GNYHA is writing to update members on the attached protocols for discharging existing New York City Department of Homeless Services (DHS) clients to isolation hotels. Please refer clients experiencing homelessness who are unknown to DHS and other individuals who cannot return home due to an ongoing need for isolation and who require clinical support and social services to the NYC Health + Hospitals (H+H) Hotel Program. The H+H Hotel Program is staffed by on-call physicians, onsite registered nurses (RNs), licensed practical nurses, certified nursing assistants, care coordinators, and social workers. Nurses who perform symptoms monitoring staff the DHS isolation hotels.
Please note: Homeless individuals requiring isolation in a DHS hotel room cannot require nursing services, medical care, or assistance to perform their activities of daily living as these services are not available in DHS isolation hotels. The H+H Hotel Program cannot accommodate patients who need 24-hour supervision.
Discharge of DHS Clients with COVID-19 or COVID-19-like Illness
Hospitals discharging DHS clients with COVID-19 or COVID-19-like illness who require isolation are instructed to call the DHS Hospital Referral Line (212-361-5590), which is available 24/7, to verify if the patient who continues to need isolation is a DHS client and to confirm whether:
- The individual lives in a congregate setting
- Shares a bathroom
- Is in a self-enclosed unit
Those in self-enclosed units can be discharged with appropriate isolation instructions (14 days from symptoms onset AND 72 hours since last fever without use of antipyretics AND symptoms improvement), specific self-monitoring instructions, and information on who to call if they feel worse. For those living in congregate or shared units, DHS will provide an isolation room. Hospitals are instructed to follow the above only for patients seen in the emergency department and those admitted for COVID-19 or COVID-19-like illness. Patients can be discharged any time after approval.
Hospital staff are required to complete the DHE Isolation Site Referral Form and send an e-mail to dhsmedical-covid19@dhs.nyc.gov after confirming the patient is an existing DHS client.
DHS Clients Not Requiring Isolation (Recovered from COVID-19 and Non-COVID-19)
For patients being discharged who do not need isolation either because they have recovered from COVID-19 and are past the 14-day isolation period recommended by the New York State Department of Health for persons living in congregate settings or were hospitalized for other conditions, please complete the usual institutional referral form and follow the standard referral procedure. If you have questions on the routine hospital referral process to DHS single-adult shelters, please e-mail dhs-hcfreferral@dhs.nyc.gov. These patients can be discharged seven days a week between the hours of 9:00 a.m. and 3:00 p.m.
Referrals to H+H Hotel Program
As previously stated, individuals who cannot return home due to an ongoing need for isolation and who require clinical support beyond what is available at DHS isolation hotels may be referred to the H+H Hotel Program. Please refer to the DHS Isolation Site Referral Form for the list of inappropriateness criteria for DHS isolation hotels. Hospitals referring to the H+H Hotel Program are required to complete the attached H+H RN Clinical Review Checklist, which a team of nurse reviewers will evaluate for appropriateness. The program operates 24 hours a day seven days a week, and patients can be transferred from the hospital upon acceptance between the hours of 9:00 a.m. and 9:00 p.m. daily; requests for discharge can be made up to 12 midnight daily, however, requests made after 9:00 p.m. will be evaluated the following day. Patient transport services are provided from the hospital to the hotel and to the patient’s home at the end of the hotel stay.
Please note: If the patient is on COVID-19-isolation precautions and uses nightly bilevel positive airway pressure/continuous positive airway pressure therapy, the patient cannot be referred due to the lack of negative pressure rooms needed for isolation. If a patient is on hemodialysis, the hospital is required to confirm the dialysis outpatient provider and send location, contact information, date/time, and arrange for transportation prior to the transfer to the hotel. If a patient is on methadone, the hospital is required to send the name and contact information of the patient’s outpatient methadone clinic so that delivery to the hotel can be arranged. If the patient is on Suboxone (buprenorphine/naloxone), the patient must depart the hospital with these medications and any other medications they use, or hospitals must arrange for delivery of these medications to the hotel within 24 hours of discharge to assure continuity of treatment.
Please distribute this updated information widely to discharge planners, social workers, care coordinators, and other staff as appropriate. Please note, the New York City Department of Health and Mental Hygiene recommends COVID-19 patients being discharged who are still in their infectious period should be supplied with a face mask or face covering.