The 10th Decile Project: Impressive Early Outcomes in Los Angeles

Popeye has been a fixture in Pasadena on the freeway off-ramp for the past 15 years. Popeye, 53, suffers from chronic health issues, mental health issues, and severe alcoholism, all of which has landed him in the hospital consistently. Today, Popeye lives in his own apartment, has quit panhandling and gets regular visits from Housing Works (a homeless service provider) to help him shop, cook, and keep clinic appointments. This month, Popeye celebrates his nine-month anniversary in his new apartment.

SE and SIF 10th Decile Projects

In April 2011, with funding from the Conrad N. Hilton Foundation and the UniHealth Foundation, CSH launched the Frequent Users Systems Engagement (FUSE) pilot to connect hospitals to homeless service providers and community health centers to target and permanently house the highest-cost, highest need individuals in supportive housing—and surround them with supportive medical and mental health homes.

In mid-2012, funding from the Social Innovation Fund (SIF) of the Corporation for National and Community Service (CNCS) allowed CSH to expand the FUSE pilot through a SIF 5-year initiative, to reach more communities and many more chronically homeless frequent users.

To date, we have enrolled 170 frequent users in the top 10% of hospital high utilizers in the county from fifteen partner hospitals in nine Los Angeles communities. Each participant has been enrolled with our network of nine experienced community-based homeless service and six healthcare providers.

Evaluation Shows Substantial Public Cost Reductions

The Economic Roundtable’s recently released evaluation of FUSE and SIF, Getting Home: Outcomes from Housing High Cost Homeless Hospital Patients , shows that there is a strong return on investment in this program.

  • For the first 89 participants enrolled, the average 12-month public cost avoidance totaled $47,977 per person.
  • Every $1 dollar in local funds spent to house and support 10th decile hospital patients is estimated to reduce public and hospital costs for those who are housed by $2 in the first year and $6 in subsequent years.

The full evaluation report looks in-depth at participant demographics and health, as well as implementation questions around enrollment and attrition. Finally the evaluation makes recommendations for how to refine and ultimately scale up the 10th Decile Project.

A Win-Win: Healthcare + Housing Navigation

Chronically homeless frequent users come to hospitals because they are the only places that do not turn them away when they were in need. The Triage Tool allows hospitals to quickly recognize which patients are most costly and most in need of supportive housing.

Homeless services providers then work to break that cycle, by partnering with community health centers and mental health providers to move frequent users into permanent supportive housing, and establish individualized health homes. Through this system, they receive not only an apartment, but consistent medical care, social services, and other resources that comprehensively address their issues and help them get back on their feet.

Through programs linking health care and housing, Popeye and others can move forward from chaos, chronic homelessness, and chronic physical or behavioral illness, and find their way to a better future.

Bringing the project to scale so that there is a discernible reduction in the number of unhoused 10th deciles will make a striking reduction in the number of chronically homeless patients seen in hospitals, and avoided costs will become tangible savings for hospitals.

For more information, contact Susan Lee, CSH, susan.lee@csh.org

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