On-Site Virtual Nurse Triage Station at Shelters for People Experiencing Homelessness

Grantee: Compass Housing Alliance
Timeframe: October 2024 – September 2025 | Amount: $30,000

People experiencing homelessness have acute health disparities and significant barriers to accessing healthcare. Compass Housing Alliance is requesting funds to improve primary health access by implementing a pilot program for a dedicated telehealth program to provide nurse consultation and triage services to guests at two Compass shelter sites. Designed specifically to address healthcare needs in homeless shelters and residential settings, the system would provide on-demand access to a consulting nurse 24 hours a day, seven days a week, providing first-level engagement with the healthcare system and providing education, information, and referrals to the local providers.

The proposed project would contract with Nurse Disrupted, a telehealth provider focused on the needs of guests in the shelter and homeless services system. The Nurse Disrupted system works through dedicated stand-alone hardware that creates a virtual nurse station where shelter or day-center guests can access an on-demand consulting nurse with the push of a button. Consulting Registered Nurses are available on demand 24 hours per day, seven days per week, to address the irregular schedules and competing demands that many shelter guests experience due to homelessness, mental health, trauma, and other barriers to stability. Services are delivered through telehealth at the program site, reducing transportation and access barriers – a shelter guest experiencing symptoms in the middle of the night can literally get up from their bed, walk over to the virtual station, and access a nurse who can review symptoms, perform a consultation, provide information, and help the guest determine if they need to seek additional medical care. The consulting nurses are not able to schedule appointments with outside providers or prescribe medication, but they can look at symptoms and provide more informed advice than a typical telephone nurse line. Because they are specifically contracted to work with shelter populations, they have experience with trauma-informed care and an understanding of some of the barriers that people experiencing homelessness face. The program has an on-demand translation service with more than 200 languages available to address the linguistic needs of clients.

Nurse Disrupted presents evidence for the system’s effectiveness through the delivery of more than 43,000 Nurse Triage visits and more than 500 Behavioral Health visits since its inception in 2020. It has addressed more than 700 common health conditions and helped clients address issues with existing resources, avoiding more than 1500 emergency room visits.

SITE LOCATIONS
Compass has selected two sites for the initial 1-year pilot of this system.

Jan and Peter’s Place Women’s Shelter provides 31 shelter beds for homeless female-identifying individuals in the Rainier neighborhood in Seattle. The program is an enhanced emergency shelter that provides beds in semi-private cubicles with locked storage, 24/7 secure access, and the ability to remain in a bed for an extended period. The program is staffed 24/7 and has on-site case managers who help guests find permanent housing, access benefits, find employment, and identify other needs and services. A mental health counselor provides mental health and SUD counseling on-site one day per week through a partnership with Harborview/UW and the Healthcare for the Homeless Network. In 2023, JPP provided shelter to 154 women.

Blaine Veterans Center has 36 shelter beds for qualified male-identifying Veterans referred through the King County Veteran’s Program (KCVP). It also provides enhanced emergency shelter beds with semi-private cubicles, locked storage, 24/7 access, the ability to stay for extended time, and on-site case management. In addition to a housing case manager from Compass, case managers from the KCVP Collaborative Case Management pilot work with guests to access Veteran benefits and county services. Blaine converted from a general shelter to a Veteran-specific center in January of 2024, so only six months of data are available, but in those six months, it provided shelter to 107 individuals.

These two sites were chosen based on the lack of other healthcare delivery or co-located healthcare options, an older adult population that has significant health issues, high rates of after-hours 911 calls that could potentially be triaged on-site, and the presence of 24/7 staffing to assist guests in accessing the service.

Project Implementation: The project involves a 12-week implementation plan, with the virtual nurse station operational at the end of week 8. Nurse Disrupted supplies all hardware, software, and technical support for a flat fee, which includes consultation on placement, system connection, and the local healthcare environment. The placement of the virtual nurse station must be done with care to balance the need for a location that offers sufficient privacy for HIPAA compliance while ensuring ease of access.

The virtual nurse triage system utilizes registered nurses contracted through a healthcare provider. Program setup and implementation entail collecting extensive knowledge of the local healthcare environment, which virtual nurses can provide to system users. The virtual nurse triage system is designed to work in conjunction with local or on-site healthcare delivery and be able to advise clients to access local resources. Virtual nurses cannot schedule appointments, prescribe medication, or make direct referrals to outside healthcare providers, but they can inform a guest with a health concern when a clinic is available or how to access an emergency room if the situation calls for it.

The Implementation and operation of the Virtual Nurse Station will be managed by the Compass Director of Emergency Services, Charlene Mitchell, who will oversee contracting, site assessment, coordination with the vendor, and monitoring and evaluation of the project. Program Manager Besert Asefa will manage on-site implementation, ongoing operation, employee training, and other program concerns at the Blaine Veterans Shelter. The Program Manager at the Jan and Peter’s Place (JPP) shelter for women (TBD) will manage on-site implementation, ongoing operation, employee training, and other program concerns at JPP. Throughout the implementation process, shelter guests will be asked to provide feedback on the initial siting, system setup, information, signage, and other aspects of the operation. Staff at both sites will be trained to show guests how to operate the system, monitor for any issues or concerns, and contact Tech Support (from Nurse Disrupted) as necessary.

Project Evaluation
Critical to this pilot program will be a thorough monitoring and evaluation of the effectiveness and results. A comprehensive evaluation will begin once two-quarters of operations are available to determine whether to renew the service. Compass will review data on patient calls from Nurse Disrupted, feedback from staff and guests, a formal guest satisfaction survey, and other observations to determine the value of the system and seek funding for renewal, expansion, and continuation of the project. The system’s renewal will not incur the implementation and equipment costs, only the annual license.

ABOUT OUR GRANTEE

Compass Housing Alliance

“Compass Housing Alliance develops and provides essential services, shelter, and affordable housing so that everyone in our community has a safe place to call home.”