G--Healthcare for Homeless Veterans | Transitional Housing

REQUEST FOR INFORMATION a. The Veterans Health Administration is requesting potential sources and information concerning the transitional housing and treatment for homeless veterans in Sussex, Newcastle, and Kent counties of Delaware. This is a sources sought and request for information for market research purposes only and is not a solicitation. b. The following information is requested from all companies capable of performing services as stated in the below draft statement of work: - - 1. Vendors Name - - 2. Contact information to include telephone number and email address - - 3. Capability statement - - 4. Similar contracts - - 5. Lessons learned from similar past contract experience - - 6. Socio-economic status I.E. large business, small business, service disabled veteran owned business, veteran owned business, women owned business, 8a, Hub Zone, disadvantaged, etc. STATEMENT OF WORK PURPOSE: CONTRACT RESIDENTIAL SERVICES BEDS The Wilmington Veterans Affairs Medical Center (WVAMC) is seeking Contract Residential Service (CRS) beds for 24 hours a day/7 days a week (24/7). Service provides a community-based early recovery model of supportive housing within the State of Delaware and accessible by public transportation that provides therapeutic and rehabilitative services in a safe environment to homeless, eligible Veterans. The purpose of this Request for Information (RFI) is to obtain availability of contractors who can provide housing, outreach services, case management services, and rehabilitative services within the State of Delaware. The areas of coverage would be for the counties of Sussex, Kent, and New Castle. Service is for Veterans experiencing homelessness and/or chronic homelessness as defined by the Housing and Urban Development (HUD), including Veterans diagnosed with severe mental illness and substance use disorders, in community-based residential facilities. BACKGROUND: The VA has been providing direct and specialized services for homeless Veterans for nearly 25 years. The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population. As part of the Plan to End Homelessness among Veterans announced in late 2009, the Veterans Health Administration (VHA) has been increasing both capacity of existing programs and services offered to program participants. The plan calls for utilizing new models of care not previously offered by VA. The Health Care for Homeless Veterans (HCHV) program is authorized by 38 U.S.C. 2031, under which VA may provide care and services under section 1710 of this title to veterans suffering from serious mental illness and to veterans who are homeless. The duties of, and standards applicable to, non-VA community-based providers is authorized by 38 U.S.C. 501, 2031, part 63.15. WVAMC is seeking Contractor(s) to assist with the provision of emergency residential placement and treatment services through the Health Care for Homeless Veterans program. WVAMC intends to issue a multiple award contract in order to service veterans in all three counties and all priority groups. Priority groups are male veterans, female veterans, veterans with a sex offender status, and sites that can house families. VA is only able to pay for services provided to the veteran themselves. Contract (s) will not exceed a total of 16 homeless Veterans, who need immediate placement in a safe environment with onsite treatment services. Many of these veterans have co-morbid conditions that include serious mental illnesses, substance abuse disorders, and other medical conditions. The goal of the HCHV Contracted Residential Services (CRS) is to rapidly stabilize Veterans medical, mental health, substance abuse and other psychosocial problems in order to place Veterans in other appropriate transitional or permanent housing within 30 to 90 days, but no more than 180 days. Contractor will provide rapid placement of VA-referred Veterans in a safe, residential treatment setting while addressing Veterans complex needs through on-site case management and therapeutic support services. This housing must meet the criteria established both by HCHV clinical staff and VA fire and safety officials. NOTE: Contractors are urged in the strongest terms to carefully review the requirements outlined in the Statement of Work to ensure that all facilities fire and safety and treatment services criteria can be met in a timely way. Definitions: Chronic Homelessness is defined by HUD in 24 CFR parts 91 and 578 to mean a homeless individual with a disability who lives either in a place not meant for human habitation, a safe haven, or in an emergency shelter, or in an institutional care facility if the individual has been living in the facility for fewer than 90 days and had been living in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately before entering the institutional care facility. In order to meet the chronically homeless definition, the individual also must have been living as described above continuously for at least 12 months, or on at least four separate occasions in the last 3 years, where the combined occasions total a length of time of at least 12 months. Each period separating the occasions must include at least 7 nights of living in a situation other than a place not meant for human habitation, in an emergency shelter, or in a safe haven. Contracted Residential Services (CRS) is a community-based early recovery model of supportive housing that serves hard to reach, hard to engage homeless individuals with severe mental illness and substance use disorders. Many have not been able to comply with traditional program requirements resulting in high use of emergency room and acute care services and more Veterans living on the streets or in shelters. CRS places no treatment participation demands on residents but expects a transition from unsafe and unstable street life to permanent housing and to re-engage with treatment services. Contracted Emergency Residential Services (CERS) CERS programs target and prioritize homeless Veterans transitioning from literal street homelessness, Veterans being discharged from institutions, including those in need of medical respite, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing. CERS Programs provide low demand time-limited services such as supporting mental health stabilization, Substance Use Disorder (SUD) treatment services, enhancement of independent living skills, vocational training, and employment services. In some cases, VA may complement the CERS program with added treatment services; such as participation in VA outpatient programs. Emphasis is placed on referral and placement in permanent housing or longer term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need. BASIC SERVICES REQUIRED BY THE CONTRACTOR: PROGRAM REQUIREMENTS: The contractor must provide Contracted Emergency Residential Services (CERS) to male and/or female veterans. Contractor is required to ensure that the facility used for this contract meets the Americans with Disabilities Act (ADA) guidelines for accessible accommodations for Veterans with physical limitations or impairments. No funds will be made available for capital improvements under this contract. All of the facility s CRS rooms must be wheelchair accessible, to include entrances/exits, bathroom facilities, and common areas. Veterans must not be segregated from the rest of the facility due to physical disability; they must have the same access to the physical plant as well as the treatment services and supports at the facility as any other resident. The contractor will offer a low-demand environment for CERS with a minimum set of rules designed to re-establish trust and engage the Veteran in needed treatment services as follows: Acceptance of treatment cannot be a condition of admission or continued stay Abstinence from alcohol or drugs cannot be a condition of admission or continued stay Repeated admission or past behavior cannot be a condition of admission or continued stay Demands are kept to a minimum Rules focus on staff and resident safety Infractions of rules are used as opportunities for engagement ROOM AND BOARD: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. Accommodations will include a private or semi-private room (no more than 4 per room) with a bed and other furnishings such as a dresser, storage, and personal linens (towels, pillows, blankets and bed sheets). The environment must be conducive to social interaction, supportive of recovery models and the fullest development of the resident s rehabilitative potential. Residents must be assisted in maintaining an acceptable level of personal hygiene and grooming. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge. MEALS: Meals shall meet 2015 dietary guidelines set forth by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, including any updates made to the guidelines. A minimum of two meals per day must be provided in a setting that encourages social interaction. In addition, the contractor must provide the availability of snacks of nourishing quality (e.g. fruits, vegetables, protein sources, etc.), between meals and before bedtime for those requiring or desiring additional food, even when it is not medically indicated. There will not be more than a 14 hour span between evening meal and breakfast of the following day. Contractor will provide alternative meals for Veterans with dietary restrictions if medically indicated (e.g. diabetic, renal and soft mechanical diets) and reasonable accommodation for Veterans with cultural/religious preferences around food (e.g. Kosher, Sikh, etc.). If food in centrally prepared, it shall be prepared, served and stored under sanitary conditions. The contractor shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The contractor shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste. GENDER SPECIFIC CARE PROVISIONS Special attention needs to be given to meeting the unique treatment needs of homeless women Veterans. These needs often may include assistance with managing sexual trauma, eating disorders, interpersonal violence, and caring for dependents while in treatment. Special emphasis on privacy and security should be noted in mixed-gender facilities. Veteran residents have a right to be treated with dignity in a humane environment that affords them both reasonable protection from harm and appropriate privacy with regard to their personal needs. The living environments of HCHV CRS must include: Residential room and board in an environment that promotes a lifestyle free of sexual discrimination. An environment conducive to social interaction, supportive of recovery models and the fullest development of the resident's rehabilitative potential regardless of gender or sexual orientation. Separate and secure bathroom arrangements to ensure an acceptable level of privacy for personal hygiene and grooming. LAUNDRY FACILITIES: Contractor must provide laundry facilities and necessary detergent free of charge and adequate for residents to do their own laundry or to have laundry done at minimum one time per week. TRANSPORTATION: The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA Liaison and/or other appropriate VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall provide alternative transport by car or taxi between the hours of 08:00am to 10:00pm. Transportation shall not be a barrier for a Veteran receiving service necessary to reach their treatment goals. Thus, if public transportation isn t appropriate or adequate, then the contractor must have the ability to provide transportation to accommodate scheduled admissions, meetings, housing search, and other appointments in the community and at the local VA facility during business hours and after hours as necessary. VA staff may also assist with logistical burdens. ADDITIONAL SERVICES REQUIRED BY CONTRACTOR: THERAPEUTIC/REHABILITATIVE SERVICES: Each Veteran must have an Individual Treatment Plan (ITP) completed by the Contractor with input from the Veteran and with consultation by VA Liaison and/or other appropriate VA staff within 72 hours of admission. Therapeutic and, as appropriate, rehabilitative services must be provided by the contractor. Therapeutic and rehabilitative services must be stated in the ITP based on the veteran s needs. Contractor must provide: Group Activities: Structured group activities, as appropriate, shall occur at a minimum of two times per month examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and recreational activities. For the purposes of this contract House Meetings and VA Housing Resource Groups may not be counted as a structured group activity. Group Activities should have a therapeutic value and facilitation shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with their ability to participate with group activities as stated in their ITP, alternate group activities will be arranged and/or the Contractor will clearly document efforts made to accommodate the Veteran. VA Coordination: Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services. In particular, coordinated efforts must be made with the VA Liaison or Designee and/or other appropriate VA staff around medical, mental health, admission and discharge needs. Case Management: Case management means arranging, planning, coordinating, or providing direct services and support; referring and providing linkage to VA and non-VA resources, providing crisis management services and monitoring; and intervening and advocating on behalf of veterans to support transportation, credit, legal, and other needs. A thorough written Individualized Care Plan (ITP) will be developed within 72 business hours of admission for each Veteran. This will include structured individual case management on at least a weekly basis to address the Veteran s psychosocial needs, develop treatment goals, and review progress/barriers towards obtaining their goals towards self-sufficiency. For the purpose of this contract, VA discharge meetings do not count towards the weekly structured individual case management requirements. It is understood that these visits do not substitute nor relieve the contractor in any way or the responsibility for the daily care and treatment of the Veteran. The contractor will assist the residents in obtaining community resources and assistance such as, but not limited to, and as appropriate: applying for social service benefits, applying for VA benefits, income assistance and financial planning, employment services, housing resources, religious/spiritual services and access to social/recreational opportunities. The contractor case manager will assist Veteran with referrals to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, NSC pension, SC compensation, etc.). Case Managers will document all structured activities that support Veteran in developing a short and long term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in group but preferably through one on one case management services. The contractor must also promote community interaction, as demonstrated by scheduled activities or by information about resident involvement with community activities, volunteers, and local consumer activities. Case managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment. Contractor will provide proper documentation verifying services and case management efforts provided to the resident by all team members including, but not limited to housing, benefit and employment specialists, and program management staff. There will be an expectation that notes are written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g. SNAP, SOAP, DAP or SMART notes). Professional Counseling: The contractor will provide professional counseling, including counseling on self-care skills, adaptive coping skills, and as appropriate, vocational rehabilitation counseling, in collaboration with VA programs and community resources. In addition, special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison, VA Mental Health Staff and/or the contractor s Case Manager. On a weekly basis the contracted case manager will be required to update the VA Liaison on Veteran progress and/or safety concerns for HSR Veterans. Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran s Safety Plan will be documented in the chart. If a veteran is deemed to be at risk of self-harm or risk of harm to others then contracted staff will immediately contact 911 or mobile crisis as well as notify VA liaison. All Veterans will be referred for VA Primary Care and Contractors will support Veterans in making initial and subsequent appointments. Particular efforts to access care will be made for Veterans who are identified by VA Liaison to be highly acute. Efforts will be documented in the Veterans ITP and reviewed by the VA Liaison at least monthly. Community Outreach: The contractor will participate with Delaware Homeless Planning Council to outreach currently homeless veterans who live in the streets, cars, parks and abandoned buildings. Permanent Housing Search: Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. As a primary goal of the HCHV program, plans for Veterans transition to permanent housing placements must be clearly reflected in each ITP and in weekly case management notes. As part of this plan, Veterans housing history and needs must be assessed through a formal and thorough Housing Assessment completed within 72 business hours of program admission. Housing Assessments must identify Veterans housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly through one to one case management. Examples of direct assistance include: 1) assistance obtaining and reviewing Veteran s free credit report, identifying housing strengths and/or barriers associated with current credit status; 2) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process 5) exploring housing option in low-rent areas. All housing efforts by Contractor shall be documented clearly and presented to VA Liaison upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements. Veterans with Sex Offender status will have increased focus on discharge to stable or permanent housing placements as evidenced in ITP. Recovery: Support for an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident s rehabilitative potential. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models including a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach. Pursuant to these principles, drug testing may not be used to admit, discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior. Discharge Planning: Securing permanent housing will be the primary discharge goal for every Veteran. All Veterans must have a discharge plan within one week of admission. Veterans must maintain a minimum of two appropriate housing placement applications until permanent housing is obtained. Contractor must provide computer and telephone access for Veterans to assist with discharge planning and case management needs. Case Managers will provide assistance with discharge planning for every Veteran and report all discharges via email within 24 business hours using a secured process (e.g. HOMES ID number). HOMES exit form is required for discharging a Veteran from any HCHV program via fax within 24 business hours from known discharge. Housing needs will be assessed upon acceptance to the program and resources will be coordinated for discharge to a successful community placement throughout the duration of the Veteran s stay. A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison prior to discharge. All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with team to determine most therapeutic option for Veteran. This does not include violations for safety reasons or physical abuse. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any and all actual violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the VA Liaison in order to schedule an appeal. MEDICATION MANAGEMENT: Medications and narcotics shall be properly stored, controlled, issued and recorded in compliance with physician s orders. Contractor shall establish written procedures for ensuring Veterans confidentiality in the storage of and keeping of records concerning medication. Medication Assisted Treatment (MAT) cannot be used to rule out Veterans participation in either of the CRS Programs. This includes prescribed use of Vicodin, morphine, methadone, oxygen, etc. Reasonable accommodation for individuals in MAT is required provided the requested accommodation does not require major financial or administrative commitments that would be considered an undue burden. Examples of reasonable accommodations include: Arranging for the individual to take medication at their clinic, physician s office, or another off-site location when consistent with the individual s treatment plan. Storing an individual s MAT medication in a lock box in the program and having the individual be personally responsible for it. Arranging to have the housing facility keep MAT medications in a locked cabinet (Copies of Inspection Packet requirements relating to medication management are available upon request). CRITICAL INCIDENT REPORTING: All critical incidents will be reported to the VA liaison or Designee within 24 hours. This includes the following: Falls Assault (to Veteran or Staff) Elderly/Dependent Adult Abuse or Neglect Sexual Assault Fire (Veteran Involved) Medical/Psychiatric Emergency (911 Calls) Hospitalization Suicide or Suicide Attempt Homicide Death Drug/Police Raid Medication Problem Infectious Control (bed bugs, TB, etc.) Active Substance Abuse Observation/ Possession of Weapons DOCUMENTATION: The Contractor shall provide treatment and discharge planning that reflects a team based assessment of health, social and vocational needs with the involvement of the Veteran, the VA Liaison and appropriate community resources in resolving problems and setting goals via the ITP. An individual case record will be created for each referred Veteran. Case records shall be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332). Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need to know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). The Contractor shall participate in the Homeless Management Information System (HMIS). HMIS means the information system designated by the Continuum of Care to comply with the HUD's data collection, management, and reporting standards and used to collect client-level data and data on the provision of housing and services to homeless individuals and families and persons at-risk of homelessness: The files shall include: Reasons for referral, data relevant to the Veteran s admission and anticipated length of stay. All essential identifying data relevant to the Veteran and his/her family including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or Veteran care conferences. Medication Management/Monitoring- Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. Contractor must be in compliance with HCHV medication inspection requirements. Case management notes written in a professional manner (i.e. SMART, SOAP, SNAP, DAP) will include the following: 1) A written and thorough Housing Needs Assessment, 2) Individual Care Plan with attendant goals and documented activity indicating Veteran and Case Manager is actively working on identified goals and 3) Discharge Plan. Final summaries on each resident who leaves the program, to include reasons for leaving, the resident s future plans, and if possible, follow-up locator information. Extension approval if relevant. Waivers as appropriate. Upon discharge or death of the patient, medical records on all VA beneficiaries will be retained by the residential housing facility for a period of at least three years following termination of care. REFERRALS, ADMISSIONS AND ELIGIBILITY: It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of room and board. It is also understood that Veterans may need more intensive case management than the general population. To be eligible for placement in emergency contract beds, all Veterans must be homeless and eligible and registered for VA services (24 CFR 576.2). A formal diagnosis is not required for the Veteran to participate in the program. Contractor must provide housing and services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, seriously mentally ill Veterans, Veterans who have abused drugs or alcohol for many years, and/or Veterans who have been involved with the legal system. VA Liaison and Contractor will mutually determine an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process. The VA is responsible for determining eligibility of Veterans prior to acceptance by the Contractor for services. After receipt of a Release of Information (ROI), a written pre-approval from VA Staff is required (hard copy, fax or e-mail are acceptable) and shall be provided to the Contractor for each Veteran referred for services under the contract. The needs of special homeless populations including women, OEF/OIF/OND, serious mental illness, and chronically homeless will be prioritized within each subgroup in admission criteria. A list of authorized VA Staff that can make referrals shall be provided to the Contractor upon award of the contract. VA Staff may be added or deleted from the list during the term of the contract at the discretion of the VA liaison. The Contractor shall be provided an updated list of authorized VA Staff whenever such changes are made. Veterans who refuse to allow this communication about their treatment needs and ongoing care will need to receive services elsewhere. Intake Packets: All Veterans must receive and sign a receipt for an intake packet within 72 business hours which includes, at minimum, the following information: Description of the Contractors services Rules and Regulations Grievance Policy Emergency procedures Veteran rights and Reasonable Accommodation Timeliness of Response- Contractor must have a dedicated phone line for VA inquiries and referrals. Return calls from the contractor are expected within 2 hours during business hours Monday through Friday. This includes calls from VA Liaison or Staff to the program. Admission Criteria: To be eligible for HCHV Contracted Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3. VA will give priority to veterans, in the following order, who; Are new to the VA health care system as a result of VA outreach efforts, and to those referred to VA by community agencies that primarily serve the homeless population, such as shelters, homeless day centers, and soup kitchens. Have service-connected disabilities. All other veterans. Contractor must have the ability to accommodate immediate admissions 24/7. All admissions must have authorization of the VA. In reference to eligibility, provider staff should contact WVAMC eligibility office to verify Veteran status during non-business hours. If unable to verify during non-business hours, a homeless person should be accepted conditionally. Contractor must notify VA Liaison of admissions that occur outside of non-business hours immediately the next business day. Within 72 hours of the notification, VA clinical staff will meet with newly admitted indiv...