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