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Short-term solutions with long-term benefits: providing frequent users of emergency departments with multidisciplinary services has dramatic payoffs.

Article Excerpt
Every month Bob sought treatment at Highland Hospital's (Oakland, California) emergency department (ED) for cellulitis. Bob was homeless, so he was unable to shower or perform necessary hygiene. Years before, Bob experienced a difficult divorce and his life fell apart. He began abusing drugs and was arrested for shoplifting and drug possession more times than he can remember. He spent much of his days in DeLauer's bookstore in Downtown Oakland, smoking, reading, and trying to deal with deep depression.

On one ED visit, staff notified Maria Culcasi, a case manager for Project RESPECT, that Bob was a "frequent user." Culcasi met Bob and connected him to a community clinic for medical, mental health, and dental care. She helped him find permanent supportive housing (affordable housing linked to healthcare and vocational services). And Project RESPECT's benefits advocacy team helped him apply for SSI and Medi-Cal (California's Medicaid program).

Eighteen months later, Bob testified before the California Senate's Health Committee on a bill that would require Medi-Cal to pay for the type of services Project RESPECT offers. He told the committee:

Maria Culcasi helped me get treatment for drug use and depression. ... Now I have a place to sleep every night and a place to keep my medicine, so I don't get sick as much. And, I have a place to keep food and prepare meals. Because of help from Project RESPECT, I don't need to go to the hospital anymore. I am also able to keep proper hygiene now so I don't have a recurrence of cellulitis. I have been clean from drugs for 18 months. I am now volunteering at the Oakland Museum and the veterans' hospital and I've reestablished relationships with my kids. It's good to be out of jails and hospitals.

Programs like Project RESPECT not only prove that offering a medical/mental health team, case management services, linkage to housing, benefits advocacy, and transportation assistance is a cost-effective way of reducing avoidable crisis care, but also that these programs change lives.

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Frequent users of health services

A small percentage of people disproportionately drive healthcare costs in this country. Sixty percent of Medi-Cal expenditures, for example, fund care for 5% of enrollees. (1) One subset of high-cost patients is people EDs identify as frequent users, who visit EDs at least...

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