Gordon Nunziato visited the emergency room 10 times in four months last year.
He was homeless, abusing alcohol and facing serious kidney and liver conditions, among other health problems. He used the emergency room as if it was a primary care provider.
“I couldn’t find a job, I was going through bad depression,” Nunziato said.
In an effort to break the cycle of constant emergency room use, Mercy Regional Medical Center started the Life Interruptions Need Kindness program, or LINK, to provide patients like Nunziato the support and resources they need to manage their health, said Elsa Inman, program coordinator.
As part of the program, a social worker meets with patients to help them manage the most basic needs: food, housing, transportation, phone communication and more.
The hope is that once patients have a handle on basic necessities and a better understanding of the health care system, they will better manage their own health, Inman said.
In Nunziato’s case, his social worker, Missy Neagos, found him housing and is helping him obtain identification so he can find a job. He was motivated to get sober after learning he would likely die if he didn’t quit drinking. He marked six months of sobriety in March.
“Without these guys, seriously, I would be in the gutter someplace,” Nunziato said of LINK employees.
Since its inception in September 2016, the program has helped 128 patients and reduced emergency room visits by 47 percent and emergency room costs by 52 percent, Inman said.
“The ER is the most expensive place that you can go to for care, so we really work to educate our patients about appropriate utilization of our emergency department,” she said.
New LINK clients are recruited to the program quarterly. To qualify, patients must have visited the ER four times in a year. However, many patients visit far more frequently because they don’t understand their health care options and they are facing physical health, mental health and substance-use issues, Inman said.
“They have experienced a lot of trauma, particularly in childhood, that’s carried on through their adult lives, and it manifests into all kinds of different issues,” Inman said.
LINK program data show 19 percent of the participants were homeless and 19 percent were in unstable housing between May 2017 and August 2019.
The majority of patients, almost 40 percent, were coming to the hospital frequently because of their alcohol addiction, according to the data. Often patients are using alcohol to self-medicate for underlying mental health issues because they don’t have effective coping skills, Inman said.
Mental health conditions and end-stage renal disease caused by untreated diabetes are the other top reasons LINK participants come to the ER, Inman said.
Because LINK patients are dealing with complex needs, Neagos typically works with only 13 to 23 patients at once.
Once patients leave the program, they are tracked, and if they start using the ER frequently again, a social worker will contact them, Inman said.
Catholic Health Initiatives provided $572,000 over three years to fund the LINK program. The funding will end June 30, but Mercy has decided to continue the services and add a social worker to help run it, she said.
Neagos will be moving into a full-time position providing behavioral health services, and a new social worker will be hired as a case manager to continue connecting patients with services they need.
The behavioral health services offered through LINK will not be capped at six visits as those paid for through Medicaid typically are, Inman said.
“That consistency and continuity of care is really, really important, so we wanted to create that,” she said.
Without the LINK program, Nunziato said he would likely be homeless, crippled by medical conditions and dependent on alcohol. Instead, he looks forward to going back to work.
“They told me all these great things, and have done it,” he said.