The path to good health can be complex especially for patients facing social issues that can harm their health – domestic violence, poor housing conditions, eviction, homelessness and the loss of food or insurance benefits.
As physicians, nurses and social workers learn about their patients’ struggles, they work to connect them with community resources as part of the patient’s discharge plan; however, once the patient is out of the hospital, it is difficult to be sure they get the support they need.
“When faced with these challenges, some patients put their health farther down their list of concerns,” says Dr. Mark Entrup, hospitalist and medical director of Case Management at Cox South. “They get well and leave the hospital but return to the same environment and the next thing you know they are back with us again.”
In an effort to break the cycle of hospitalization, CoxHealth and Legal Services of Southern Missouri have partnered to create a Medical-Legal Partnership (MLP), the first of its kind in southwest Missouri.
Through a four-year grant from the Missouri Foundation for Health, The CoxHealth MLP brings health care and legal professionals together to provide free legal services to patients who meet income guidelines. Caregivers refer patients to the MLP for a free consultation with a Legal Services attorney who is available to come to the patient’s bedside to begin addressing legal needs even before they leave the hospital. MLP staff will follow the patient after discharge if needed to resolve the issue.
“This partnership has the potential to impact the community as a whole as we begin to remove those economic and social barriers to health for people living in poverty,” says Sharon Alexander, Legal Services of Southern Missouri.
The grant provides for a Legal Services attorney, Andrea Long, and a paralegal, Jeanne Crawford, who work from an office on the first floor at Cox South. MLP services are available for CoxHealth patients at any location, as well as for CoxHealth employees who are eligible.
MLP staff will provide training to caregivers on how to screen patients for the social factors of health that may have legal remedies. Long says caregivers can listen for “IHELP” issues – Income maintenance and food insecurity; Housing such as evictions, utilities and foreclosures; Ensuring safety through orders of protection, divorce and custody for victims of domestic violence; Legal help with simple estate planning and health care directives; and Powers of attorney and guardianship.
“A patient might say they have a hard time making it to the end of the month, they can’t pay their bills, their utilities were cut off, or they don’t have enough food,” says Long. “The caregiver can make a referral and we can talk to the patient.”
Since caregiver referrals are vital to connecting patients to the service, Dr. Entrup asks physicians and nurses to incorporate this new resource into their delivery of care.
“It’s not going to take any more of our time to have someone come in and talk to the patient,” he says. “To improve the health of this community as our mission directs, we have to be thinking about this.”
Dr. Entrup says one of the biggest needs is guardianships. A common situation is a patient with psychiatric issues who can’t make medical decisions. A patient may have to wait up to 90 days for a court order to grant a family member the ability to make those medical decisions.
“We’re going to see more action earlier on to help these patients transition out of the hospital sooner,” says Dr. Entrup.
“This is the next piece of the puzzle in the transition of care,” says Bobby Davis, social worker manager in Case Management. “This will help us close the gap in getting patients connected to the services they need.”