LA hospital, county partner to address unhoused crisis

Homelessness was declared a public health emergency in Los Angeles in late 2022, with an estimated 43,699 people who are unhoused in the city and 72,308 people unhoused in LA County.

People experiencing homelessness are twice as likely to end up in the emergency department compared to people with housing, according to one 2023 study. But emergency departments are experiencing overcrowding across the country, and appointments are expensive for both the patient and the hospital due to frequent and complex medical care that’s often further complicated by mental health issues within this population.

At the same time, it’s difficult to provide consistent care for people experiencing homelessness.

“There has been a demonstrated need…for this specific population to get some stabilizing healthcare in a way that’s more affordable than getting it in the hospital,” Brittnee Hill, director of interim housing and enriched residential care for LA County’s Housing for Health, told Healthcare Brew.

A new kind of program

Opened in July 2022, the 96-bed Restorative Care Village provides free short-term housing for patients discharged from the hospital to continue their recovery while gaining access to stabilizing and housing resources. The program is a county partnership between Los Angeles General Medical Center and the Housing for Health effort within the LA County Department of Health Services.

The idea is to have one medical campus that can treat everything from mental health to substance use disorder to emergency and inpatient care, Brad Spellberg, chief medical officer at the Los Angeles General Medical Center, said.

“And no matter what level of care you need, you move up or down that ladder to get to where you need to be until ultimately, you’re reintegrated into the community,” he added.

Something that sets the program apart from the 100+ medical respite programs in the US, Heidi Behforouz, chief medical officer at Housing for Health said, is patients are also allowed to stay in the facility for longer periods. While some programs last only a few weeks, Hill said the average stay for recuperative care center patients is 180 days. (For comparison, the average respite stay in the US is 31 to 45 days, according to the National Institute for Medical Respite Care.)

“Sometimes it just takes two to three weeks to even unpack who are they underneath all of this immediate trauma and then start to work on recovery and rehabilitation,” Behforouz said.

The center, which also treats victims of domestic violence and substance use, additionally helps patients prepare for treatment that requires prep, like a colonoscopy.

In an attempt to build long-term solutions, the staff also works to connect patients with housing. In 2019–2020 in LA County, there were more than 186,167 emergency department visits from unhoused patients, according to the California Department of Health Care Access and Information.

Patient story

The recuperative care center is just the first phase of a three-part plan. The campus will also include a residential treatment program for mental health, a sobriety center to help with substance use, and permanent housing support.

Since the program is still in its early stages, Spellberg said it’s still too early to understand its effects on the hospital and county.

But that doesn’t mean the program isn’t already affecting individuals.

Moises Alvarado has been homeless in Los Angeles for eight years.

In April, the 56-year-old was taken to Los Angeles County Hospital for the seventh time for the same affliction: ulcers in his feet. He was there for 12 days receiving antibiotics.

It’s a cycle for Alvarado. “Pretty much every year” his feet get infected, he said, and he’d be brought to the hospital before getting sent to a local respite center. But the treatment didn’t stick because he’d get discharged and lose access to social services. As a result, he wasn’t able to recover enough to get healthy or find a job and permanent housing.

But this time, he was sent to the Los Angeles General Restorative Care Village.

“Being on the street, it makes it a little hard to keep up with the appointments and for them to contact you,” Alvarado, who doesn’t have a cell phone, said, adding it’s challenging to keep paperwork.

Alvarado’s wounds are healing and he can walk better now. He’s also spoken with staff about finding permanent housing and connecting with agencies that can help with his condition.

“This is the best [facility] that I’ve been to,” he told us.