From Homelessness to Hope: Wrapping Support Around a Community Member in Need
Home & Community Services worked alongside a client who was struggling with issues of grief and loss in addition to being unhoused and living out of his stationary truck during the winter. Without a range of Medicaid services, this client would not have had his personal care needs met while working towards finding the community setting that he desired. The client shared that maintaining his storage, which held all his belongings, and maintaining a relationship with his dog—who resided in the truck with him--were his two top priorities. The client was referred to Roads to Community Living which was able to assist with the client’s delinquent storage bill to ensure the client wouldn’t lose his belongings. The client was also approved for Foundational Community Supports which provided him with supportive housing services. Home & Community Services was able to secure a home healthcare agency willing to provide caregiving hours to the client in his truck while a housing plan was being built. The client’s Managed Care Organization was brought in and worked in conjunction with the client on housing and personal care needs, providing additional resources to him. The client was referred to Health Homes to have a Care Coordinator to assist him in meeting his complex medical care needs. When the client’s health issues required intervention and a hospital stay, the team continued to support him. Following a significant surgery, the client transitioned to a skilled nursing facility to rehabilitate safely. Because of the client’s hospital stay, he became eligible to receive additional resources including an Acute Care Hospital housing voucher and approval for 6-months of hotel expenses through the Motel Interim Stays for Transition program. Under Roads to Community Living, the client was connected to a Medicaid contracted provider who assisted the client with truck repairs and found and funded a stay for the client’s dog at a boarding home while he was seeking care and rehabilitative services. This client is now being cared for while his next chapter in life is safely and respectfully mapped out, thanks to the many Medicaid services that wrapped around him.
Navigating Complexity: A Client’s Path to Success
Home & Community Services supported the successful transition of a client from an acute care hospital to an Adult Family Home. Previously, this client had experienced multiple unsuccessful transitions and had four separate hospital admissions due to complex medical and behavioral health issues. Both the client and their Durable Power of Attorney expressed a desire for him to transition to any environment that could adequately address his needs. During the client’s fifth acute care hospital stay, the client was placed on an Involuntary Treatment Act hold due to the severity of his behavioral health issues. Understanding the complexities of this client, Home & Community Services wanted to ensure that all available Medicaid services were utilized to increase the likelihood for him to thrive. The Medicaid services which ultimately helped this transition to be successful were: the utilization of a Community Choice Guide to obtain necessary clothing for the client, Residential Support Waiver services to empower the client through behavioral health training and support, Molina Healthcare coordination to assist the client in meeting their health care needs and a behavioral health evaluation which included provider training to assist the provider in meeting the client’s unique needs. The comprehensive nature of these Medicaid programs aided the client in experiencing stability, support and success in the community setting that he chose.
A Symphony of Support: A Client’s Journey to Fulfillment
The client is a 52-year-old male, who enjoys playing music, exercising and wishes to be employed. The client was at Harborview Medical Center in their in-patient psychiatric department on an Involuntary Treatment Act hold for an extended period after being released from King County Jail when Home & Community Services were introduced to him. The client has a history of dangerous, violent behaviors and experiences delusional and psychotic symptomology. The client also has a history of multiple incarcerations and psychiatric hospitalizations. Home & Community Services assessed the client’s personal care needs and partnered with Harborview Medical Center in caring for this client. Medicaid offers a wide range of services for clients with complex medical and behavioral health needs. This client was a great fit for one of those programs: the Residential Support Waiver program. This program provides a higher level of support for clients with complex behavioral health issues and supports the providers caring for them. Without these services, the client would not have experienced a safe transition into the community. The client transitioned to a facility with a Community Stability Supports contract. This setting helps clients with personal care needs and behavioral challenges to remain in community-based settings. The client was able to receive medication oversight, personal care, and behavioral health support. He was also able to access Community Behavioral Health Support through his Managed Care Organization, as well as Intensive Residential Treatment monitoring of the Less Restrictive Order the client was on. These wrap-around supports, available through Medicaid services, offered this client the opportunity to not only reside in the community and setting of his choice but also to pursue activities that he found fulfilling.