DRAFT Updated: 5/29/20 Created by L.A. Care Safety Net Initiatives: Please contact Becky Lee at blee3@lacare.org with any questions.

COVID-19: Interim Housing Placement Options for Patients Experiencing Homelessness during the Pandemic

Purpose: This reference document outlines information on interim housing placement options for homeless patients

during the COVID-19 crisis. Please refer to individual agencies / program websites for most detailed information.

Document audience: Case managers and other staff working with homeless patients at community health providers

such as community health centers and Health Homes Community-Based Care Management Entities (CB-CMEs).

Please note that details of placement options may change.

Quick placement options guide based on homeless individual’s COVID status:

Homeless Member’s COVID Status

Placement Options Tier 1 COVID High-Risk Group, Not Exposed, Asymptomatic

Tier 2A COVID positive

Tier 2B&C COVID Exposed or Suspected

Tier 3 COVID Low-Risk Group, Not Exposed, Asymptomatic

COVID Recovered

Project Roomkey ✔ ✔ Isolation and Quarantine sites

✔ ✔

Homeless Shelter Settings

✔ ✔

DHS Interim Housing Program

✔ ✔

Safe Parking Program ✔

See next page for more details on placement options.

DRAFT Updated: 5/29/20 Created by L.A. Care Safety Net Initiatives: Please contact Becky Lee at blee3@lacare.org with any questions.

Placement Options Which members is it appropriate for? Referral pathway? Notes / considerations

Project Roomkey (Tier 1, hotel/motel rooms) Project Roomkey FAQ These sites are led by Los Angeles Homeless Services Authority (LAHSA). They are leasing hotels and motels for people experiencing homelessness throughout LA County. Clients will have their own room in order to isolate from COVID-19. Meals and COVID-19 screening will be provided, but case management is limited. Stay up to or more than 90 days. There is an on-site nurse to screen for COVID symptoms. Some sites have medical teams to provide non-COVID health services. There are recuperative care beds through PRK that is in partnership with DHS Housing for Health. Projected to have 35 hotels.

Homeless status o People experiencing homelessness

COVID status o COVID negative (presumed) and

asymptomatic Medical/BH Risk Levels

o Must be 65+ years old; OR o People experiencing homelessness of all

ages with underlying medical conditions: chronic lung disease or moderate to severe asthma, serious heart conditions, conditions that can cause a person to be immunocompromised, severe obesity, diabetes, chronic kidney disease and who are undergoing dialysis, and liver disease.

ADLs o Able to complete ADLs

Homeless services providers w/HMIS read/write access can refer directly via assessment in HMIS.

If you do not have HMIS, call LAHSA COVID-19 Call Center at 213-536-0720, option 7 for Project Roomkey, from 8AM-8PM, Monday-Sunday. o OR contact tier1referrals@lahsa.org; will

send assessment information + spreadsheet to submit referral information. Call center is recommended option, though.

For PRK Recuperative Care referral, please complete and submit this form via email, fax, or CHAMP. Write “Project Roomkey” on the application when submitting.

Check HMIS. If available, provide member’s HMIS ID to call center.

Review the PRK Assessment questions (see below). Need to know member’s health conditions.

Placement can be immediate, but placement time can vary.

Member may have to travel to another location that is not near them.

LAHSA will email a confirmation to referrer that includes a LAHSA Point of Contact information. This person can help with trouble shooting PRK referral issues.

Check in time for hotels is usually between 2-5pm.

Referring agency needs to continue to provide case management—telephonically or in person.

Referring provider needs to provide transportation. If member is with L.A. Care, Non-Medical Transportation is available to transport member to PRK location (see below).

Isolation & Quarantine for people experiencing homelessness (a.k.a. Tier 2, medical sheltering, alternative care facilities) These sites are led by Los Angeles County Department of Public Health (DPH) with Department of Health Services (DHS) Housing for Health support. These are medical shelters to isolate and quarantine symptomatic and COVID-positive people. These placements consist of RVs and hotel/motels.

Homeless status o People experiencing homelessness o This includes people who are couch

surfing or living in SRO housing who cannot self-isolate in their current environment.

COVID status o COVID positive; OR o COVID symptomatic and need to wait for

test results; OR o Not symptomatic but have been exposed

to COVID positive individuals Medical/BH Risk Levels

Call Quarantine and isolation intake call center (8 am / 8 pm): 833-596-1009

Approximately 2 to 6 hour turnaround time from initial call to confirm placement, plus time to arrange transfer.

Need 2 week supply of meds.

Transportation available through DPH.

DRAFT Updated: 5/29/20 Created by L.A. Care Safety Net Initiatives: Please contact Becky Lee at blee3@lacare.org with any questions.

Projected to have 2,000 rooms.

o Does not require hospitalization or skilled care

ADLs o Able to complete all ADLs

Other criteria o In need of a safe place to self-isolate /

quarantine for 2 weeks

Congregate Homeless Shelter Settings (Tier 3) LAHSA is the lead. LAHSA Winter Shelters: Winter shelters provide shelter and food to homeless individuals during the cold and wet weather season. Each program location provides access to supportive services and housing assistance. 900 beds are opened through September. L.A. City Parks & Rec Shelters (Mass Shelter Expansion Plan): These are COVID emergency shelter beds at City recreation shelters. These are staffed by LAHSA contractors. On-site nurse screening for symptoms of COVID-19. There are medical teams that provide non-COVID health services.

Homeless status o People experiencing homelessness

COVID status o COVID negative (presumed) and

asymptomatic Medical/BH Risk Levels

o Not a high risk group for COVID ADLs

o Able to complete ADLs

Winter Shelter Referral Information

At this time, there is no referral pathway to the City Parks and Rec Shelters. It is recommended to connect with your local homeless outreach teams for connections to these sites.

Winter shelters have transportation options to get to sites.

City Parks and Recreation shelters: Bus service from access points across LA to bring people experiencing homelessness to the shelters. You can get this information through homeless outreach teams. However, most sites are at capacity.

DHS Housing for Health Interim Housing Program (a.k.a. Recuperative Care & Stabilization Beds) This is short-term residential care for individuals who are homeless and who are recovering from an acute illness or injury and whose condition would be exacerbated by living on the streets, in a shelter, or other unsuitable places.

Homeless status o People experiencing homelessness

COVID status o COVID negative (presumed) and

asymptomatic Medical/BH Risk Levels

o Does not require skilled nursing facility or residential care

o Discharging from a hospital or Skilled Nursing Facility (SNF)

ADLs o Able to complete ADLs

For non-DHS facilities: Please download and follow the instructions that are indicated on the LAHSA/DHS/DMH Referral Form for Bridge/Interim Housing Program. Additional supporting documents: 1. LAHSA/DHS/DMH Referral Form for

Bridge/Interim Housing Program 2. DHS Housing for Health Authorization for Use

and Disclosure of Protected Health Information Form– English

3. DHS Housing for Health Authorization for Use and Disclosure of Protected Health Information Form – Spanish

o Low vacancy rate – availability may be limited

DRAFT Updated: 5/29/20 Created by L.A. Care Safety Net Initiatives: Please contact Becky Lee at blee3@lacare.org with any questions.

4. DMH Authorization for Use and Disclosure of Protected Health Information Form

5. Admission Guidelines and Referral Process DHS/DMH Interim Housing Program

6. Supplemental Form for DHS Interim Housing Program (Attachment A)

Safe Parking programs The Safe Parking program gives people living in their cars, vans, and RVs/campers a safe and legal place to park and sleep at night.

Homeless status o People experiencing homelessness

COVID status o COVID negative (presumed) and

asymptomatic Medical/BH Risk Levels

o Not medically vulnerable to COVID ADLs

o Able to complete ADLs Other criteria

o Have a vehicle

Safe Parking programs can be accessed by contacting or visiting a service provider in your area.

https://www.lahsa.org/news?article=592-safe-parking

Availability may be limited due to capacity.

Compiled HMIS related to Tier 1 Referral

--------

COVID-19 Vulnerability Assessment & Tier 1 Referral

By completing this assessment, you are assessing whether someone is at high risk of severe illness if they contract COVID-19, based on age and/or health conditions. Through this assessment you

also have the ability to place these high-risk people on the interest list for Tier 1 quarantine beds in hotels or motels.

Please note, all persons must be asymptomatic (no COVID-19 symptoms). All persons will be screened for COVID-19 upon intake. Please read the following carefully before proceeding.

Please also be aware that these are self-quarantine settings; clients are strongly encouraged to abide by Los Angeles’ Safer At Home order and remain in their rooms. Please complete this

assessment by referring to their case notes and in consultation with your clients to ensure you are capturing their information accurately. You can start out with a general client-centered question such as, “Is there anything about your health background that you believe would increase your chance of becoming severely ill if you were to contact COVID-19?” You can then continue to

navigate through additional assessment questions as necessary.

WHO IS ELIGIBLE:

A) Persons experiencing homelessness who are 65 years of age and older

OR

B) Persons experiencing homelessness of all ages with underlying medical conditions, particularly if not well controlled. (Please see assessment drop down menu for health conditions.)

Part 1: COVID-19 Vulnerability Assessment

Assessment Date

What is the client's current homeless status?

What area is the client being referred from?

Which category or categories does the client fall into?

Anyone 65 years of age and older

People with chronic lung disease, including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic conditions associated with impaired lung function

or that require home oxygen 

People who have serious heart conditions

People who are immunocompromised (i.e. cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly

controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications)

People who are immunocompromised due to smoking history *

[box only marked ‘yes’ if client indicates they have smoked at

least 100 cigarettes in their lifetime OR if they have used e-

cigarettes at least 100 times]

[Subquestion- cigarettes] Have you smoked at least 100 cigarettes in your lifetime?

Yes/No/Refused/Don’t Know

[If yes to above] Do you now smoke everyday, somedays, or not at all

Everyday/ Some days/ Not at all/

Refused/ Don’t Know

[Subquestion- e-cigarettes] Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life?

Yes/No/Refused/Don’t Know

[If yes above] Have you used e-cigarettes at least 100 times in your lifetime?

Yes/No/Refused/Don’t Know

[If yes to above] Do you NOW use e-cigarettes or other electronic vaping products every day, some days, or not at all?

Everyday/ Some days/ Not at all/

Refused/ Don’t Know

People with blood disorders (e.g., sickle cell disease or on blood thinners);

People with obesity (body mass index [BMI] of 30 or higher)

People with diabetes

People with chronic kidney disease

People with liver disease

People with a high-risk pregnancy

Other health conditions that may significantly impact someone’s vulnerability to contracting COVID-19

Please choose one of the above

Please check this box if none of the above categories applies to the client

[box]

[Place a ‘Submit Covid-19 vulnerability assessment’ button here]

[--------Division to Part 2 and 3 if provider wants to complete a PRK referral for a client who is high-risk-----------------------------------]

[new page]

Part 2: Tier 1 ADL Eligibility Questions All PRK clients need to be able to complete their ADLs (activities of daily living) independently. If a

client has a companion and/or caregiver who supports them with their daily needs, they can be jointly referred into a tier 1 site. While there are some supportive services on site, clients who

cannot attend to certain activities of daily living may not be suitable candidates for referral. Below are the three core ADL indicators that would make a client potentially ineligible for PRK.

Can the client control their urination and defecation? (Please note

any need for supplies such as adult diapers and bed pads)

Yes/Yes, with incontinence supplies [space for

Narrative]/No

[Yes, with incontinence supplies: Please contact the client’s

insurance provider or primary care physician to order

incontinence supplies for the client and any assistive devices

needed.]

Can the client get on and off the toilet and clean their genital area

without help?

Note: If the client has a companion and/or caregiver who supports

them with toileting and they will be jointly referred into a tier 1 site,

the response can be ‘yes’.

Yes/Yes with assistive device/No

[Yes/Yes with assistive device]: Please contact the client’s

insurance provider or primary care physician to order

incontinence supplies for the client and any assistive devices

needed. Please provide the assistive devices upon discharge

to the Tier 1 site.

Can the client move in and out of bed or a chair unassisted?

Note: If a client is using a transferring aid such as a cane or walker

to complete this task, or if the client has a companion and/or

caregiver who supports them with this movement and they will be

jointly referred into a tier 1 site, the response can be ‘yes’.

Yes/Yes, with transferring aid [space for Narrative]/No

[Yes, with transferring aid: Please contact the client’s

insurance provider or primary care physician to order

incontinence supplies for the client and any assistive devices

needed.]

[Button to submit above 3 questions]

[If ‘No’ is selected for any of the 3 ADL above questions, the following should pop up and they

should not be able to proceed any further with the PRK referral process:

Unfortunately, if a client is unable to use incontinence supplies on their own, they are unable to

move within bathroom unassisted, and/or they do not have an existing companion/caregiver for

these needs, they will need a higher level of care. Options for this client would be skilled nursing or

board and care placement. ]

[New screen/page of assessment]

Part 3: Additional Information for Tier 1 Referral

Please note:

The following questions are being asked in order to both 1) support providers in assessing what resources their clients would need to have a smooth transition if they are enrolled in a PRK site and 2) gather information that would be useful for PRK site operators. With these two goals in mind, please

complete the ADA, ADL, and health care questions for the client you are referring as thoroughly as possible. The answers to these questions will not impact a client’s eligibility for PRK.

All PRK clients need to be able to complete their ADLs (activities of daily living) independently; these

include bathing, dressing, transferring, toileting, and eating. If a client has a companion and/or caregiver who supports them with their daily needs, they can be jointly referred into a tier 1 site. In

order to best support clients you are referring to PRK, be sure to refer to linked resources regarding additional supports for which they may qualify and would support their potential PRK enrollment.

-Nurses located on site will only be looking for COVID-19 symptoms

-Assistance animals can be accommodated

-Pets cannot be accommodated

- Each PRK-IH will ensure that it is accessible to and usable by persons with disabilities, as required by

the Americans with Disabilities Act (ADA) of 1990.

Key ADA Accommodation Questions

[HMIS Programming note: the following section of ADA questions are mandatory]

The following questions are mandatory so that PRK site operators can appropriate plan for client needs.

Does the client need any special accommodations in order to

complete their ADLs, use an assistive device, or have any other ADA

needs?

This might include a larger bed for bariatric clients, grab bars or a roll

in shower for clients with mobility issues, need for a first-floor room

to minimize stair use or other ADA resources.

Yes(Branch) /No on to next section

Can the client climb stairs? Yes/ No [Space for narrative])

Is the client unable to step into a bathtub and/or do they require a

walk-in/roll-in shower?

If Yes

Branch 1:

Does the client require a shower chair?

Does the client require grab bars for stability?

Yes/No

Yes/No

Yes/No

Additional Client ADA & ADL questions

[HMIS Programming note: the following section of ADA, ADL, and

health questions are not mandatory]

Does the client need any

assistance walking

(ambulation)? Yes/No

[If no, skip down to

Additional Client ADA

& ADL questions. If

Yes to above question

about assistance

walking, continue with

the following questions]:

How far can the client

walk unassisted in feet?

[number field for feet]

Does this client use an assistive device such

as a wheelchair or walker to get around?

[If Yes, branch to 3 questions below]

Branch 1: If yes:

Indicate the device that describes their highest

level of need

Branch 1.1 If Walker/Wheelchair:

Can the client navigate in a small room with

their assistive device?

Branch 1.2 Does the client have the assistive device

they need or will you be supplying it before they

arrive at the site?

Yes/No

[Branch 1 response options]

Cane/Walker/Wheel chair

[Branch 1.1 response options] Yes/No

[Branch 1.2 response

options] Yes, currently has

it/Yes, will supply one prior to arrival /No

[Yes, will supply one prior to

arrival or No: If the client

needs an assistive device

please contact their primary

care provider or health

insurance to obtain this

device.]

Does the client

have an assistance

animal?

Yes [space for narrative]/No

Does the client require oxygen?

If Yes

(Branching) How often?

How will the participant refill

their oxygen tank? There must

be a plan in place to supply the

participant with this if they are

admitted to the site.

Yes/No

1-2 times a day/ 3-5 times

a day/ continuous

Narrative

Does the client have a companion and/or

caregiver who supports them with their daily

needs?

Yes/No

Can the client bathe themselves completely or

do they need help with bathing?

Note: If the client has a companion and/or

caregiver who supports them with bathing and

they will be jointly referred into a tier 1 site,

the response can be ‘yes’.

Yes, can bathe independently/No, needs assistance

[No, needs

assistance: Please start the process of

applying the client to IHSS. An Expedited process is available for clients at tier 1

sites. ]

Can the client pick out their own clothes and

put them on, including clothes with fasteners

(buttons/clips)?

Note: If the client has a companion and/or

caregiver who supports them with dressing and

Yes/No [No: Please start the process of applying

the client to IHSS. An Expedited process is

available for clients at tier 1 sites.]

they will be jointly referred into a tier 1 site,

the response can be ‘yes’.

Can the client obtain and prepare food on their

own?

Note: If the client has a companion and/or

caregiver who supports them with food

preparation and they will be jointly referred

into a tier 1 site, the response can be ‘yes’.

Yes/No [No: While this does

not disqualify the client, if the client

needs assistive devices to feed

themselves please provide these to the

client]

Does the client have the ability to do their own

laundry?

Note: If the client has a companion and/or

caregiver who supports them with laundry and

they will be jointly referred into a tier 1 site,

the response can be ‘yes’.

Yes/No

[No: Please start the process of applying

the client to IHSS. An Expedited process is

available for clients at tier 1 sites.]

General Health Questions

Is the client currently undergoing any medical treatments that

require access to prescription medication?

Branch-- If yes:

Does the client have at least 30 days of medication?

Yes/No

Yes/No

If enrolled into a PRK site, will the client need support in maintaining

medical appointments and/or obtaining medication?

Yes [space for narrative]/No

Does the client have regular/frequent medical appointments (excluding dialysis)? If so, list level of frequency, where are the appointments are located and what transportation options are

available

Yes [Space for Narrative]/ No

Does the client need dialysis? Branch If Yes:

Where is the dialysis center they are connected to?

If enrolled into a PRK site, how would they be getting to this

center?

Yes/No

Name/Address/phone number

[Space for narrative on Transportation method]

Does the client have Medical Insurance Coverage?

If Yes:

List the coverage plan

Yes/No

Name of coverage

[End general health section]

If the client is part of a couple or an adult family unit (including companion/caregiver), do they need to remain lodged together?

Can transportation be provided for the client?

Where is the client currently located?

If in a shelter, please provide the shelter address. If unsheltered, enter the clients location. IMPORTANT NOTE: If you're unable to

see the save option after clicking Add Location, please try and zoom out on the webpage, increased zoom may cut it off.

If there is no current availability in client’s SPA, please select all

SPAs where they would like to be considered for a placement.

SPA 1

SPA 2

SPA 3

SPA 4

SPA 5

SPA 6

SPA 7

SPA 8

Client verified that all information provided in this assessment is true and correct.

Please confirm that the client verified all information

Are there any additional notes you would like to include?

Who at your agency can be contacted if the client is matched to a Tier 1 site?

Name Phone Email

Is your agency going to be continuing to provide case management?

MESSAGING TO CLIENTS: -Please do not guarantee a bed

- Clients should indicate willingness to take a bed, if/when it comes available, in order to be placed on this interest list

WHAT TO EXPECT: Approximately two days before the opening of a new Tier 1 site, a LAHSA staff person will contact

the agency point of contact above if client is matched to the site.

Tier 1 site operator will then reach out to agency point of contact to schedule client intake.

Please be prepared to move quickly when notifying clients and coordinating transport to the site.

Page 1 – Last Updated May 5, 2020

Transportation to Project Roomkey for L.A. Care Members Quick Reference Guide

What is LAHSA’s Project Roomkey?

• Project Roomkey (PRK) is led by the Los Angeles Homeless Services Authority (LAHSA) to provide interim housing (in hotels and motels) for people experiencing homelessness who are high risk and COVID-negative & asymptomatic.

• L.A. Care Health Plan (L.A. Care) members who are COVID-19 asymptomatic and have been approved by LAHSA for placement in LAHSA’s PRK can request transportation.

• LAHSA typically provides phone confirmation of the location and time when a member should arrive at PRK for check-in. L.A. Care is working closely with LAHSA to update the list of approved PRK sites.

• People requesting transportation (Community Health Worker, Case Manager, or someone acting on member’s behalf) can request non-medical transportation from L.A. Care’s transportation vendor – Call the Car (CTC).

What is Call the Car – NMT (Non-Medical Transportation)?

• CTC is L.A. Care’s transportation vendor. CTC will provide NMT – Non-Medical Transportation primarily through Lyft.

• If the member requires a wheelchair accessible transportation, please notify CTC when requesting transportation.

Who is eligible for Transportation to Project Roomkey by Call the Car?

• The NMT transportation benefit is only available to L.A. Care Members under the Medi-Cal or Cal MediConnect lines of business.

• Members who have received placement in PRK who are either 65+ or with a high risk condition for COVID-19 (e.g. chronic obstructive pulmonary disease (COPD), immunocompromised).

• Person calling to arrange transportation on behalf of member must be able to provide a physical address where the member can be picked up by CTC. Ideally, the location should be an easily identified landmark like a bank, fast-food chain, or other recognizable location.

• Member may only transport basic belongings that can fit inside a standard 4-door sedan. CTC cannot transport large items such as bicycles or furniture.

• Member is permitted one (1) escort/companion/partner who must have the same end point destination.

How to Request Transportation for Members for Initial Trip to Project Roomkey

• As soon as person acting on behalf of the member receives confirmation for PRK by phone, please contact L.A. Care CTC to arrange transportation (See Page 2 for instructions).

• Transportation reservations generally require 24-48-hour notice. Same-day requests may be accommodated based on vehicle and driver availability.

• Initial member transportation to PRK by CTC has been authorized from May – July 2020, with possible extension if needed.

Please review Page 2 for complete instructions and referral form for arranging transportation

Page 2 – Last Updated May 5, 2020

L.A. CARE & CALL THE CAR (CTC) NMT TRANSPORTATION INSTRUCTIONS FOR PROJECT ROOMKEY (PRK) LOCATIONS

Upon receiving reservation information from Los Angeles Homeless Services Authority (LAHSA) for PRK, referrers / schedulers should call L.A. Care Health Services Line to arrange transportation for

L.A. Care members at: (877) 431-2273. Please wait for the prompt to play before pressing #4, then press #1.

*COVID-19 Screening Questions will be asked by CTC* INFORMATION TO PROVIDE CTC CALL CENTER REPRESENTATIVES

Member Information □ First & Last Name □ Date of Birth (DOB) □ Member ID Number (located on the member’s L.A. Care-issued medical card)

o If the member does not have their Member ID, provide CTC with member name & DOB. □ State that member needs transportation to Project Roomkey (PRK) Hotel Location.

Scheduler Information

□ Name of the Scheduler [First & Last Name] □ Phone Number to return the call, including extension. □ Note to Schedulers: Please be available by phone to troubleshoot potential issues.

Reservation Information

□ Date & Time of Service - Note to Schedulers: Transportation should be arranged at the beginning of the PRK

check-in timeframe to ensure timely arrival. Example: If check-in timeframe is between 2:00pm-4:00pm, schedule

transportation for arrival at 2:00pm. □ Member Telephone Number

- If member does NOT have a cell phone, please indicate to CTC representative for appropriate vehicle transportation.

- A smart phone / flip phone are both appropriate for Lyft transportation. □ Does the member require wheelchair accessible transportation?

- If yes, indicate to CTC representative.

Additional Member Information

□ Please indicate any pertinent information related to the member’s needs. - Does the member require door-to-door assistance? - Indicate if the member has any mental health or cognitive concerns or potential

hygiene status. - Indicate if the member is traveling with a service animal (no pets at PRK). - Indicate the potential volume of belongings the member is transporting.

Volume is limited to vehicle capacity. CTC is unable to transport large items.

PICK-UP INFORMATION

Where is the member being picked-up?

□ Location address where the member will be picked-up. o Address must be a safe & identifiable location (such as a McDonalds, Starbucks, etc.)

DROP-OFF INFORMATION

PRK Hotel Location where the member will be dropped off.

□ Hotel Name & Address where the member will be dropped-off.

POST-CALL FOLLOW-UP

What to Expect □ Upon scheduling, CTC will provide you with a Reservation ID to confirm the transportation

arrangement.

Status of Transportation Reservation

□ To check on the status of your transportation arrangement on the day of the reservation, call L.A. Care Health Services at (877) 431-2273 (press #4, then press #1) and provide them with the reservation ID.