As COTS’ CEO, each month I take a moment to consider what I want our community to know about our organization and our progress in serving Sonoma County’s homeless. I look forward to sharing these thoughts with you in this Virtual Cup of Coffee – my monthly communique about the business and mission moments of COTS (Committee On The Shelterless).

My best,

Health Care and Homelessness

Many articles on homelessness stress the need for more housing to solve homelessness. Those articles also talk about the complexity of homelessness. Yes, homelessness is complex and housing is one answer. But any mention of housing also needs to include the critical role of and co-solution to solving homelessness – health care. Why?

Annual Point in Time Counts show similar co-occurring conditions that the sheltered and unsheltered experience: 23% have a physical disability; 29% have PTSD; 23% have chronic health issues; 10% have a traumatic brain injury; 36% suffer from drug and alcohol use; and 40% from psychiatric or emotional conditions. Talk with our COTS team and they will tell you that 99% suffer from serious mental, substance abuse, and medical conditions. And we haven’t even talked about the need to address other social determinants of health and wellness, some of which are the conditions that people are born into, grow, live, and work in as well as the interrelated social and economic systems that shape their lives. Those include income, education, literacy skills, access to nutritious foods, transportation, neighborhoods lived in, racism, discrimination, and violence. Solving homelessness is complex and it’s not as simple as building more housing.

So what’s my point. Help is on the way…in a big, bold, and innovative way. It’s called CalAIM – California Advancing and Innovating Medi-Cal. And COTS is doing this. California and Medi-Cal realized the vital role that health systems can play in addressing homelessness. They also realized that there is a health gap. Treating those experiencing homelessness in the emergency room and then releasing them back into homelessness provides no opportunity for follow up care. And making a follow up appointment on a certain day and time is well…simply not going to happen. Health care is so much more than what happens in an exam room; health and homeless systems impact each other. Medi-Cal also realized that to be effective and meet the unique needs of this complex population, they needed to meet “the homeless where they are.” Thus, the homeless, health, and housing systems must work together to deliver better health and housing outcomes over time.

CalAIM will couple traditional medical care with non-medical services such as:

  • Help with developing a housing plan or with housing search.
  • Assist with housing documentation needed for leasing a rental unit.
  • Landlord education and tenant advocacy.
    Security deposits, first and last month’s rent.
  • Case management for help with behaviors that may jeopardize housing or help with late rent, lease violations.
  • Recuperative Care for homeless patients discharged from the hospital that are not sick enough to be in the hospital but too sick to be on the streets; and much more.

These and more services are grouped into two categories of services – Community Supports and Enhanced Care Management. And Community Based Organizations (CBO) such as COTS will get reimbursement for delivery of these services.

Of course this will not be easy. Homeless services and health care each have a different language, acronyms, and culture. We need to understand and educate each other on our systems and then build a common language. That means massive collaboration, education, and communications so that no one falls through the cracks.

COTS received a grant from CalAIM and Partnership Health Plan of California to train and hire new staff, and put the infrastructure (policies, procedures, technology requirements) in place between now and December 31. Our goal then is to “Go Live” with CalAIM and provide and bill for services starting January 1, 2023. It will take COTS and others doing this at least two years before we feel comfortable with a new language and a new way of doing business. We are building the proverbial plan as we fly, and we know that we need to be patient, as none of us have all the answers.

CalAIM is a win for Medi-Cal to better serve its members/enrollees more efficiently and effectively; for health care providers to provide urgent and preventative care for their patients in the proper setting; for the sheltered and unsheltered to receive more comprehensive services; and for COTS to keep our clients healthy and housed long term. This is also a win for public health, social justice, and equity.

Yes, health, housing, and homelessness are intertwined. Housing is health care and affordable housing is an important social justice component. Health care services are more effective when patients are stably housed. And maintaining housing is more likely if proper health care services are delivered. And stable housing is a key social determinant of health. We just need to address all three together.

CEO Search

The CEO Search Committee has made much progress in the last month. Robert Half Executive Search (RHES) has identified several very good candidates, and we have been in an active interview process. The Committee is careful, thorough, intentional, and respectful during this process. This is the best, most professional search process I have ever participated in. They are taking their job seriously and will settle only on the best candidate for COTS and our community. I am impressed and proud to be a part of this process.

Until next month,

Chuck Fernandez