Shawn Vestal: Hot Spotters tackle overuse of medical services

Randall Sluder has laid his head in a lot of downtown spots over the past 13 years. Few were comfortable, and few his own.

He spent a lot of nights simply wherever he could – or, more to the point, wherever he ended up, so drunk he couldn’t remember. Doorways, hallways, anywhere he could find. Fire crews hauled him to the emergency room more than 50 times last year.

“I’m a habitual trespasser,” Sluder said. “I got 32 of ’em.”

But for the past two weeks, he has called a nice, new, clean one-bedroom rental house near Latah Creek his home. And if he, and the significant number of people who are working to help him, have their way, he’ll be there for a while.

“I love it,” he said, grinning broadly as he stood on the front step. “It’s beautiful! It’s fantastic!”

Sluder is one of the first to benefit from a new approach toward people who gobble up medical and social services, all without ever achieving the stability such programs are meant to provide. A team of health care and social services providers, called the Hot Spotters, identify people like Sluder – “complex clients” who cycle constantly and expensively through the ERs and other public services – and put extra effort and resources into helping them.

“There’s six or eight people constantly watching Randall,” said Lee Taylor, director of strategic initiatives for the Spokane County Medical Society, and a member of the team.

The Hot Spotters group grew out of the collaborative spirit and projects around the work of Darin Neven, an ER doc at Providence Sacred Heart Medical Center and medical director of the medical association foundation’s Consistent Care Program. That program was established to develop ways of reducing the overuse of medical services. Part of that problem tracks back to chronic inebriates or addicts; part of it is fueled by the difficulties the homeless have in recovering from illness or injury, and their high rate of readmission.

The Hot Spotters start from the premise that these people need help – they have a heart for this population, in Taylor’s words. But there is also an economic motivation, because people like Sluder use up a lot of costly services. His ER visits in 2012 added up to more than $30,000.

In any case, Neven, Taylor, Assistant Fire Chief Brian Schaeffer, Jan Dobbs of Frontier Behavioral Health and others began working together on ways to help people with chronic homelessness stabilize their lives. This entailed identifying such people, and then “wrapping” them in services; it’s almost as if the Hot Spotters stalk people with assistance, alert to the potential pitfalls and backsliding.

Taylor pointed out that it can be a juggling act for anyone to navigate a medical emergency – treatment in an ER with a follow-up visit at a specialist and perhaps another follow-up visit later, followed by any prescriptions, etc. and etc. For people with chaotic lives, the connections often simply don’t get made.

Something similar is true among the wide range of services out there to help people. One program in one office in one part of town provides one service; another program in another office in another part of town provides another. The programs don’t communicate or collaborate much, and in some cases, due to concerns over federal privacy laws, they won’t communicate personal information at all.

“There are fairly big gaps between these services,” Taylor said.

It would take a smart, savvy, engaged, alert, sober, organized person to follow this path from homelessness and addiction to health and stability. Or it would take a team.

Sluder moved from Coeur d’Alene to Spokane 13 years ago, and spent more than a year in the volunteer program at the Union Gospel Mission – in and out of the shelter, he said – and then lived in a low-income apartment building. He worked for a while as a baker at Cyrus O’Leary’s, but his drinking repeatedly undercut his efforts to live a safe, solid life.

In recent years, he was on the streets again. In late 2012, as the Hot Spotters group was coming together, Assistant Fire Chief Brian Schaeffer’s crews were hauling Sluder to the ER a lot.

Schaeffer emailed the rest of the Hot Spotters: “Does anyone want to do anything about it?”

They began trying to work with Sluder to coordinate and manage his case. He receives Social Security disability payments to live on, and qualifies for housing assistance and rehab services, in addition to his medical care. He gets a lot of public services, in other words – enough, in a perfect world, to address his problems, if they could be coordinated.

The team provided him legal help, and got him enrolled in inpatient treatment for his drinking and behavior problems. He met with doctors, counselors and a housing manager. The team worked with Sluder for a few months before he backslid and started drinking again. In August, he took a drunken fall down some stairs and hit his head, causing bleeding in the brain. He was hospitalized for a month and is still recovering.

The accident may have helped jar Sluder in a way that other events in his past have not, he and Taylor said. He’s now set up in his house. He’s got a routine for medical care and rehab. He goes to outpatient treatment for his “big-time” alcoholism twice a week.

He says he’s not drinking. Since March, he’s had just one “hospital episode.”

“For all the people working on it, it feels like a success story,” Taylor said. “But it may not be over.”