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    9.    
FAMILY AND HUMAN SERVICES COMMITTEE
Meeting Date: 11/13/2019  
Subject:    Healthcare for the Homeless Annual Update
Submitted For: Anna Roth, Health Services Director
Department: Health Services  
Referral No.: FHS #5  
Referral Name: Continuum of Care/Healthcare for the Homeless
Presenter: Joseph Mega, Health Care for the Homeless Medical Director; Rachael Birch, Project Director Contact: Rachael Birch (925) 608-5123

Information
Referral History:
Since 1990, the Health Care for the Homeless (HCH) Program has provided health care services to the homeless population in Contra Costa County through mobile clinics, stationary health centers, the Concord Medical Respite facility, street medical outreach clinics and the medication-assisted treatment program. Health care services provided by the HCH team include routine physical assessments, basic treatment of primary health problems such as minor wounds and skin conditions, respiratory problems, TB screening, acute communicable disease screening, coordination and referrals for follow up treatment of identified health care needs, dental services, health education, behavioral health services, medication assisted treatment for opioid addiction, and outreach and enrollment services. A significant portion of the homeless patients seen by the HCH team have chronic diseases, including asthma, hypertension, diabetes, and mental health/substance abuse issues. They also have disproportionately more dental, substance abuse and mental health needs than the general population.

At the last report to the FHS Committee one year ago, Dr. Joseph Mega, presented the staff report on health care services for the homeless, including opioid addiction treatment, and the number of clients and encounters with clients. The data showed that homeless Medi-Cal patients were more than twice as likely to have a chronic health condition and drastically more likely to visit hospital emergency than general Medi-Cal patients. Dr. Mega highlighted the gap in services for elderly people with conditions such as dementia, incontinence, and mental illness, citing that such conditions are often barriers to private board and care placement. He suggested that County-operated board and care might fill that gap and for less cost than long term County Hospital stays.

Supervisor Andersen had asked Dr. Mega what research had been done on county-run skilled nursing programs and if the County would realistically take on that service within the Health Care budget? She suggested that it might be more cost effective to contract out for these services. She asked about what other counties might be doing in this area and what, if any, contractors they use and how they fund the program. Dr. Mega had commented that only preliminary discussions had occurred but he would work to develop a proposal.
Referral Update:
The attached presentation includes program updates from the last report. It also highlights the increasing needs of the rapidly growing senior homeless population and provides an update on the increase in Medication Assisted Treatment for homeless patients with Opioid Use Disorder.
Recommendation(s)/Next Step(s):
1. Accept this report from the Health Services Department; and

2. Forward this report to the Board of Supervisors for acceptance; and

3. Direct staff to continue to report on an annual basis to the FHS Committee regarding health status of the homeless population in Contra Costa County by the Health Care for the Homeless Program.
Fiscal Impact (if any):
No fiscal impact.
Attachments
Healthcare for the Homeless Powerpoint

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