A Hospital Offers Frequent ER Patients An Out — Free Housing

Jun 29, 2016
Originally published on July 19, 2016 7:01 pm

For a lot of us, the hospital's emergency room is a stressful place.

Not so for Glenn Baker.

When Baker, 44, steps into the emergency room at the University of Illinois Hospital in Chicago, he's completely comfortable.

He has a favorite double-wide chair in the corner, knows where to find the Cheetos in the vending machine, and the staff is like family.

Patty Zion, a nurse at the hospital on the West Side, says she knows Baker well: "He's one of our very famous patients who comes around and sees us quite often when he's not feeling well."

Baker has severe asthma and other chronic medical issues. But he's quick to admit he often ends up in this hospital not because he was sick, but because he was homeless.

"I would just try and fake an illness or something so that the hospital would admit me," Baker says, "so I wouldn't have to be on the streets when it was cold."

Baker says that last winter he spent about 20 nights every month checked into different Chicago hospitals.

In the medical world, patients like Baker are often called "superutilizers" or "frequent fliers" — people with a mix of chronic medical problems, mental health issues and homelessness that drive them to visit the hospital far more than the average patient.

There are thousands of these patients across the country. More than 55 million people are on Medicaid in the U.S. But according to a recent government report, about half of the program's annual resources go to just 5 percent of its beneficiaries.

This year the University of Illinois Hospital is trying something different to care for Glenn Baker and its other "superutilizers."

The hospital is paying to get them out of the emergency room and into housing.

"I think this is a program that is a win, win, win for everybody involved," says hospital CEO Avijit Ghosh. "Glenn wins, other patients who are in that same situation win, the hospital wins ... and I think society and the state win by the cost savings."

The hospital's pilot project is using $250,000 of its own money to get 25 patients like Baker into "housing first" style housing.

Along with an apartment, patients get a case manager who helps them do things like schedule doctor's appointments instead of going to the ER. The program is run in partnership with Chicago's Center for Housing and Health.

Ghosh is quick to note the program is focused on getting patients healthy — it's not simply a financial calculus. But he does point out that hospital care costs about $3,000 per day.

By contrast, the hospital pays about $1,000 a month for the patients' apartments.

"So you can see the difference between $3,000 a day, and $1,000 a month," Ghosh says.

And the program is already showing results: Currently, the health care costs of the 15 people the hospital has helped house so far, including Baker, are down 42 percent.

That's good for them, Ghosh says, and good for the hospital's other patients as well. "Quite often we are at capacity. So if we are using a bed for somebody who really doesn't need to be there, somebody else is forgoing the care."

Treating housing as part of a patient's health is an idea that has caught on in recent years, says Dr. Kelly Doran. She's an assistant professor of emergency medicine at the New York University School of Medicine who studies how homeless people use emergency services.

"The new thing here, really, is that the hospital is putting forth money for this effort," Doran says.

But for a program like this to work, there needs to be a long-term investment, Doran says. The Chicago hospital's pilot project is set to run out of funding by next summer.

"Housing is an intervention that goes on for many years," Doran says. "So, for how many years will they be paying for the housing? And after they stop paying, who's going to pay for the housing?"

Hospital officials say they are looking into ways to continue the project, but they pledge that nobody who has been housed already will lose housing if that does not happen.

The hospital's investment so far has got Glenn Baker into a light, airy one-bedroom apartment with a living room and kitchen.

He says he is thrilled to have a home of his own. Even if there are some things he misses about the hospital.

"This bed here is like, it's kind of firm," he says, laughing. "So, I mean, I would take a soft, comfortable hospital bed any day."

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KELLY MCEVERS, HOST:

Across the country, thousands of homeless people check into the ER dozens of times a year for chronic medical problems or just to get off the street. Hospitals struggle to take care of them while making sure beds are open for true emergencies. In Chicago, one hospital is trying something different. Miles Bryan of member station WBEZ reports.

MILES BRYAN, BYLINE: For Glenn Baker, the University of Illinois Chicago hospital's emergency room is a very familiar place. He's got his favorite double-wide chair in the corner, knows where to find the Cheetos in the vending machine and the staff is like family. Patty Zion is a nurse here.

PATTY ZION: I do know Glenn very well. He's one of our very famous patients that comes around and sees us quite often when he's not feeling well.

BRYAN: For a lot of people, the ER is a scary place, but Baker says he likes it here.

GLENN BAKER: This is home to me because everyone...

BRYAN: In the ER?

BAKER: Yes - everyone's here. I've been through here numerous - over 20 times...

LASHERIN MCFARLAND: Literally home - where you know he wants something to eat or he's sitting out there...

BAKER: That's nurse Lasherin McFarland who knows Glenn Baker all too well.

MCFARLAND: I used to see him every night.

BRYAN: Baker suffers from severe asthma and other medical issues, but he's quick to admit he often ended up here in this hospital, not because he was sick, but because he was homeless.

BAKER: Just try and fake an illness or something, so that the hospital would admit me and I would not be able to be on the streets while it was cold.

BRYAN: In the hospital world, patients like Baker are often called frequent fliers. Last winter, he spent about 20 nights each month checked in to Chicago hospitals. There are thousands of people like Baker across the country. More than 55 million people are on Medicaid in the U.S.

But according to a recent government report, about half of the program's annual resources go to just about 3 million patients. And even if the patient has Medicaid, frequent visits can cost the hospital money, says Avijit Ghosh. He's the University of Illinois Chicago hospital's CEO.

AVIJIT GHOSH: Well, typically on an average, it's about $3,000 a day. That's about how much it costs to provide hospital bed care.

BRYAN: This year, his hospital is putting up $250,000 of its own money to get those people into apartments instead, which Ghosh says, costs the hospital about $1,000 a month per patient.

GHOSH: So you can see the difference between 3,000 a day and a thousand a month.

BRYAN: The Chicago Hospital has partnered with the city homeless advocate group for the project. It's starting small aiming to get about 25 people housing and connect them with a case manager who helps them do things like schedule doctors' appointments, instead of going to the ER.

Ghosh says it seems to be working. Currently the health care costs of the 15 people the hospital has housed so far are down 75 percent.

GHOSH: Our hospital quite often is at capacity, so if we are using a bed for somebody who really doesn't need to be there, somebody else is foregoing the care.

BRYAN: Treating housing as part of a patient's health is an idea that's caught on with local governments and social service organizations in recent years.

Dr. Kelly Doran studies how homeless people use the emergency room at the NYU School of Medicine.

KELLY DORAN: The new thing here really is that the hospital is putting forth money for this effort.

BRYAN: Doran says for a program like this to really work, there needs to be a long-term investment. The investment so far has got Glenn Baker this light, airy one-bedroom apartment.

BAKER: Yes, this is it. This is my own room. I have my own private space.

BRYAN: This is home now, even if there are some things he misses about the hospital.

BAKER: This bed here is like - it's kind of firm, so I mean, I would take a soft, comfortable hospital bed any day because it's really softer than this.

BRYAN: Oh, and he misses his nurse friends, too. For NPR News, I'm Miles Bryan in Chicago.

POST-BROADCAST CORRECTION: We say that the health care costs of the 15 people the hospital has helped house so far "are down by 75 percent." That number should actually be 42 percent. The University of Illinois, Chicago hospital researchers who gave NPR the incorrect number say the error arose because they made a mistake in their calculations. Transcript provided by NPR, Copyright NPR.