Care Alliance Recuperative Care (CARC)

1. Care Alliance Recuperative Care(CARC) 2100 Lakeside Men’s Shelter Care Alliance Health Center

2. Care Alliance Recuperative Care(CARC) • Respite care through the back door • 3-Tiered System • Shelter-based/Motel-based • Daily nurse visits • Coordination with other community health care services • Follow-up beyond discharge to continue the process of linkage with community resources

3. CARC Tiers • Tier 1-Daily nurse visits in shelter, no 24 hour bed • Tier 2-Daily nurse visits in shelter, 24 hour bed • Tier 3-Regular nurse visits in motel, motel voucher

4. Case Example 1 • Patient EC • 53 year old male • Wrist fracture and puncture wounds to both shins • Identified in shelter cafeteria

5. Case Example 1 • Patient identified by another shelter resident • Patient’s primary concern was wrist fracture • Upon examination, puncture wounds in shins were discovered

6. Case Example 1

7. Case Example 1 • Patient initially treated in public ED • Provided temporary cast, prescription for Percocet and recommendation to follow up with orthopedics the next business day • Leg wounds had been bandaged with gauze

8. Case Example 1 • CARC team identified and admitted individual to Tier 2 • Patient was provided 24 hour access to a bed and daily nurse monitoring with physician appointments every two days • Patient given tetanus shot and started on antibiotics • Follow-up appointment with orthopedics department was facilitated

9. Case Example 1 • Shortly after admission, infection in puncture wounds was noticed and patient taken to public hospital • Patient admitted to hospital for 7 days with MRSA/osteomyelitis • Patient was discharged to skilled nursing facility for continued antibiotic treatment

10. Case Example 1-Outcomes • Earlier and more aggressive management of wound infection • Facilitated continued therapy for wrist fracture • Advocated with hospital on behalf of patient • Social reintegration • Reestablished connections to family

11. Case Example 2 • Patient RL admitted to CARC Tier 3 following assault • Patient discharged from hospital with broken jaw and appointment for surgery to repair jaw • Patient received regular (every 2-3 days) nurse visits and support in preparing for surgery

12. + Flexible to meet needs of patient Mobile to continue patient advocacy Holistic approach considers social, psychological, and material goals as well as medical goals - Limited therapy options Still a general shelter environment Limited staffing CARC Strengths & Limitations

13. CARC future goals • Establish designated space in shelter or other facility • Expand staffing to enable more regular care • Include volunteers in supporting the recovery of CARC patients

14. CARC partnerships • First phase of long road of future development to improved capacity • Partnership Goals • Formalize partnership relationships for health care services • Establish outside funding sources • Strengthen our relationship to our parent organization locally and other respite providers nationally

15. CARC partnerships • Service Partnerships • Shelters • Hospitals • Skilled Nursing Facilities • Volunteers • Funding/Political Partnerships • County Office of Homeless Services • Local Foundations • Hospitals

16. CARC Partnerships Lessons • It always takes longer than you think it should • Everybody has a unique interpretation of the problem and a unique set of solutions and a unique set of pressures • There will be times when you think everybody is finally on the same page and then. . . .

17. CARC Partnerships Lessons • Baby steps to recuperative care, baby steps to recuperative care • Be clear about problem definition before moving on to proposed solutions; write it down • Be patient and persistent

18. CARC Partnerships Lessons • Do not ignore what you are already doing, or should be doing for your patients. • Do it well. • Document it. • Be precise in your goals and accomplishments during evaluation. Promising what you did not deliver will not be a step forward.

19. Final thought • Remember that it is about providing the quality of care that these patients deserve