Everyone in Clearlake knew Charlie. You could find him in the park, sleeping on a bench, or around town adding to his impressive list of transgressions. In a single year, Charlie racked up more than 35 skirmishes with law enforcement, 25 hospital visits, and 16 emergency transports. By most accounts, he was a burden to the system.
Many of us in health care have treated dozens, if not hundreds, of patients like Charlie (we’re using a pseudonym here). Millions of Americans like him — victims of poverty, inequity, mental illness, and circumstance — get caught in an unending loop of incarceration, hospitalization, and hardship. It’s more than morally unacceptable; it’s economically unsustainable. The Agency for Healthcare Research and Quality estimates that vulnerable individuals account for just 5% of the population but half of all health care resources.
For years, communities across the country have turned a blind eye to people like Charlie. In 2017, residents in the small, northern California town of Clearlake decided to respond with a radical experiment in compassion.
Called Project Restoration, this county-wide collaboration includes representatives from law enforcement, emergency services, nonprofits, municipal and health agencies, and faith organizations. It took a new approach to providing proactive, unconditional, and comprehensive care. Charlie was its first case.
A local health care provider and a police officer began the process by visiting Charlie in the park. They asked him a single question, “Will you tell us your story?”
Charlie was skeptical, and didn’t answer.
They returned a few days later, this time with food and water, and asked again. Still nothing.
As trust grew between the team and Charlie, so too did their rapport. Charlie told them he had lived in Lake County for more than 25 years. He had been married, had children, enjoyed his work, and had been a sponsor in the local Alcoholics Anonymous group. After a few hard losses, he started drinking again, losing his marriage, his home, and his job.
“I’ve been living in the bushes ever since,” he disclosed.
The team asked a second question, “What matters to you, Charlie?”
“I just found out I’m going to be a grandfather,” he said, simultaneously smiling and choking back tears, “but my family won’t let me meet my granddaughter until I get sober.” He wanted to get well enough to meet her.
The Project Restoration team members rolled up their sleeves.
Within days, Charlie was admitted to an inpatient detox unit. While he focused on recovery, they focused on housing. Working with area agencies, they transformed a local motel into transitional housing. Churches got involved, renovating the interior of the building and preparing meals. By the time Charlie left rehab, Restoration House had opened its doors, becoming Charlie’s first stable home in more than a decade.
What’s more, all of this was accomplished not by a sizable financial investment, but with savings projected — and ultimately realized — from reduced use of the health system by Charlie and others and savings from unreimbursed care.
Project Restoration didn’t just save Charlie’s life. It also transformed Clearlake.
As one of us (LH) described in a recent TEDx talk, In less than a year, its approach yielded a 44% reduction in hospital utilization, an 82% reduction in use of the community response system, and a 45% reduction in hospital costs among the high-use population. The project is freeing up resources, sharing data across agencies, and creating cross-sector teams to address access to affordable housing, transportation, and behavioral health. Project Restoration leveraged its success to secure a $1.6 million grant to develop a center for integrated support services. In partnership with the Camden Coalition’s National Center for Complex Health and Social Needs, the project is extending the concept to more hospitals and stakeholders.
Perhaps most important, this small community has discovered the power of shared purpose and collective action.
This story isn’t an example of the exceptional. Project Restoration is an example of the possible: a workable, effective approach to healing people and communities.
It’s an approach we are seeing work in locations nationwide — from rural California to urban Memphis — where cross-sector collaboratives are reducing costs and improving outcomes for vulnerable populations.
We are often asked why health systems and communities should care for folks like Charlie. It’s easy to answer with data on savings and reduced resource utilization. Instead, we think of Charlie’s granddaughter. She didn’t meet the Charlie that everyone in Clearlake could find in the park, sleeping on a bench and getting in trouble with the law. She met the Charlie we know: a man whose journey to recovery inspired a community to come together in a radical experiment in compassion.
Lauran Hardin is the senior adviser for the Camden Coalition’s National Center for Complex Health and Social Needs. Shelly Trumbo is the community integration executive for Adventist Health System, a Project Restoration partner.