To stop the revolving ER door, start with a bed

Rebecca Doughty’s grad-school project is going big time. Which is excellent news for homeless people in Spokane.

The simple but revolutionary tool at the heart of Doughty’s project was a bed.

There’s much more to it, of course. But Doughty’s Inland Northwest Transitional Respite Program – which began as part of her work toward a master’s degree in nursing at Washington State University – starts by providing a place for homeless people to rest and recover after being treated in the emergency room, much as anyone else might do at home. In addition, Doughty provides a range of other support and coaching for the patients, to help them move forward once they’re healed.

The idea is to halt the revolving door at the ER, through which homeless people sometimes return again and again, in an unhealthy and costly cycle.

Doughty’s first bed came open three months ago at the House of Charity. One sick man could stay in the bed all day, if need be, without having to leave for several hours during the day, like the rest of the population at the men’s shelter. A nurse would provide some care – dressing wounds, checking progress – and Doughty would help the men learn some of the skills for managing their own health care.

“We immediately filled it,” said Doughty. “I was getting calls every day from the social worker at the hospital, asking to put people in that bed.”

Now the hospital – Providence Sacred Heart Medical Center – is ready to expand the program, along with Catholic Charities, adding two beds each at the House of Charity and the women’s shelter, Hope House. The beds will be open for rest on Monday.

Doughty has joined forces with a loose affiliation of local organizations trying to combat health problems among the homeless, she will be presenting information about her transitional-care project at a national convention in Washington, D.C., and there is talk of expanding the respite program even further.

Oh, and her master’s project has become a doctoral project.

“Becky worked for a year to get this thing to happen,” said Lee Taylor, director of Project Access Spokane, a Spokane County Medical Society program to provide access to health care services to low-income residents.

Now, it’s happening faster than she could have expected.

Providing ER care for homeless people is a problem in lots of ways. Not least among those is the high rate of return among patients who don’t get better because they’re on the street. Sometimes, faced with discharging a patient to the streets, hospitals admit them for long, expensive stays instead.

The revolving door is bad for patients, of course, and it’s very costly for hospitals. Doughty said Providence saved $30,000 to $40,000 in the treatment of the first two homeless men to use the respite bed program.

Still, Taylor said, “This isn’t necessarily about saving money. It’s about making people healthier, and getting them a place to heal. If it also saves money, that’s a secondary benefit.”

The first bed “opened” Nov. 1, and Providence had a patient ready: a man with cellulitis, a deep, persistent skin infection that is common among the homeless. The man had a cut on the top of his foot from dropping a heavy tool chest on it, and it became badly infected; returning to cold, wet conditions of a Spokane November was not what the doctor ordered.

Doughty met with the man, helped him arrange to get a prescription, and made sure he was right for the House of Charity.

Then, “They put him in a cab and sent him down there. I picked up his medication,” Doughty said.

The man was allowed to rest and recuperate in the bed at the shelter. He received some nursing care through the hospital, and Doughty helped connect him with a wide range of help and services, including access to a primary-care doctor. Then, when the foot infection began coming back, he was able to see the doctor, get an antibiotic prescription, and return to the respite bed to recover, Doughty said.

He was up and walking by the end of November.

Had he been on the streets, “As sick as he was starting to get with that foot, he would have been back in the ER,” Doughty said.

One piece of Doughty’s project aims to do a better job of managing the information around each homeless patient’s case. Repeated ER visits is not the way to build a medical history, and the homeless patients themselves often don’t have a good understanding of their cases or their history of treatment.

One tool in Doughty’s arsenal is a waterproof card that homeless patients can hang onto, with their medical histories. Doughty worked as a geologist before going into nursing; she modified the waterproof field notes she used in that profession to provide a way for homeless people to keep track of their medical histories, in a way that would withstand the elements.

Doughty already has more candidates than beds opening Monday. Her program has expanded rapidly, but not so rapidly as the need, she said.

“It definitely exceeds my one bed,” she said.