This agenda item is intended to provide information regarding the discharge planning policies and practices at local hospitals operating in Yolo County. In preparation for this presentation, the County Administrator and Director of the Yolo County Health and Human Services Agency met with staff from Woodland Memorial Hospital and Sutter Davis Hospital. Both hospitals shared the documents that guide their practices related to hospital discharge (Attachments A and B). Additionally, staff was able to secure a joint document (Attachment C) prepared by all the hospital systems in our neighboring community of Sacramento (including Dignity Health, Kaiser Permanente, Sutter Health, Valley Area and UC Davis Health), which outlines the partnerships and strategies used by Sacramento hospitals to end homelessness. The document provides a brief overview of the hospitals’ joint philosophy on hospital discharge, and indicates that the Sacramento hospitals are currently reviewing each of their independent discharge policies to ensure consistency across hospital systems.

Intersection Between Hospital Discharge and Homelessness
As we begin to consider hospital discharge policies, it is important to note that many of the most complex discharge challenges arise due to the frequent co-occurrence of health issues and homelessness for patients. While discharge planning is an activity that should be occurring with all patients who are exiting the hospital, patients who are experiencing homelessness often face great barriers with identifying a safe and appropriate discharge plan. All of our local and neighboring hospital systems are operating within the current realities of homelessness in California.

• According to the most recent homeless count in Yolo County, conducted on January 23, 2017, there are approximately 459 people experiencing homelessness in Yolo County on any given day.  
• Of those 459 people, there are only enough beds to provide shelter for approximately 50 percent of them. On the night of the count, 46 percent (209 people) reported that they were living in an unsheltered situation, while 91.24 percent of shelter beds (250 of 274 total beds) were in use.  
• There is a high prevalence of health issues among people living homeless. In the 2017 homeless count, 52 percent of those who were homeless reported having at least one serious health condition (including serious mental illness, substance use disorder, developmental disabilities, physical disabilities and/or post-traumatic stress disorder).This is a self-reported number, which means it likely underestimates the true prevalence of health issues among the population.    

All of our local and neighboring hospitals have expressed their commitment to partnering with local providers to develop safe discharge plans for patients experiencing homelessness. However, it is necessary to acknowledge that there are simply not enough beds in our community to provide shelter to all the people who are homeless.

Definition of Discharge Planning
Each of the local hospital systems have developed their own language regarding the meaning and core responsibilities of discharge planning.

• The Sacramento hospitals share several common themes, including that treating patients with compassion and respect is central to the mission of each hospital, and that they will adhere to state and federal regulations regarding discharge planning while seeking to ensure the well-being and safety of their patients.
• Woodland Memorial Hospital defines a safe discharge as beginning with an assessment of the patient’s baseline status and resulting in a discharge plan that ensures the patient has access to food, shelter, clothing and necessary medical after care.
• Sutter Health refer to this process as “transition of care” rather than discharge planning, but emphasizes that this process involves a safe and planned transition for each patient to their next level of care whether it be to a skilled nursing facility or to home.

Common Elements of Woodland Memorial and Sutter Health Discharge Practices

• Care Coordination Teams with Skilled Professionals: Both hospitals use a myriad of licensed and skilled professionals to assist with discharge planning, including some combination of physicians, registered nurse case managers, social workers and physical therapists.
• Assessment of Safety: Both hospitals require staff to complete an assessment with patients prior to discharge, to determine that a safe plan is in place. Some of the elements considered include whether health conditions have stabilized; the time of day of the discharge; the patient’s cognitive capacity, ability to care for self and barriers to communication; and whether the patient has access to seasonally appropriate clothing, shoes, food, transportation, shelter, prescribed medications, specialized services, assistive devices and medical supplies.  
• Collaboration and Linkage with Community Resources: Both hospitals emphasize their frequent partnerships with local services providers to ensure the ongoing well-being of their patients. In cases where a safe discharge is not immediately available, hospital staff work with local providers (including the Yolo County Health and Human Services Agency) to identify appropriate services and connections. In cases where the patient is homeless, the hospitals attempt to connect the patient with an immediate housing option, such as placement in a skilled nursing facility, board and care or shelter.   
• Financial Assistance: Both hospitals express that financial assistance is available to patients who need assistance with identifying a safe discharge plan. Financial assistance may be used to secure a safe housing placement, offer transportation or provide access to needed medical equipment or medications.  
• Free Will of Patients: Both hospitals express that they must respect the rights of patients to make their own decisions. Hospitals may not keep patients beyond when they are stabilized for discharge. However, both hospitals also have procedures regarding the documentation and possible interventions in cases where a patient has identified a discharge plan that is deemed to be unsafe.

City of Woodland

County Administrator’s Office

Hospital Council of Northern and Central California

Sutter Davis Hospital

Woodland Memorial Hospital