AND SO, UM, FOR THAT 40%, THERE WERE ACTUALLY A LOT OF SUCCESSES THERE, BUT NOT
[01:20:01]
TERMINAL SUCCESS.SO THERE, BECAUSE SUCCESS, BECAUSE THE MEASURE OF SUCCESS FOR ALL OF THEM WAS TO BE PERMANENTLY HOUSED.
PERMANENTLY HOUSED, OR THERE WERE SOME INDIVIDUALS THAT ARE UNDER RESOURCED.
AND I DON'T THINK EVERY INDIVIDUAL, THE MAJORITY OF THEM EXPERIENCE HOMELESSNESS, BUT THERE ARE A COUPLE FOLKS THAT, UM, UH, ARE UNDER RESOURCED INDIVIDUALS, BUT YOU KNOW, ACTUALLY DO HAVE A PLACE TO LIVE.
UM, AND, UM, AND I THINK FOR THOSE INDIVIDUALS, UM, JUST SEEING THAT THEY WERE WELL ENOUGH, UM, AND THEIR, THEIR HOME ENVIRONMENTS IS NOT NECESSARILY SECURE ENOUGH FOR THEM TO HEAL AND, AND DO WELL.
UM, AND SO, UM, I DON'T THINK THE END POINT AT THIS POINT IS A HUNDRED PERCENT HOUSING FOR ALL OF THESE FOLKS.
I DON'T, I DON'T THINK THAT'S POSSIBLE, UH, FOR THEM TO BE CONNECTED TO SOCIAL SERVICES AND OR HOUSED.
DO YOU KNOW IF ALL OF ALL OF THE INDIVIDUALS WHO PARTICIPATED IN THE PROGRAM ARE PART OF OUR, OUR, UM, HAVE GONE THROUGH COORDINATED ASSESSMENT? IS THAT SOMETHING THAT YOU DO EARLY ON SO THAT THEY'RE IN THE QUEUE FOR HOUSING? YEAH, I WOULD, I WOULD, I WOULD HAVE TO CHECK THAT.
I THINK THAT IS PART OF THE INITIATE.
I START WORKING ON THAT THERE, BUT MY GUESS IS THAT MANY OF THEM DO NOT OR HAVE NOT BEEN, BUT I'D HAVE TO CHECK THAT THAT WOULD BE, I WOULD REGARD THAT AS A HIGH PRIORITY EARLY ON SO THAT WE, SO THAT THEY ARE IN THE QUEUE FOR HOUSING.
DO YOU WANNA JUMP IN THERE? I, I WAS JUST GONNA SAY, OKAY, A CAVEAT THAT I UNDERSTAND THE COMPLEXITIES AND IS DIFFICULT, BUT IDEALLY YOU WOULD HAVE ATTACHED TO YOUR SERVICE, THE VOUCHERS OR THE OTHER, UH, RESOURCE THAT SAYS THAT THERE'S HOUSING AVAILABLE FOR EVERYBODY THAT GOES INTO THAT PROGRAM.
SO IF YOU HAVE 10 BEDS, YOU HAVE 10 VOUCHERS, OR YOU KNOW, THAT YOU CAN USE, I KNOW IT'S MORE COMPLEX THAN THAT, BUT IDEALLY THAT WOULD BE THAT SOMETHING TO WORK TOWARDS.
UH, BECAUSE I THINK THAT EVERYBODY THAT GOES INTO RESPITE, NOBODY SHOULD GO BACK ON THE STREETS EVER.
THERE IS, AND THIS IS WHERE AUDREY HAS GREATER EXPERTISE THAN I DO, BUT THERE IS A SUB-SECTOR OF INDIVIDUALS EXPERIENCING HOMELESSNESS WHO ARE NOT READY TO BE HOUSED YET, WHO DON'T WANT TO BE HOUSED YET.
YEAH, NO, I UNDERSTAND THAT PART.
BUT I'M TALKING ABOUT IF THEY'RE READY TO, YOU KNOW, ACCEPT SERVICES.
WELL, IF I MAY PUT ANOTHER QUESTION ON THE TABLE, IS THERE A, IS THERE A TIMELINE MISMATCH? AND SO THERE'S THE MEDICAL RESPITE AND SO WE'RE, WE'RE BRINGING COORDINATED ASSESSMENT AND HOUSING REFERRALS TO THE TABLE.
WE'RE MAKING THOSE WHERE THOSE CONNECTIONS FOR THOSE RESOURCES, BUT THAT POTENTIALLY THAT FULFILLMENT OF THOSE RESOURCES IS ON A DIFFERENT TIMELINE THAN THE ACTUAL MEDICAL RESPITE.
DOES THAT OCCUR? AND, AND MIKE, JUST TO CLARIFY, UM, ARE YOU, ARE YOU SAYING THAT THERE, THAT THE RESOURCES FOR HOUSING SAY MAY FOLLOW, MAY NOT BE READY BY THE TIME AN INDIVIDUAL MAY, MAY BE ABLE TO RECEIVE THE MEDICAL RESOURCES? IT'S ACTUALLY A QUESTION THAT I'M POSING CUZ I'M NOT INTIMATELY FAMILIAR WITH, YOU KNOW, FOR COORDINATED ASSESSMENTS AND THE HOUSING REFERRALS AND THE OTHER, THE OTHER CONNECTION POINTS.
I KNOW WHAT, WHAT WE ARE DOING ON OUR SIDE OF THAT.
BUT IN TERMS ON THE OTHER SIDE OF THE SERVICE PROVIDERS, WHAT THEIR TIMELINES ARE LOOKING WELL, I WOULD, THEY'RE A MISMATCH.
WELL I POTENTIALLY WE NEED TO LOOK AT THAT'S VERY, VERY, YES, I WOULD SAY ABSOLUTELY BECAUSE THE HOUSING RESOURCES ARE SO SCARCE.
BUT, BUT, BUT THAT'S BUT THE M SORRY, GO AHEAD.
I WAS JUST GONNA SAY, BUT THE COORDINATED ASSESSMENT IS, IS KIND OF THE FIRST STEP IN THAT PROCESS.
AND SO MAKING SURE THAT, THAT THOSE INDIVIDUALS ARE, ARE PART OF OUR SYSTEM, UM, I THINK MAKES, MAKES, UM, IS REALLY CRITICAL.
AND, AND, AND CONNECTING THOSE DOTS, I THINK WAS WHAT I WAS GONNA ADD.
SO THAT, UM, SO THAT IF SOMEONE IS IN RESPITE THAT THEY THEN THEY THEN HAVE A PLACE TO STAY UNTIL THEIR HOUSING IS AVAILABLE TO THEM.
SO THAT MAY BE THAT THEY'RE DISCHARGED FROM RESPITE TO, UH, YOU KNOW, A BRIDGE SHELTER OR IT MAY BE THAT YOU HAVE A CERTAIN NUMBER OF UNITS OR DOLLARS AVAILABLE THAT'S JUST SET ASIDE FOR FOLKS THAT ARE IN RESPITE.
I DON'T KNOW WHAT THE SOLUTION IS.
UH, BUT, BUT THAT'S A REALLY GOOD POINT THAT, YOU KNOW, THE E RAISE COUNCIL MEMBER, TOBRA, THERE NEEDS TO BE, THOSE DOTS NEED TO BE CONNECTED.
SO, UM, AND THAT'S NOT SOMETHING THAT, THAT YOU ALL CAN DO THAT, THAT'S A CONNECTION WITH, UH, WITH OUR WHOLE, UH, SYSTEM OR HM.
I S SYSTEM, OUR, YOU KNOW, OUR SYSTEM OF ALLOCATING VOUCHERS AND HOUSING AND STUFF LIKE THAT.
[01:25:01]
REALLY BE IMPORTANT TO DO SO THAT WHEN SOMEONE GOES INTO RESPITE, THEY, THEY HAVE A PLACE TO STAY WHEN THEY'RE READY, ASSUMING THEY'RE READY, BUT THEY HAVE A PLACE TO STAY, WHETHER THAT'S A BRIDGE, SHELTER, OR ACTUAL HOUSING.CUZ THE TIMING MAY NOT WORK AT ALL POINT AT, YOU KNOW, BUT THE OTHER WAY, THE OTHER THING THAT WOULD BE INTERESTING ABOUT THAT, AND WE'RE GETTING, YOU KNOW, BEYOND WHAT WE NEED TO BE DOING HERE, BUT THAT'S WHY ONE REASON THERE MIGHT BE OPPORTUNITIES TO COORDINATE WITH OUR SHELTER PROGRAM, WITH OUR BRIDGE SHELTER PROGRAM.
SO, UM, SO THAT THERE'S EITHER SPACE IN A BRIDGE, SHELTER THAT CAN BE HAND, THAT CAN BE RESPITE OR THAT THERE'S A, A DISCHARGE TO A BRIDGE SHELTER FROM RESPITE IF, IF PERMANENT HOUSING'S NOT AVAILABLE.
ANYWAY, THERE'S LOTS OF OPPORTUNITIES THAT NEED TO BE DISCUSSED.
UM, BUT THAT'S A REALLY CRITICAL PIECE OF IT BECAUSE AS, AS WE ALL KNOW, AND YOU ALL KNOW, AND I'M, I'M JUST PREACHING TO THE CHOIR, ONE THING THAT'S REALLY, REALLY IMPORTANT, AND ONE THING THAT HAPPENS TO PEOPLE THAT ARE ON THE STREETS IS THERE'S A BREAK IN THE CONTINUUM THAT THEY FALL OFF, YOU KNOW? AND, UM, AND PART OF WHAT WE REALLY OUGHT BE DOING AS A COMMUNITY IS REALLY, UH, ADDRESSING THOSE GAPS SO THAT SOMEONE CAN BE SERVED ALL THE WAY THROUGH.
AND AGAIN, I KNOW I'M PREACHING TO THE CHOIR, BUT, UM, BECAUSE THEN THEY JUST GO BACK INTO THAT CYCLE.
AND I THINK AS WE CONTINUE TO MATURE IN OUR DEVELOPMENT, YOU KNOW, WE, WE ABSOLUTELY NEED TO FILL WITH SOME OF THOSE GAPS.
WE ARE WORKING ON OTHER ASPECTS SUCH AS, YOU KNOW, ONCE INDIVIDUALS ARE BACK ON THE STREET, WE CAN'T CONNECT WITH THEM ANYMORE.
AND SO EVEN IF SOME OF THESE, SO, AND SO IT'S EXACTLY TO YOUR POINT, YOU KNOW, EVEN IF SOME OF THE SOCIAL SERVICES HAVE BEEN STARTED TO BE CONNECTED, HOW DO WE CONNECT THEM BACK INTO CARE? AND SO, UM, WE'RE ACTUALLY PROGRAM'S ABOUT TO GO LIVE IS PROVIDING CELL PHONES TO INDIVIDUALS.
NOW THEY HAVE TO BE PRESCRIBED BY A PROVIDER AND THERE'S CERTAIN CRITERIA AND THEIR LOANER DEVICES, BUT SO THAT, WHETHER IT'S EITHER FOR APPOINTMENT OR SOME OF THE SOCIAL SERVICES, WE CAN KEEP THEM ENGAGED TO GET THEM, YOU KNOW, INTO HOUSING, INTO THEIR ENDPOINT CARE.
THAT SEEMS LIKE A REALLY NECESSARY STEP AND THAT'S A, THAT'S GREAT.
HOW SOON DO YOU, YOU SAID IT'S ABOUT TO GO LIVE HOW SOON? I THINK WE'RE JUST LOOKING AT A VENDOR, WHICH FOR AN ORGANIZATIONAL CENTRAL CAN TAKE A LITTLE BIT OF TIME.
BUT THE PROGRAM IS SET UP AND GREAT.
AND THEN ONE OTHER, UH, DATA POINT I WANTED TO ASK YOU ABOUT WITH REGARD TO, I'M STILL ON NUMBER FOUR, THE DISPOSITION, THE 15% THAT ADMINISTRATIVELY DISCHARGED ARE THOSE, THOSE ARE INDIVIDUALS WHO YOU WOULD'VE LIKED TO HAVE STAYED LONGER THROUGH THE PROGRAM SO THAT THEIR CARE NEEDS COULD BE MET, BUT FOR, FOR RE FOR SOME REASON THEY WERE ASKED TO LEAVE, IS THAT THEY WERE A VERY FEW NUMBER OF PEOPLE.
AND YOU KNOW, FROM MY UNDERSTANDING IS THE MAJORITY OF THOSE REALLY NEEDED ACTIVE DETOX AND TO FIND AN ACTIVE DETOX ENVIRONMENT IS JUST VERY, VERY CHALLENGING.
AND SO THE INDIVIDUALS, IF THEY JUST, IF THEY WANT TO GO BACK TO THE STREET, THEY GO BACK TO THE STREET.
IF THEY'RE A AGREED TO DETOX IN THE ED, POTENTIALLY THEY'RE TRANSITIONED TO THE ED.
UM, BUT THAT IS WHERE, YOU KNOW, THE PARTNERSHIP THAT WE HAVE, NUMBER ONE, THOSE PATIENTS, IT'S JUST DANGEROUS TO THEMSELVES IF THEY ACUTELY DETOX IN A NON-CLINICAL ENVIRONMENT.
AND IT'S JUST NOT APPROPRIATE FOR THAT SETTING.
SO OUR PARTNERSHIP, THAT IS ONE OF THE ASPECTS THAT THEY CAN'T STAY.
THANK YOU FOR THAT EXPLANATION.
OTHER QUESTIONS? YES, COUNCIL MEMBER.
LET ME JUST TURN TO VICE CHAIR FOR NONE.
UH, YOU KNOW, HOUSING IS A SOCIAL DETERMIN, YOU KNOW, IT'S IMPACTED IN ONE OF THE, THE SOCIAL DETERMINANTS OF HEALTH.
UM, WHAT IF, WHAT ARE Y'ALL THINKING IN TERMS OF, UM, FUNDING FOR HOUSING AND OTHER SOCIAL DETERMINANTS OF HEALTH? THAT'S A BROADER PICTURE QUESTION.
UH, FOR, FOR CENTRAL HEALTH'S ROLE IN CENTRAL HEALTH BUDGET, WELL, I'LL, I'LL START OFF THE, THE ANSWER AND THEN ASK COLLEAGUES TO CHIME IN.
RIGHT NOW WHEN WE FOCUS ON THE HEALTHCARE EQUITY PLAN AND THE NEEDS ASSESSMENT, UH, WE ARE, WE ARE SO FOCUSED ON FILLING THOSE GAPS IN THE HEALTHCARE SYSTEM, ESPECIALLY IN A VERY CHALLENGING WORKFORCE ENVIRONMENT WHEN IT COMES TO HEALTHCARE PROVIDERS.
IT'S NOT JUST PHYSICIANS, IT'S IT'S NURSES, NURSE PRACTITIONERS, MEDICAL SYSTEM, UM, ADMITTING CLERKS, IT'S, UH, COMMUNITY HEALTHCARE WORKERS THAT THERE IS, THERE'S, THERE'S A LOT THAT WE NEED
[01:30:01]
TO BUILD OUT IN A HIGH FUNCTIONING HEALTHCARE SYSTEM.NOW, AS PART OF THAT, ALTHOUGH THERE ARE NO DIRECT DOLLARS FOR HOUSING OBVIOUSLY, OTHER THAN WHAT WE'VE TALKED ABOUT WITH RESPITE, BUT THAT'S A, THAT'S A SHORT TERM, YOU KNOW, ON AVERAGE 22.6 DAYS.
BUT IT'S MAKING SURE THAT PEOPLE ARE CONNECTED TO THOSE RESOURCES SO THAT WE CAN, ACROSS THE SPECTRUM OF THE SOCIAL DETERMINANTS OF HEALTH, UH, HELP INDIVIDUALS, UH, GET ACCESS TO RESOURCES AND THEN HAVE THE FOLLOW THROUGH NECESSARY, UM, TO MAKE SURE THAT, YOU KNOW, WE'RE, WE'RE ALL, WHEN I SAY WE, I MEAN EVERYBODY IN THIS COMMUNITY, NOT JUST CENTRAL HEALTH, THE CITY, THE COUNTY, UH, NONPROFITS, THAT EVERYBODY'S DOING WHAT THEY CAN TO WRAP THOSE SOCIAL DETERMINANTS OF HEALTH AROUND THAT INDIVIDUAL.
CUZ WE'VE ALL KNOW, WE'VE ALL HEARD THAT AND SEEN DATA THAT, YOU KNOW, THERE'S, THERE'S A, SO MUCH OF YOUR HEALTH IS ONLY AFFECTED WITHIN THE FOUR WALLS OF, OF A CLINICAL EXAM ROOM OR PROCEDURAL ROOM.
IT'S, IT'S WHAT HAPPENS OUTSIDE THOSE FOUR WALLS.
SO THAT'S, THAT'S BIG PICTURE WHERE WE ARE.
AND IF YOU NOTICE, YOU KNOW, GO BACK TO THE COG SLIDE AND SOCIAL DETERMINES THE HEALTH BEING IN THE CENTER OF THAT AND MAKING SURE THAT THOSE NAVIGATING AND CONNECTION RESOURCES ARE ALWAYS GOING TO BE THERE.
UM, AS LONG AS THE BOARD KEEPS RATIFYING THAT APPROACH AND FUNDING IT, AND THE COUNTY COMMISSIONERS APPROVE IT, THEN WE'RE GOING TO KEEP DOING THAT.
I CAN TOUCH ON SOME SPECIFIC, UH, ASPECTS OF THE SOCIAL DETERMINANTS AND THEN I CAN HEAD IT TO MONICA, BUT I'M GONNA SPEAK VERY SPECIFICALLY.
SO AS FAR AS PEOPLE, UM, HAVING THE OPPORTUNITY TO HEAL AND, AND, AND DO WELL, TRANSPORTATION IS A FACTOR.
UM, SO WE, WE DO WORK, UM, ON TRANSPORTATION, WHETHER THEY'RE VOUCHERS OR WHETHER WE DIRECTLY FUND TRANSPORTATION AND THAT INFRASTRUCTURE, AS WE BUILD OUT OUR, OUR, UM, OUR CLINICAL, OUR DIRECT CLINICAL PRACTICE OF MEDICINE, PART OF OUR, I I THINK WE'RE CALLING IT PATIENT ACCESS AND SERVICE CENTER, PART OF THAT CENTER WILL BE GEARED TOWARDS ENSURING THAT TRANSPORTATION IS NOT THE REASON THAT PEOPLE DON'T GET INTO SERVICES.
SO WE'RE PROVIDING IT NOW AND, AND THAT IS A DIRECT FOCAL POINT.
UM, IN ADDITION, I REMEMBER, YOU KNOW, MY TIME IN COMMUNITY CARE IS THEIR CMO.
UM, THE NUMBER ONE, WHEN WE DID A HEALTH RISK ASSESSMENT, THE NUMBER ONE SOCIAL DETERMIN OF HEALTH THAT KEPT COMING TO THE TOP WAS THE AFFORDABILITY OF MEDS.
AND EVEN WITHIN A THREE 40 B, YOU KNOW, WHICH IS A PHARMACEUTICAL PROGRAM WITHIN A, A FEDERALLY QUALIFIED HEALTH CENTER, IT STILL WAS AT THE TOP.
AND SO BETWEEN CENTRAL HEALTH AND COMMUNITY CARE, WE WERE RUNNING A PILOT PROGRAM WHERE WE LOOKED AT INDIVIDUALS THAT ACTUALLY HAVE UNCONTROLLED DIABETES AND WE WAVED ALL OF THEIR COPAYS.
UM, AND THEY ACTUALLY GOT, YOU KNOW, THE, SOME OF THE NEWER MEDS THAT ARE OUT TO SEE IF, IF WE REMOVE THAT BARRIER, ARE WE ACTUALLY MORE LIKELY TO SEE THEM SUCCEED IN THEIR HEALTH.
AND SO, UM, WE ARE, HEB HAS A COURIER SERVICE FOR MEDICATIONS.
WE ARE ALSO WORKING WITH PARTNERS TO PROVIDE CAREER, A CAREER SERVICE AND, AND ARE FOCUSING ON WHAT DOES THAT MEAN MOVING FORWARD, BECAUSE IT HAS TO BE EXPANDED.
SO IF PATIENTS CAN AFFORD THEIR MEDS, BUT THEY CAN'T PICK UP THEIR MEDS, RIGHT, UM, AND SO WE'RE, WE'RE LOOKING AT ONE SOCIAL DETERMINANT, UM, NOT AT A TIME.
WE'RE FOCUSING AS MANY AS WE CAN THEN, THEN, YOU KNOW, IF YOU LOOK AT FOOD DESERTS AND, AND THIS IS WHERE, YOU KNOW, I HAVE TO TALK TO MY COLLEAGUES BECAUSE, YOU KNOW, THERE'S SOME ENVIRONMENTS WHERE IT'S APPROPRIATE FOR CENTRAL HEALTH OR WE NEED TO TALK TO OUR PARTNERS AND PARTNERS, BUT, UM, YOU KNOW, UH, MOBILE FOOD PANTRIES OR DO WE SET UP, YOU KNOW, FOOD PANTRIES AND SOME OF THE CLINICS AND THIS IS WHERE, YOU KNOW, WE HAVE OUR LEGAL EXPERTS HERE AND, AND I HAVE TO KEEP LOOKING OVER TO MAKE SURE THAT I'M NOT GETTING IN TROUBLE.
NO, BUT WE, UM, CURRENTLY THERE IS A PARTNERSHIP AND I'M, I AM NOT SURE, UH, EXACTLY, BUT ON, UM, LAST, LAST FRIDAY AT, UH, OR LAST THURSDAY AT, UH, COMMUNITY CARE, SOUTHEAST HEALTH AND WELLNESS, UM, CENTER, WE HAVE PARTNERSHIPS WITH SOME OF THE LOCAL, LOCAL FOOD BANKS TO MAKE SURE THAT THERE IS ACCESSIBILITY, UH, FOR FRESH FOODS IN SOME OF OUR CLINICAL, UH, HUB SETTINGS.
I THINK THAT THAT'S SOMETHING THAT, YOU KNOW, MIKE AND THE TEAMS THAT WE HAVE WORKING ON DEVELOPING OUR PROGRAMMING AT, UH, HORNSBY BEND AND, UM, AT DEL VALLEY AND, UH, TO COME IN, IN COLONY PARKER THAT WE'RE ALREADY DOING AT THE NORTHEAST, UM, UH, HEALTH RESOURCE CENTER THAT, UH, WE ARE LOOKING AT THESE SOCIAL DETERMINANTS AND, UM, YOU KNOW, THE, THIS PROGRAMMING AND ALSO PROGRAMMING AROUND, UH, THERE IS A COMMUNITY KITCHEN AT, UH, THE SOUTHEAST HEALTH AND WELLNESS, SO THAT WE DO HAVE PLACES FOR THERE TO BE PROGRAMMING AROUND, UM, YOU KNOW, DIET, EXERCISE, SOME, SOME OF THESE OTHER, UH, PREVENTION, UM, ASPECTS IN ADDITION TO MAKING SURE THAT, UH, MEDICATIONS ARE AFFORDABLE, UM, AND THAT THERE'S ACCESSIBILITY, AT LEAST TRANSPORTATION TO GET TO, UM, HEALTH, HEALTHCARE, UH,
[01:35:01]
APPOINTMENTS.AND THEN REALLY JUST CONTINUING, UM, TO LOOK AT HOW WE CAN PARTNER.
QUANG AND I STILL, UH, ARE, ARE WORKING WITH THE FOLKS AT SOCIAL FINANCE ON THE AT HOME INITIATIVE TO SEE IF, YOU KNOW, WE, WE CAN BRING THAT HOME WITH CENTRAL HEALTH.
REALLY FOCUSING ON HOW DO WE BRING THE MEDICAL, UM, PIECE TO THE TABLE, UM, FOR HOUSING INITIATIVES AS AS THEY'RE DEVELOPED AND HOW DO WE CONTINUE, UM, TO WORK AS ADDITIONAL, UM, PERMANENT SUPPORTIVE HOUSING IS, UH, BROUGHT ONLINE IN THE COMMUNITY.
WHAT'S THE BEST WAY AND BEST MODEL TO MAKE SURE THAT FOLKS WHO ARE IN, UH, WHO BECOME, UH, HOUSED, UH, IN, UH, THAT, THAT NEW HOUSING, THAT IF THEY ARE READY TO MAKE SURE THAT THEY'RE CONNECTED AND HAVE ACCESS TO CLINICAL CARE IN CLINICS, IF THEY NEED, YOU KNOW, THIS LEVEL OF TOUCH THAT DR.
SHASHA WAS TALKING ABOUT WITH MAYBE THE CARE, CARE AT HOME, THAT, THAT THAT'S AVAILABLE IN THE APPROPRIATE, UH, SETTINGS WHEN THERE'S A LARGE ENOUGH DENSITY OF, OF FOLKS THAT WOULD REQUIRE KIND OF REGULAR, UH, INTERVENTIONS FROM OUR MOBILE TEAM.
AND THEN ALSO MAKING SURE THAT WE ARE STILL, UH, FOCUSING ON, UM, PEOPLE WHO ARE, ARE IN ENCAMPMENTS OR ARE, ARE STILL, UH, YOU KNOW, LIVING, LIVING, UH, ON THE STREET OR SLEEPING ROUGH, THAT, THAT ARE YET TO BE HOUSED, THAT WE ARE STILL FOCUSED ON, ON THE NEEDS OF, OF, UM, YOU KNOW, THO THOSE NEIGHBORS AND THOSE INDIVIDUALS.
DO YOU HAVE ANY CLOSING REMARKS OR ANY ADDITIONAL THINGS THAT, THAT YOU'D LIKE TO SHARE BEFORE WE CONCLUDE OUR CONVERSATION? WELL, FIRST OF ALL, WE VERY MUCH APPRECIATE THIS DIALOGUE AND YOU ALL PROVIDING THIS FORM TO HAVE THESE VERY IMPORTANT DISCUSSIONS.
WE HAVE SOME HOMEWORK ASSIGNMENTS AND SOME THINGS THAT WE'LL CONTINUE TO FOLLOW UP ON.
UM, BUT ALSO THANK YOU BOTH FOR YOUR SERVICE.
THANK YOU COUNCIL MEMBER WIN THIS.
THIS HAS BEEN A REALLY TERRIFIC PRESENTATION WITH A LOT OF INFORMATION AND EXCITED ABOUT, ABOUT SOME OF THE NEW DIRECTIONS THAT YOU DISCUSSED.
SO, ALL RIGHT, WELCOME COMMITTEE MEMBERS.
THAT BEING OUR LAST ITEM, UM, I WILL CALL THIS MEETING ADJOURNED AT 1116.
THANKS TO OUR TREMENDOUS STAFF AS WELL.