Home Care for the Homeless

For some patients, a hospital stay is followed by caregiving visits at home from a home health nurse – but what if the patient doesn’t have a home?

Because of infrequent access to medical services, members of the homeless population often need emergency care and hospitalization. During the past two years, Knox Area Rescue Ministries, a faith-based organization in downtown Knoxville that provides services for the homeless, and Covenant HomeCare have implemented a program to provide medical care and resources for homeless people to begin building healthier lifestyles. Thanks to a $150,000 start-up grant from Fort Sanders Foundation, the program cares for male patients in an eight-bed unit at the shelter.

Bringing HomeCare to KARM

As a clinical supervisor for Covenant HomeCare, Lori Molter, RN, oversees a team of home health nurses and therapists. Her responsibilities also include planning next steps for her homeless patients, and she says her visits to KARM are among the most enjoyable parts of her job. “This partnership and how we reach people has exceeded my expectations,” Molter said. “When I think about ways to best serve the patients, this goes far beyond what I could have dreamed. This is what our Covenant Health pledge to ‘put patients first’ looks like.”

A home health nurse often instructs a family member or caregiver how to dress a wound, manage an IV, or assist with other medical care – but in this case, the “family member” is a KARM employee. Iesha Yarbrough, KARM respite care team member, is on site at the transitional care unit  Monday through Friday and has a weekend counterpart. Covenant HomeCare social worker Lisa Bentley, MSW, also visits the residents weekly and says she sees changes in patients’ demeanor simply because someone is paying attention to them.

Patient Story – “I wouldn’t be here without this place”

Robert W. was hospitalized because of chronic kidney illness and untreated diabetes. After leaving the hospital, he didn’t have anywhere to go. Covenant HomeCare found a place for him at KARM’s transitional care unit. “If I wasn’t in this program I would probably not be healthy,” said Robert. “They make sure we take our medicine and do what’s good for us to get better.” While staying in the transitional care unit, Robert graduated from LaunchPoint, KARM’s 30-day program that helps build a support system and reinforce life lessons such as budgeting and finding housing before transitioning back into the community.

“Before the transitional care unit existed, homeless patients had nowhere to go after the hospital, or they were on the streets,” Molter said. “Now we know exactly where to find them and are seeing bonds form, not just between the resident and the nurses or social worker, but among the men, who support each other through their difficulties. It’s amazing to see – this program has saved lives.”

By the Numbers

Covenant HomeCare’s partnership with Knox Area Rescue Ministries has resulted in fewer emergency care visits, lower hospital readmissions, lower risk of subsequent illness or infection, improvement in medication compliance and better patient outcomes for the homeless.

Overall, the program has seen:

• Repeat ED visits reduced by 50%

• Total hospital inpatient days reduced by 87%

• Average hospital inpatient length of stay reduced by 62%
  

Click for information on Covenant HomeCare and Hospice services or call 865-374-0600.