REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
September 24, 2024
FROM
DIANE RUNDLES, Assistant Executive Officer, Community Revitalization
SUBJECT
Title
Grant Agreement from the Kaiser Foundation Hospitals for the Homeless Discharge Planning Grant
End
RECOMMENDATION(S)
Recommendation
1. Approve the Grant Agreement, including non-standard terms, with Kaiser Foundation Hospitals, for the Homeless Discharge Planning Grant, in the amount of $200,000, for the retroactive grant period of July 1, 2024 through June 30, 2025.
2. Authorize the Chief Executive Officer, Assistant Executive Officer, or the Chief of Homeless Services, to execute the Grant Agreement with Kaiser Foundation Hospitals, as requested by Kaiser Foundation Hospitals, any subsequent non-substantive amendments, and all other ancillary supporting documents necessary for the administration of this grant, subject to review by County Counsel.
3. Direct the Chief of Homeless Services to transmit the Grant Agreement and amendments in relation to this grant to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Marcus Dillard, Chief of Homeless Services, 501-0610)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The Kaiser Foundation Hospitals Homeless Discharge Planning Grant (Grant) allocation is $200,000. There is no match requirement for this grant. Adequate appropriation and revenue have been included in the Office of Homeless Services’ (OHS) 2024-25 budget.
BACKGROUND INFORMATION
Approval of this item will allow the Office of Homeless Services (OHS) to accept the Grant award in the amount of $200,000. The grant funding will support the cost of one existing budgeted Program Specialist position, in OHS, that will coordinate with Arrowhead Regional Medical Center (ARMC) staff and service providers to facilitate patients’ hospital and emergency room discharge planning and transition to appropriate recuperative care facilities and convalescent service networks.
Medical respite provides post-acute care for people experiencing homelessness who are too ill or frail to recover from an illness or injury on the street or in a shelter, but who do not require hospital level care. Short-term residential care allows individuals an opportunity to rest, recover, and heal in a safe environment, while also accessing clinical care and support services, including transitioning into a stable living environment. Without medical respite, homeless individuals are often discharged from hospitals or other medical settings back onto the streets where they are likely to have a recurrence of their medical condition.
In some situations, a hospital or other medical setting will not discharge a patient who is homeless to ensure continuity of the patient’s care, even though the patient is no longer sick enough to be hospitalized. Though the patient receives necessary care to continue recovery, this comes at an excessive cost to the medical facility and takes up beds that may be needed for others. Locally, ARMC staff have expressed that they have experienced a difficulty in finding appropriate placement options for homeless and conserved patients that no longer meet an acute level of care for hospitalization but require a post-acute placement at skilled nursing facilities or other housing options.
Recognizing the need for medical respite providers, Kaiser Permanente, in partnership with the National Institute for Medical Respite Care, established a Medical Respite Initiative that aims to strengthen the ecosystem of medical respite providers and advance best practices, expert services, and state-of-the-field knowledge in medical respite care. The initiative intends to build capacity of medical respite providers to improve medical care, behavioral health interventions, patient access to care, and overall health and housing outcomes. Long-term goals include reduced rates of disease transmission, decreased hospital in-patient stays, lower hospital readmission rates, and placement in temporary and permanent housing.
On February 26, 2024, Kaiser Permanente Southern California Region issued a Request for Proposals (RFP) for Strengthening the Medical Respite/Recuperative Care Ecosystem in the Inland Region. This procurement was competitive and by invitation only. OHS received an invitation to apply for the grant from Kaiser Permanente Southern California Region on the same date as the Request for Applications was released. Upon Chief Executive Officer approval, OHS submitted the grant application to Kaiser Permanente on April 16, 2024 for the maximum amount of $200,000.
On July 11, 2024, OHS received the Grant Agreement (Agreement) from Kaiser Foundation Hospitals, on behalf of Kaiser Permanente for the Chief Executive Officer’s signature. Due to delays for operational, administrative, and legal reviews, this item is being presented at the first Board of Supervisors meeting available. Although this is a retroactive item, the grant funds being recommended for approval in the Recommendations are effective for 2024-25.
The Agreement from Kaiser Foundation Hospitals is non-negotiable and includes the following terms that are different from the standard County contract as follows:
1. The Agreement requires each party to indemnify and hold the other party harmless from all liability for damage to persons or property arising out of or resulting from acts or omissions of the indemnifying party.
• The County standard contract indemnity provision requires the contractor to indemnify, defend and hold the County harmless from third party claims arising out of the acts, errors or omission of any person.
• Potential Impact: If Kaiser Foundation Hospitals is sued for any claim under the County’s use of the grant award funds, the County would have to indemnify and hold Kaiser Foundation Hospitals harmless for damage to persons or property arising out of the County’s acts or omissions.
2. The Agreement cannot be terminated by the County for convenience.
• The County standard language allows for the County to terminate a contract for convenience with a 30-day notice.
• Potential Impact: The County is bound to the terms until the end of the contract period.
3. The Agreement states that in the event that any suit or action is instituted concerning the Agreement, that the substantially prevailing party shall recover all costs, including attorneys’ fees.
• The County standard language provision states that neither party is responsible to pay for the other party’s attorneys’ fees and costs.
• Potential Impact: In the event of litigation, the County may be liable to pay for the other party’s attorneys’ fees.
OHS recommends approval of this Agreement, including non-standard terms, due to the critical need to provide medical respite outside of the traditional hospital setting to improve the well-being of county residents and reduce the burden on existing medical facilities.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Suzanne Bryant, Deputy County Counsel, 387-5455) on August 20, 2024; Finance (Christopher Lange, Deputy Director, 386-8393) on September 5, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Director, 388-0238) on September 10, 2024.