“Este hotel en particular iba a ser confiscado por la ciudad de Buena Park, por causa de las drogas, el alcohol y la prostitución”, explicó Leon. Pero Leon, CEO de la Illumination Foundation en Irvine, una organización sin fines de lucro, tuvo una idea diferente. Él propuso transformar la recepción del motel en un centro de atención médica y convertir las habitaciones en limpias instalaciones de recuperación para personas sin hogar recientemente dadas de alta del hospital. Y eso fue lo que hizo.

Para las personas sin hogar es imposible recuperarse de una crisis de salud cuando sólo vuelven a la calle luego de ser dados de alta del hospital. Terminan volviendo repetidamente a las salas de emergencia y a los hospitales, lo que es muy costoso.

Los centros de cuidado recuperativo son costosos de instalar, pero el modelo del motel fue justo lo contrario, dice Leon.

“La belleza de esto [es] lo recuperativo de un hombre pobre”, dijo. “No son el Hyatt o el Hilton, pero para nosotros sirve para un propósito. Los costos para ejecutarlo son mucho menos”.

La habitación de recuperación del motel cuesta aproximadamente la mitad de lo que costaría en un hospital, alrededor de $2.000 menos por día por paciente. Y es como estar en casa. De hecho, puede ser hasta mejor que el hogar, porque tiene una enfermera en el personal, para ayudar a supervisar el cuidado y manejar las complicaciones.

Leon, que fue entrenado como enfermero en salud pública, lanzó la

Illumination Foundation para proveer precisamente este tipo de cuidado y relacionarlo con la comunidad.

Ahora, la fundación está expandiendo el modelo del motel a seis sitios en cuatro condados, Orange, Los Angeles, Riverside y San Bernardino.

Elvin Quiñones, uno de los pacientes en el Coral Motel, camina con pasos pesados alrededor del estacionamiento en flip-flops (ojotas) para mostrar su hogar anterior – un pequeño Datsun B210 sedan blanco.

“Le mostraré mi casa”, dijo. “No es muy grande”.

Quiñones es un hombre grande, y es difícil imaginarlo hacinado dentro del auto con sus dos perros. En los días posteriores a su operación de vesícula, tuvo que ajustarse también a un montón de engranaje médico.

“Seré honesto, estaba durmiendo enfrente de un Walmart abierto las 24 horas, porque tenía baño”, contó Quiñones. “Todavía tenía un tubo atrapado dentro de mí que estaba drenando, por lo que necesitaba un lugar en donde pudiera vaciar el drenaje”. Estar sin hogar y sin ayuda, agregó, es algo que nunca olvidará.

“Es surrealista”. Usted piensa que se va a despertar y todo era una pesadilla. Y se despierta y no lo es”, dijo. “Es sólo el próximo día”.

Una semana después de su alta médica, el hospital llamó y lo ayudó a colocarlo en el motel.

“Éste es un nuevo modelo de cuidado para el condado de Orange”, dijo Ginny Ripslinger, vicepresidenta de la red de cuidado del St. Joseph Health System.

Hospitales y aseguradoras de salud ayudan a financiar los centros de cuidado con sede en moteles, dijo Ripslinger, porque ellos ahorran dinero estabilizando a estos pacientes.

Los dólares con los que contribuyen son adicionales a cualquier pago del Medi-Cal, el programa de salud para personas de bajos ingresos financiado con fondos estatales y federales.

Más allá del interés financiero de los hospitales, proveer fondos para esta atención con sede en un motel es “simplemente hacer lo correcto”, dijo Ripslinger. “No queremos darles el alta a la calle, y hay una obligación de parte de los hospitales de proveer continuidad de la atención y altas seguras”.

También hay un beneficio adicional en acomodar a estos pacientes sin hogar en habitaciones de motel por dos o tres semanas.

“Podría decir que son una audiencia [cautiva]”, dijo Ripslinger. “Entonces, podemos proveerles servicios sociales y vínculos con la comunidad para vivienda estable, y mantenerlos en un medio ambiente protegido”.

Leon dijo que ha estado trabajando con docenas de ciudades alrededor del país para establecer modelos similares en otras partes.

“Si recién está empezando y no tiene un programa de atención recuperativa”, dijo, “un método fácil y rápido es usar los moteles. Básicamente, podrían comenzar en cuestión de días para albergar a algunos de los pacientes que son los más vulnerables”.

Toda ciudad tiene un problema con las personas sin hogar, agregó Leon, y toda ciudad tiene su versión del destartalado Coral Motel. Es una rara oportunidad, dijo, de transformar dos grandes problemas en una solución.

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“This particular motel was going to be taken back by the city of Buena Park, because of the drugs, alcohol, prostitution,” Leon explained.

But Leon, CEO of the Irvine-based Illumination Foundation, a homeless services nonprofit, had a different idea. He proposed turning the motel lobby into a triage center and converting the rooms into clean recovery facilities for homeless people recently discharged from the hospital. And that’s what he did.

It’s impossible for homeless people to recover from a health crisis when they just go back out onto the street after being discharged from the hospital. They end up returning repeatedly to emergency rooms and hospitals, which are very expensive.

Recuperative care centers are pricey to set up, but the motel model was just the opposite, Leon says.

“The beauty of this [is] it’s the poor man’s recuperative,” he said. “They’re not the Hyatt or the Hilton, but they do serve a purpose for us. The costs to run it are much less.”

The motel recovery room costs about half as much as a hospital would — about $2,000 less a day for each patient. And it’s like being at home. In fact, it may be even better than home, because it has a nurse on staff to help supervise care and handle complications.

Leon, who was trained as a public health nurse, launched the Illumination Foundation to provide precisely this type of care and links to the community.

The foundation now has expanded the motel model to six sites in four counties — Orange, Los Angeles, Riverside and San Bernardino.

Elvin Quiñones, one of the patients at the Coral Motel, padded across the motel parking lot in flip-flops to show off his previous home — a small white Datsun B210 sedan.

“I’ll show you my house,” he said, “it’s not very big.”

Quiñones is a large man, and it’s hard to picture him crammed into the car along with his two dogs. In the days immediately following his gall bladder operation, he had to fit a bunch of medical gear, too.

“I’ll be honest, I was sleeping in front of the 24-hour Walmart, because they had a bathroom,” Quiñones recounted. “I still had a tube stuck inside me that was draining, so I needed someplace where I could empty out the drain.” Being homeless and helpless, he added, is something he’ll never forget.

“It’s surreal. You think you’re going to wake up and it’ll all be a nightmare. And you wake up and it’s not,” he said. “It’s just the next day.”

A week after his medical release, the hospital called and helped place him in the motel.

“This is a new model of care for Orange County,” said Ginny Ripslinger, vice president of network of care at St. Joseph Health System.

Hospitals and health insurers help fund the motel-based care centers, Ripslinger said, because they save money by stabilizing these patients. The dollars they contribute are in addition to any payments from Medi-Cal, the state- and federally funded health program for people with low incomes.

Beyond the financial interest of hospitals, providing funding for this motel-based care is “just the right thing to do,” Ripslinger said. “We don’t want to discharge them to the street, and there’s an obligation on the hospitals to provide continuity of care and safe discharges.”

There’s also an added benefit to accommodating these homeless patients in motel rooms for two or three weeks.

“You might say they’re a [captive] audience,” Riplinger said. “We can then provide the social services and the linkages to the community for stable housing and get them in a protected environment.”

Leon said he has been working with dozens of cities across the country to establish similar models elsewhere.

“If you’re just starting and you don’t have a recuperative care program,” he said, “one easy quick method is to use motels. They could basically start within days to house some of the patients that are the most vulnerable.”

Every city has a homeless problem, Leon added, and every city has its own version of the beat-up Coral Motel. It’s a rare opportunity, he said, to turn two big problems into one solution.

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“St. Joseph’s in Orange, [Saddleback Memorial in] Laguna Hills,” he says. “The best one for me around here is PIH in Whittier.”

At 52, Meade has chronic heart disease and other serious ailments, and he is recovering from a longtime addiction to crack cocaine. Today, he lives with his dog Scrappy in a small apartment in Fullerton.

Beyond making a trip to the ER pretty much every week of the year, Meade has had innumerable X-rays, scans, tests and hospital admissions — all of it on the taxpayers’ and hospitals’ dime, since he is a beneficiary of Medi-Cal, the state and federal program for the poor.

“The doctors and a few nurses knew me [by name], and I told them I should get some stock in the hospital because I was there so much,” he muses.

As health care costs continue to rise, attention has turned to a tiny number of expensive patients like Meade, called super-utilizers. A program that started in Orange County has taken a different approach to treating Meade and other high-cost patients: Over the past two years, it has tracked them, healed them and saved a ton of money along the way.

Meade received more than a million dollars worth of care in each of the two years before he entered the program, according to Paul Leon, CEO of the Illumination Foundation, a homeless health services group based in Irvine. Leon’s foundation runs the program, known as Chronic Care Plus, which has stabilized Meade and found him housing.

“It’s crazy,” said Maria Raven, an associate professor at the University of California, San Francisco who specializes in frequent-user policy. “This small group of people makes quite an impact on the health care system, and on the finances of the health care system.”

In Medi-Cal, the state’s health insurance program for the poor, frequent health care users representing just 1 percent of the patient population account for about one-fourth of health care spending, according to Kenneth Kizer, MD at the Institute for Population Health Improvement at UC Davis.

That’s why health professionals across California have started targeting this problem group.

In a small, busy room at a recuperative care center in Santa Fe Springs, just up Highway 5 from Disneyland, the Chronic Care Plus program’s lead nurse, John Simmons, directs treatment for a select group of homeless frequent users.

Simmons says the big secret about these health care frequent fliers is that they’re not necessarily the sickest patients — they’re often just homeless, with substance abuse or mental health issues, and they routinely end up in the emergency room.

“It was them relying on the ER for everything,” Simmons said. “They got a common cold, they’d want to run to the ER.”

To break the cycle, Simmons conducts what is known as intensive care coordination. He helps the 37 participants, including Don Meade, find housing, get off drugs, get access to services, and make appointments with primary care doctors.

The Illumination Foundation launched the program with the goal of breaking the vicious cycle into which these patients had fallen, then following them over a two-year period. Getting consistent care and support for that length of time, Simmons says, can change their lives for good.

“The beauty of the program was, we took those people and got them self-sufficient,” Simmons said, “and you notice their health [go] on an upward trend.”

The program saved $14 million in health care spending for just those 37 people over two years, compared with the two years prior to the launch of the program.

That doesn’t count the savings attained by using fewer police and emergency transportation services, Simmons said.

Saving so much money with so few participants is an open invitation to expand the program, said Pat Brydges, an administrator at St. Joseph’s Hospital, which helped fund the program.

“There are homeless people in every city in every state,” Brydges said. “There’s no reason why this wouldn’t work across the nation.”

The program is consistent with St. Joseph’s mission to help all people, and the cost savings is an extra perk, she said.

She pauses briefly to contemplate how much money would be saved if this tiny pilot program went national.

“Wow, I don’t even know if I could count that much,” Brydges said. “But if we can do $14 million in this one area alone, it’s amazing what we could do across the nation.”

Back in his Fullerton apartment, Meade said he now sees a primary care doctor instead of going to the emergency room. He still has ongoing heart and health problems.

Being followed by program coordinators over such a long time has really made a difference in his life, Meade said.

“A lot of the stress leaves after you’re in your own home, but if you’re out in the street you’re worried so much all the time,” he said.

Getting off the street is one thing, Meade said, but the staying off it is another. It’s not just that he has his own doctor now, and better health. He has a new life, he said.

The Illumination Foundation plans to release data at the end of June on its first two years.

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The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation.

Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.

The plan, to be implemented over seven years, is based on a that oversees the government-run Medicaid and Medicare health insurance programs.

The California Hospital Association, in a statement issued late Thursday, said it supported the exchange’s decision to phase in the plan incrementally.

The exchange, known as Covered California, will also on a variety of quality metrics or charging too much for care. The plans must dump the providers from their networks as early as 2019 if they don’t mend their ways. The plans could choose not to cut the hospitals or doctors, but they would have to explain in writing why, and detail what the providers are doing to address their deficiencies.

“Covered California’s mission is not just getting patients health insurance; it’s about improving the quality of the health care delivery system,” Peter V. Lee, the exchange’s executive, said in a written statement. “We are creating a market that rewards quality over quantity.”

Some doctors have noted that provider networks in many of the health plans sold by Covered California are already thin and warned that cutting the networks even more would only exacerbate the problem. And, they say, some hospitals and physicians might balk at the stringent new requirements and decline to participate in Covered California networks.

The insurers are not happy about transparency provisions that involve disclosing the rates they negotiate with their providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.

But Covered California officials believe that scrutinizing the negotiated rates will help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a medical procedure.

Nicole Evans, spokeswoman for the California Association of Health Plans, said that in some rural areas, where hospitals are few and far between, eliminating even one that is deemed to be underperforming might seriously compromise access to medical care.

“Or maybe one of them didn’t score as well on one quality measure but other quality measures are higher,” she said.

Evans added, though, that she was pleased Covered California would at least allow exceptions to this rule.

Among other elements of Covered California’s contract overhaul:

• Health plans must assign a primary care doctor to enrollees within 30 days of coverage.
• Health plans and doctors must share data to better track and treat patients with chronic conditions such as diabetes.
• Plans are obliged to monitor and reduce health disparities among all their patients, starting with four major conditions: diabetes, hypertension, asthma and depression.
• They also are required to better manage the price of high-end pharmaceuticals and aid consumers in reducing the cost of expensive drug treatments.
• The health plans must help consumers better understand their diseases and treatment choices — and their share of the costs for those treatments.

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Li is 89 years old, she knows her own mind, and she’s not afraid to speak it.

“Don’t think you are useless because you’re old,” Li tells the group, admonishing them with a raised finger. “I am 89, and I am not useless. It’s important to always think about your health. You have to always use your brain or you will start to lose memory.”

The gathering at this low-income housing project in downtown Oakland, California, is called Neighbors Helping Neighbors. It’s part of an ambitious plan to help elderly residents, many of them Asian immigrants, take control of their health — in part by joining at least one of 14 groups intended to enhance their physical and mental well-being.

This particular meeting focuses on improving memory and warding off dementia. Other groups range from healthy eating to karaoke singing.

The residents also get extensive coordination of care and personal “wellness plans” through the Hook Fong Community-Based Adult Services center next door to the hotel. Services provided by the center are funded in part by Medi-Cal, the state and federal insurance program for low-income Californians.

Program managers said the integration of medical care, assistance with daily living tasks and participation in the groups has helped keep Hotel Oakland residents out of the ER and the hospital.

This is the only health project of its kind in any low-income housing development subsidized by the U.S. Department of Housing and Urban Development, Hotel Oakland administrators said. They hope eventually to spread this model of care to other senior centers across the state and the nation.

State health officials have expressed strong interest in melding housing and health projects, but haven’t made much headway so far. The success at Hotel Oakland could lay new groundwork for the concept in California.

Nancy Lu, the facility’s assistant director, said the large gathering of elderly Chinese people shows just how much seniors — even wary and insular non-English-speaking seniors — want to improve their health.

“We have about 280 of the 400 residents participating in one or more of these groups,” Lu said. “The first goal is to get them to participate, to get out of their rooms, because that ends their isolation.”

She motioned to the crowded, broad lobby. “They are part of all this,” she said.

The property is privately owned but qualifies for federal subsidies, known as section 8, from HUD. The federal agency doesn’t pay for any of the health services; it just subsidizes the low-income housing.

Tom Azumbrado, a HUD director at the agency’s , said what Hotel Oakland offers is more complete than other federally subsidized residences that provide some of the same services.

“This is a full-blown medical situation,” he said. “There are others that offer meals or have some adult day care, but this one is integrating doctor support, helping you figure out how to buy a walker, all kinds of things.”

Azumbrado said he is convinced the program at Hotel Oakland is improving seniors’ daily lives and outlook.

“When people are connected that really helps them,” he said. He noted that a key factor in longevity is “people’s connection to others. Someone else loves them and makes them feel valued. … Because usually at these places, people just sit in their rooms.”

Azumbrado added that HUD would like others to incorporate such a program in the housing projects it subsidizes.

“This is on the cutting edge,” he said. “If this could play out with other seniors, it would be very beneficial.”

Bill Langelier, the owner of Hotel Oakland, sees his place as a model others can follow. He ponies up an additional $250,000 a year to finance some of the health care components of the facility, but he expects that cost will decrease over time.

“That’s our goal, to create a model where other senior communities might scale this in some fashion,” said Langelier, a real estate investor who bought the hotel in 1979 and has developed a personal attachment to the place and its residents.

He said the health program at Hotel Oakland, including coordination of care, personal wellness plans and resident-run health groups, has reduced emergency room visits by 25 percent over the past year, while cutting hospital admissions and readmissions by 17 percent each.

“This is repeatable in senior properties that are affordable,” he said. Most senior facilities across the country have program directors and it would be a relatively simple matter to retrain them as wellness directors, he added.

In the Hotel Oakland lobby, after the presentation on building memory, group co-leader Qi Yu Xiao asked residents to give their own perspectives. She offered a small prize as an incentive — a magenta plastic flashlight.

Hsiao-Lan Kung Ting stood up. She didn’t have much interest in the flashlight, but she definitely wanted the microphone.

“My husband has dementia,” Ting told the group. “He was admitted last year to a nursing home.”

Ting explained that her husband had been a resident at Hotel Oakland, but by the time anyone figured out what was wrong, his dementia was too far advanced.

“It was sad for me to see my husband losing his mind,” Ting said, trying to keep her voice level. “We must improve our memory. Every day. We don’t want to wait till it’s too late.”

After the gathering, Ting, who also speaks English, said her life would not be what it is today without Hotel Oakland.

“Hotel Oakland is a big family. The attention to health education for… seniors, that is so important,” she said. “We need help. Without it, we don’t live. We don’t live at all.”

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