Care Alliance Recuperative Care (CARC) Care Alliance Health Center 2100 Lakeside Men’s Shelter
Jan 13, 2016
Care Alliance Recuperative Care(CARC)
Care Alliance Health Center
2100 Lakeside Men’s Shelter
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
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
Case Example 1
Patient EC
53 year old male
Wrist fracture and puncture wounds to both shins
Identified in shelter cafeteria
Case Example 1
Patient identified by another shelter resident
Patient’s primary concern was wrist fracture
Upon examination, puncture wounds in shins were discovered
Case Example 1
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
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
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
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
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
CARC Strengths & Limitations
+ 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 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
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
Respite CareProvidersNetwork
HCHBase
Funding/PoliticalPartnerships
Service Partnerships
Capacity
CARC partnerships
Service Partnerships Shelters Hospitals Skilled Nursing Facilities Volunteers
Funding/Political Partnerships County Office of Homeless Services Local Foundations Hospitals
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. . . .
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
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.
Final thought
Remember that it is about providing the quality of care that these patients deserve