Healthcare facilities are required to submit an institutional referral for all in-patients being discharged to NYC DHS single adult facilities (e.g., single adult shelter or safe haven).
Reference documents:
Institutional Referral Training Presentation for Hospitals: For new referrers or for frequently asked questions
Institutional Referral Flowchart: Overview of steps for completing a successful institutional referral
Shortcuts to forms to be completed by health care facilities:
Institutional Referral Form: To be submitted it to DHS 2-5 days before patient discharge
Reasonable Accommodation Request (RAR) form: Learn how to submit to an RAR
Shortcuts to:
Listing of mobile health programs (e.g. SPACT, SOS, Care Coordination) and enrollment information
Listing of non-DHS residential placement options and referral instructions
Where do I send the institutional referral form to?
The recipient of the institutional referral depends on whether or not the patient is an active DHS client (has a DHS "assignment").
For patients new to DHS (or has not resided at DHS facility for more than 365 days), institutional referrals should be submitted to the DHS Health Services Office.
For patients assigned to an DHS facility, institutional referral should be submitted to the assigned facility contact.
See page 3 of the Institutional Referral Form for instructions on how to determine the institutional referral contact.
What if my patient refuses discharge to shelter?
Patients who refuse discharge or shelter may benefit from a shelter transfer or placement at a safe haven, if available. Learn more about shelter refusals.
What are common reasons that institutional referrals are deemed incomplete and delayed?
Institutional referrals must meet the following criteria in order for the referral to be deemed complete and a determination of medical appropriateness to be made:
All referrals must attach a signed patient consent form.
Patients who meet absolute medical exclusion criteria are not eligible for shelter.
The most common absolute medical exclusion criteria is the patient needing assistance with activities of daily living (ADLs). These patients should be discharged to a higher level of care, such as supportive housing or assisted living. See residential placement options.
Patients who need absolute medical exclusion criteria and present to shelter intake will be instructed to return to the hospital.
Patients cannot be eligible for other types of permanent or short-term housing or emergency shelter. All applicable non-DHS residential placement must be attempted prior to discharging to DHS.
Patients must have at least one follow-up medical appointment listed on their referral.
Patients with a history of street or subway homelessness must be enrolled in Safe Options Support (SOS) prior to the referral. Patient consent is not required for enrollment.
Patients with a history of serious mental illness who are not engaged in care must be enrolled in Shelter-Partnered ACT or another mobile mental health program prior to the referral.
All required medical documentation must be provided (listed below under "What medical documentation do I need to send with the institutional referral form?").
Referrals are processed in the order they are received. If any section of the form is incomplete or requested documentation missing, the form will not be reviewed and will be returned to the sender. Ensuring that the referrals meet all of the above criteria prior to submission will facilitate a more timely determination of medical appropriateness.
What if I don't receive a response to my referral?
Contact DHS-HCFreferral@dhs.nyc.gov for assistance when assigned shelters, safe havens or street outreach teams do not respond to the institutional referral within two business days. Use the email subject heading "Assistance requested: No response to institutional referral to DHS assignment".
Why can't all patients be discharged to DHS shelters?
DHS is required to ensure safety in shelter. According to New York State regulations, a person should not be placed in shelter if they:
Have a mental/physical condition that causes danger to self/ others
Requires services beyond what shelter is able to provide
Find non-DHS residential placement options here.