State officials say a quarantine facility set up for homeless people awaiting COVID-19 test results shows broader promise as a permanent crisis stabilization center.
The city-owned Kaaahi Street COVID-19 Temporary Quarantine Isolation Center in Iwilei opened in late March. It provides isolation space for unsheltered people suspected to have COVID-19. About half of the participants so far were referred by emergency department officials, said Edward Mersereau, the Department of Health’s deputy director for behavioral health.
Everyone is treated as if they have COVID-19 until tests show otherwise.
“People with behavioral health issues need a lot of additional support,” Mersereau said. “We cannot just stick them in a room and say, ‘Don’t go anywhere.’”
As of Thursday, 69 people with suspect symptoms have stayed at the isolation center. Just one has been diagnosed with COVID-19.
On average, participants stay for four days. They receive medical help and counseling for mental illnesses, substance addictions and other diseases such as diabetes. They get help to apply for food and medical benefits for which they are eligible. Of the participants who stayed at the center between March and the end of May, many were connected to shelter — some transitional housing, and some permanent housing.
Hawaii state officials say there have been very few cases of COVID-19 among people without permanent housing.
“We thought COVID could potentially spread like wildfire among the homeless population. But it didn’t, and I think that’s because of how responsive homeless providers were and the partnership that happened,” said Mersereau, who is part of the state Behavioral Health & Homelessness Statewide Unified Response Group.
The Institute for Human Services is one of the organizations that operates the center. Connie Mitchell, IHS executive director, said many of the people who stayed in the temporary quarantine center were chronically homeless.
“It’s been a real encouragement to see what can come out of having someone stay for a few days and moving on to more permanent solutions,” she said.
A new report analyzed the facility’s first months in operation and noted the facility demonstrates value in developing a permanent crisis stabilization center, citing the potential to cut unnecessary and costly emergency room visits. Many of these patients would typically go through a revolving door at emergency departments. Studies show that most psychiatric referrals end up in hospital discharges, a costly cycle.
Last year, about 5,700 people were discharged from Hawaii hospitals with primary psychiatric diagnoses, which could be tended to elsewhere. The bills associated with those visits total $130 million.
Victoria Fan, a professor and health researcher at the University of Hawaii who compiled the research for the report, says it’s too premature to measure the money saved by TQIC, but other states have demonstrated how crisis stabilization centers save money.
“You don’t need an emergency doctor necessarily if they’re not experiencing a medical emergency,” she said. “It is quite costly — we’re talking millions of dollars that are charged mostly to public payers, mostly Medicaid — that could be saved. It’s not saying we’re going to save it all, but a portion.”
The Kaaahi Street facility is destined for another use as the home of the Sand Island Treatment Center, one of the state’s largest rehab centers, so the TQIC operation is currently looking for a new home.
There are already prospects for alternate locations that would be long-term, Mersereau said.
“We’ve narrowed it down and hope to have a finalized agreement within two months,” he said.
IHS is embarking on a similar endeavor. It hopes to open what they call the Homeless Triage and Transfer Station sometime within the next few months. The station would provide outreach and assist people who have behavioral health or mental health circumstances that make it difficult for them to wear masks, social distance, or wash their hands, Mitchell said.
“If we were to roll it out, personally I’d like to see things more localized,” Mitchell said. “If we had several of these in communities with the same purpose, it allows people to go in their own community.”
Before COVID-19 reached Hawaii, the Department of Health was planning to designate space for a crisis center with “stabilization beds” to link unsheltered people to services. The goal was to meet the needs of people who do not need to be hospitalized but need other social service and health support.
Now, officials are faced with a new reality — that screening for COVID-19 is going to be a regular part of programming for the foreseeable future.
“Now we have an added layer of COVID-19, which will be with us for a while for the foreseeable future,” Mersereau said. “With that layer of infection control involved, we definitely had to go back to square one. We need to set it up so we have the ability to have a dual role.”
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