In March, when two homeless patients who had been treated for COVID-19 were about to be discharged from Cleveland Clinic Marymount Hospital, nursing staff and case management recognized a problem.
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“The only option was to discharge them to a homeless shelter. From a public health perspective, this did not make good sense,” says Kristine Adams, MSN, CNP, ACNO of Care Management and Ambulatory Services at Cleveland Clinic. “Nurses knew there was no way to ensure they could self-isolate, so we found a very helpful mom-and-pop motel who took these patients and quarantined them for two weeks.”
That was the genesis of a collective initiative to quarantine COVID positive homeless people and migrant workers in a hotel while they recover. Since its inception, more than 70 people have stayed in a Cleveland hotel. “Nursing got the ball rolling and began collaboration with community partners to make this work,” says Adams.
County-wide collaboration fuels success
Several healthcare systems, government entities and social service agencies are involved in the initiative. Hospitals include Cleveland Clinic, MetroHealth, University Hospitals and St. Vincent Charity Medical Center.
“On an individual patient level, each hospital has this population of homeless patients, all of whom were in a really bad spot,” says Geoffrey Lake, MBA, MSW, LISW-S, CCM, Manager of Care Management for Cleveland Clinic. “Normally, we tell COVID positive patients who don’t require hospitalization to go home and stay there for a couple weeks. That works great, unless you don’t have a home.”
Lake says that the four hospital systems all realized the problem was universal and impacted public health, so the first step was beginning a conversation with one another. They then began meetings with numerous other community partners to hammer out the details, including Cuyahoga County’s Department of Health and Human Services, the Cleveland/Cuyahoga County Office of Homeless Services and FrontLine Service, an agency that provides comprehensive care for homeless people.
Patients receive a multitude of services
Patients are provided a free room at the hotel for two weeks and receive “grab-and-go” meals outside their doors. They are given linens, which they double bag daily along with any trash for pickup by hotel staff. The staff received personal protective equipment to ensure safe handling of any items coming out of the patients’ rooms.
In addition, the patients are monitored daily by a nurse, who performs temperature checks and breathing assessments to ensure their condition is not deteriorating. “Medical interventions are applied as needed, although the patients have done very well,” says Adams.
Organizers also enlisted the help of the Visiting Nurses Association, who arranged for a social worker to work full time with the patients. The social workers, who trade off weeks, help people apply for Medicaid and transitional housing, as well as look for employment.
Initiative benefits patients and the community
Putting patients with COVID-19 up in the hotel has helped contain the spread of coronavirus in the community. “We have seen places of congregate living – skilled nursing facilities, dormitories and crowded bars – associated with outbreaks,” says Adams. “Due to fast action, we did not see homeless shelters contribute to outbreaks. That is truly a success.”
Equally important, the initiative has made a difference for individuals. One of those people is a migrant worker who went to Cleveland Clinic Union Hospital’s Emergency Department and tested positive. He agreed to recuperate in the hotel, about 80 miles north of the hospital, but was concerned about his work truck. “We made arrangements to bring the truck to Cleveland so it was available and gassed up upon his quarantine completion,” says Adams.
Finally, from a structural level, the initiative has brought community organizations together and forged new partnerships between nurses, social workers, community agencies and government entities. “Back in the 80s, almost every family movie had this moment when the whole town pulled together to solve some problem. Most of the time that doesn’t happen in real life, but in this moment it did,” says Lake. “The city, county and local medical providers worked together for the benefit of the least among us – for folks who often get forgotten.”