On December 31, 2016, I visited the people of the streets of Kensington for the first time. I have written about that experience here.
It was in those weeks in October 2018 that the beginnings of a storm front developed in my soul. The cold air of the Medicaid system of health care for patients of Substance Use Disorder clashed with the warm air of health care for patients of the same exact medically recognized condition who have private insurance.
Allow me to brag a bit about RCA and what a patient with Substance Use Disorder experiences upon arrival…
When a person arrives at RCA, they are greeted by the receptionist at the front door with words similar to:
"Hello (First name). Welcome to RCA. I'm glad you're here. Would you like water, soda, or a snack?"
They enter a pleasantly decorated reception area and begin the process of registration. They are offered water, soda, or Gatorade and a snack. A full dinner prepared by on-location chefs can be made available very quickly to those who need it. Within a short time of entering and completing the registration process, they are guided to their five-star hotel quality room and the process of detox and healing begins.
If this patient is already experiencing dope sickness upon arrival, comfort care is made available as soon as possible and to the fullest medical extent possible. To better understand why this expediency is so critical, please read my blog: "Drug vs Detox: A Civil War in the Mind"
Such is not the case for people on the streets of Kensington. You can read a comparative blog here that looks at both approaches.
It is time for us to extend the best of the model of health care demonstrated by RCA to the needs of the patients of Substance Use Disorder who are on the streets of Kensington.
I am envisioning a storefront on Kensington Avenue.
1. It would be decorated in a warm and welcoming style.
2. It would not be inside a larger facility. This welcoming area would be visible from the street. By entering one door, the patient of Substance Use Disorder would be walking into a welcoming environment to learn more about their options and, if they are ready to do so, an expedited dignity and respect filled entree into detox.
This storefront has large windows through which passersby can see a warmly decorated, well lit and welcoming environment staffed by caring people who are prepared to register anyone who is contemplating detox/rehab services. Further back in the storefront would be the private offices and exam rooms.
1. Anyone who is contemplating: For various reasons, an individual may not be ready to go to detox. They may be ready to have their contact and insurance information on file for that time when they are ready to go. This storefront would gather this information and be ready to expedite the patient's entry to a detox facility when the patient decides they are ready.
2. Partial registrations would be acceptable. If someone wants to give just their street name and nothing else, so be it. They would be encouraged to come back any time and keep an eye on the storefront window that will display how many beds are available throughout the system.
3. Staff on site would make every reasonable effort to greet this person by name whenever they see each other at or near this storefront.
4. A staff member would be available outside the storefront chatting with people letting them know what this is all about and building relationships and trust.
5. Partnering with the Kensington Storefront and Prevention Point employees/volunteers with their already established community connections would prove very worthwhile.
As referenced above, staff would know the availability of beds throughout the city and suburbs for patients reliant on Medicaid. There would be in the window a continuously updated bed availability sign. Bed availability would already be a known factor.
1. Philadelphia based Medicaid and that of the suburbs require two different processes for admission to detox. The staff of this storefront would understand these differences and provide services accordingly. It would not be a requirement of a Philadelphia based Medicaid patient to go to a crisis center for this process. This storefront would meet this requirement.
2. One of the delays for a Medicaid reliant patient in a crisis center is the process of that center's staff calling around to find a bed. This can take many hours. Having a system in place where bed availability is a known factor would greatly reduce this waiting time and eliminate experiences as related to me in this blog.
3. Patients with private insurance would enter the private insurance health care system.
An expedited registration system would be in place so that a person can be evaluated.
1. If there are no additional medical conditions to be dealt with prior to admission to the detox facility, the person would be registered and taken by designated car service to the facility that will be detoxing the patient. Every reasonable effort will be prearranged with local facilities to streamline the "warm handoff" process between the storefront and the facility, therefore, greatly reducing the wait time between initial intake and the first steps of detox care.
2. If the patient needs medical evaluation, they will be taken by this same car service to a hospital that has agreed to take these patients and WILL treat them with dignity and respect.
3. If at all possible, the driver will wait with the patient and transport them to the awaiting detox facility upon medical clearance. There would be no need to come back to the storefront.
4. If the patient needs to be admitted, this hospital WILL assure (through prior established agreement) that comfort care for all detox/dope sickness related symptoms are promptly and completely addressed to the fullest extent medically possible simultaneous with medical interventions specifically associated with the direct reason for admission. Here is a blog that looks at this issue of treating the primary reason for hospital admission and not treating symptoms of dope sickness. It is titled "Damaged Determination."
5. In the event that this patient needs a multiday admission, representatives from this storefront will call and/or visit the patient each day to offer encouragement and address any issues that the person identifies - therefore serving as their advocate during this time of medical provision prior to entry into an actual detox facility. All clearances related to HIPPA will be appropriately addressed so as to assure that this storefront representative can freely discuss the patient's situation with representatives of the hospital.
Patients of Substance Use Disorder who are reliant on Medicaid for their detox/rehab needs are incredibly underserved, neglected and, on occasion, verbally abused by a system of health care staffed by professionals who had dedicated their careers to the ideals of Hippocrates. It is WAY past time for us who love these street bound patients of Substance Use Disorder to identify new ways to serve them and save their lives. In so doing, we will greatly reduce suffering and the tragedy of overdose, reunite families, and slow the increase in the population of orphans created by this ongoing tragedy.
Calming the storm of the clash of the warm air of private insurance with the cold air of Medicaid is a very viable way to bring further healing to this population of people who have a great desire for healing and no significant professional support for achieving it.
Let us fine-tune and further develop this proposal and make it happen!