September 10, 2013 – Coordinated care is nothing new at Our House of Portland.
The 24-year-old nonprofit started providing residential hospice care to people living with HIV and AIDS, expanding its model in the mid-1990s to include in-home care through its neighborhood care program. Now the state Department of Health and Human Services plans to award $350,000 to Our House so that it can serve as an example for other types of care management.
Clients of the neighborhood care program live in supported housing and receive assistance tailored to their specific needs. Some clients may need occupational therapy and medication management, where others may just need assistance with meals. Housing is funded with Housing and Urban Development's Housing Opportunities for Persons with AIDS program, through a grant jointly administered by Our House and the Cascade AIDS Project. Our House staff then assist neighborhood program clients with whatever they need – medication administration, meals or occupational therapy. The neighborhood care program serves 25 to 29 people, on top of the 14 clients served in its residential care facility. Our House of Portland also manages Esther's Pantry, a program that provides food and personal care items to clients, and Tod's Corner, which provides free clothing and household goods to people with HIV or AIDS.
The organization created the neighborhood care program after the development of combination antiretroviral drug therapy, which lengthened the life expectancy of people living with HIV and meant people started coming to Our House not necessarily to receive end-of-life care, but to receive acute care when they were really sick – but then would recover and move back to their community. Board member Nancy Sellers said they'd leave the 24-hour care facility in southeast Portland once their health improved, only to find they had nowhere to go, or still needed certain types of assistance, if not intensive, round-the-clock care.
“Now that we have this sort of continuum of care, people get to know Our House, get to know the staff,” Sellers said. “It's just a model that is really effective and cuts down on emergency care visits.”
The organization hasn't received the grant funding yet – executive director Miya expects it to arrive later this year – and is still hashing out the details about how the money will be spent.
Miya said the grant will enable Our House of Portland to serve more people – currently anywhere between 25 to 29 people are served by Our House of Portland's neighborhood care program – and work with partner organizations, including hospitals and other care providers to determine who will be eligible for the neighborhood care program. Right now, Miya said, that program employs a nurse, a social worker and an occupational therapist, and is debating whether to expand – in which case it would hire three more staff, as well as investing in additional resources for dispatch and transportation to visit clients.
Last year the organization had a $3 million budget raised from donations and grants, and while all clients are low-income and most are eligible for the Oregon Health Plan, the organization doesn't bill Medicaid or Medicare, instead dedicating funds wherever there is most need within the organization.
“We have a multidisciplinary team, very very client centered, one of the huge advantages of this type of model,” Miya said. “Because the funding is not Medicaid or Medicare we don't have to ask for approval, or coding. If they need something for their health, we try everything possible to get it for them.”
That philosophy is very similar to the idea behind “global budget” that forms a cornerstone of Oregon's healthcare transformation project, allowing flexible spending and the possibility of purchasing items – such as an air conditioner or a sturdy pair of shoes – that would help Oregon Health Plan members manage chronic conditions or prevent serious health problems down the road.
Bob Weir, advocacy and development manager for the Department of Human Services, said the innovation fund is intended to invest in pilot projects that will save money and improve care. The creation of the innovation fund was a result of talks earlier this year between Department of Human Services director Mike McCormick and Gov. John Kitzhaber's office, Weir said, adding that staff from Our House of Portland was involved in those conversations as well, with the result that $350,000 was earmarked for expansion.
“The approval of the innovation fund came with the idea that of that $2.3 million, $350,000 is dedicated to [Our House],” Weir said. In the near future, Weir said the department intends to create a public advisory board to assess grant proposals for other projects that could serve as a model for improving care and cutting costs.
“I need to give credit to them. They work with a population that can be marginalized, stigmatized,” Weir said. “When people are underserved or not served well at all, there are high societal costs.”
Christen McCurdy can be reached at [email protected].
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