Medical respite programs serve people experiencing homelessness who are ready to be discharged from a hospital but too sick or frail to recover on the streets or in shelters. Respite programs offer acute and post-acute health care in a short-term residential setting which allows people to rest and recover from illness, surgery, or injury. Studies suggest that while medical respite is not a long-term substitute for permanent housing, it can be a cost-effective way to address health problems and reduce hospitalizations for people experiencing homelessness.
Problem or Challenge:
People who experience homelessness often have serious acute and chronic health conditions. They may also have mental illnesses and/or substance use problems. They may have illnesses or injuries that result in frequent emergency room visits and hospitalizations. They are at high risk of dying on the streets. Often they are discharged from hospitals without a place to stay where they can recover from injuries or illness. Homelessness worsens health conditions and diminishes the effectiveness of health care that has been provided during hospitalization. Without a stable place to live and a place to store food, medications, and medical supplies, people experiencing homelessness may be unable to follow up on recommendations for rest or other care instructions following discharge from a hospital or after an outpatient medical procedure. The alternatives—including extended stays in hospitals or nursing homes, avoidable re-hospitalizations, or repeated trips to the emergency room—can be very costly.
Medical respite (sometimes called recuperative care) programs are short-term residential programs intended to serve people experiencing homelessness when they are too sick or frail to recover on the streets but do not require hospitalization. Medical respite programs allow people experiencing homelessness to rest and receive appropriate acute and post-acute medical care and supportive services when they leave or are diverted from a hospital. Medical respite programs “close the gap” between acute medical care in a hospital or nursing home setting and the more limited capacity of most homeless shelters. Respite programs offer time-limited stays that allow a person to complete medical recovery from illness, surgery, or injury and to access community services including connections to permanent housing. Ideally a person’s long-term housing needs can be addressed while they are in respite care so that they do not return to the streets or shelter.
Medical respite programs have been implemented in a range of settings and program models that include:
Shelter settings that provide designated beds or rooms that allow respite program participants to recover without having to leave the shelter during the day, and provide space for health care providers to care for clients.
Rooms or apartments designated for time-limited respite stays with on-site or home-visiting services delivered by health care providers; these may be located in a setting that also includes rooms or apartments for transitional or permanent supportive housing.
Partnerships between health care providers who deliver care to people experiencing homelessness and hotels, motels, treatment facilities, nursing homes, or assisted living facilities
Free-standing medical respite facilities that offer beds or rooms, on-site nursing and other clinical care, meals, and other services.
Health care services are often delivered by nurses or mid-level practitioners working with appropriate clinical supervision. Respite program services often include educating clients about how and why to use prescribed medications or follow other care recommendations, and how to monitor or manage symptoms of chronic medical conditions. Respite program staff members often help clients access housing as well as income from public benefits, health coverage, and treatment for mental health or substance use problems.
Respite programs need to be linked to other community resources including housing. Respite programs offer time-limited assistance. This assistance should be linked to organizations that deliver comprehensive primary care and long-term housing for people with complex health needs experiencing homelessness.
Understand the needs and priorities of hospitals and seek support from them. Hospitals may be discharging homeless patients to the streets or to emergency shelters, or delaying discharge longer than is medically necessary because safe options for discharge are not available. This may result in significant unreimbursed costs for extended hospital stays or repeated emergency room visits and hospital readmissions. This problem is likely to be exacerbated by the aging of the population experiencing chronic homeless. Changes in federal law enacted as part of the Affordable Care Act and other changes in health care payment mechanisms create opportunities to engage hospitals in partnerships with medical respite programs. Hospitals may face financial penalties or other incentives to reduce avoidable readmissions and improve quality outcomes. When designing and implementing respite programs it is important to understand the concerns of hospital administrators and discharge planners and to work with them to understand the costs, risks, and poor health outcomes that are associated with current practices. This may include partnering with the hospital to identify frequent users of emergency rooms or people who have avoidable readmissions to the hospital after being discharged without appropriate housing and follow-up care. This may also mean documenting cases in which very sick and vulnerable people who are experiencing homelessness are being inappropriately discharged from local hospitals to the streets or to emergency shelters. With an understanding of current practices it may be possible to identify which stakeholders have an incentive to reduce avoidable hospital stays and emergency room visits. Some medical respite programs have been able to document their success in reducing avoidable costs for hospital care, and use this evidence to negotiate funding arrangements with local hospitals.
Respite care prevents avoidable, costly hospitalizations. Patients discharged to a medical respite program experience significantly fewer hospital readmissions compared to patients experiencing homelessness who are discharged on their own. People served in medical respite programs also experience fewer subsequent emergency room visits and days of inpatient hospital care. Medical respite programs are associated with significant reductions in health care costs.
A summary of evidence from research about medical respite programs is available from the National Health Care for the Homeless Council.
The National Health Care for the Homeless Council website provides a toolkit with information and tools to help organizations and advocates plan, develop, and sustain medical respite programs.
Promising Practice: Frequent Users of Health Services
Model Program: Chicago Housing and Health Partnership