When caring for people experiencing homelessness, medical respite care (also called recuperative care) is a place of integrated services for someone who is too sick to be on the street or in a shelter setting, but not sick enough to be admitted to the hospital. It is a place for healing and recovery as well as preparation for procedures. Many times, someone is admitted for an acute need and the team also manages chronic conditions.
When I worked at a medical respite program, we made a concerted effort to coordinate with the Community Health Centers. We accepted referrals from the centers. Sometimes that meant getting the person in an Uber and sending them directly from their outpatient visit to our site for admission. We relied on the health centers to connect people to an ongoing primary care provider as well as specialty care. Lastly, and not least of which, the clinical staff were employees of the health center.
One man, whom I met at the respite program, I had the pleasure of seeing consistently when I was at the health center because he would meet with the pharmacist to fill his pillbox every few weeks. He usually had book recommendations for me when I saw him. Another man had his specialist at the health center, and I am grateful that we got the chance to catch up one day in the lobby just before I learned that he went on hospice care and passed away from cancer.
Until we can house people or design a system where people can quickly move from experiencing homelessness to being housed, medical respite care is essential in the care continuum. Imagine, as Dr. Janelle Goetcheus relayed in a story in 1983 (at 5 minutes 48 seconds in the recording called “The Reality of Poverty”), “A mother of 8 in a shelter hotel for the homeless. Given two tokens a day and a newspaper to find housing on her own and I’m treating her high blood pressure just with pills.” Similar stories ring true today. In addition, even routine preventative care such as a colonoscopy requires a safe place to prepare and recover. It was one of the procedures I felt was a standard in our repertoire.
Two things we know, medical respite care is not a replacement for housing and housing is health care.
What does medical respite care typically include?
Although each program can vary in its exact services, all programs should offer:
- 24-hour access to a bed
- Transportation to any/all medical appointments
- Safe space to store personal items
- Wellness check at least once every 24 hours by medical respite staff (clinical or non-clinical)
- 3 meals per day
- Care coordination
- Access to a phone for telehealth and/or communications related to medical needs
Medical respite care by the numbers: Cost savings and other data
As reported recently by NPR, payers and state Medicaid offices are taking note of the medical respite model as an innovative, effective, and cost-saving approach. For example, a health insurance company in the District of Columbia, AmeriHealth, covers approximately 3,500 people who are experiencing homelessness. By partnering to operate a medical respite program, they can improve health outcomes while saving up to $200,000 a year.
Out of the 133 medical respite programs in the United States currently, 36 programs are operated by a health center (27%). Therefore, only a small group of the approximately 1,400 health centers operate medical respite programs. However, health centers intersect with about 50% of the current respite programs for clinical care.
- Clinical care is provided onsite by health center staff for 35 programs (26%)
- Clinical care is provided offsite at a nearby health center for 33 programs (25%)
Medical respite is still an innovation for health centers, but one that requires us to scale and improve what is already being done.
Housing as health care
We cannot only work on providing services. Part of being in the health center movement means also focusing on partnerships, social drivers of health, advocacy, and policy.
Stay tuned for more information on work the Center for Community Health Innovation (CCHI) is doing with CVSHealth on Health Zones. The current cohort is working on community partnerships to address social drivers of health.
More articles related to medical respite:
- How a Medical Respite Care Program Offers a Pathway to Health and Housing for People Experiencing Homelessness by The Commonwealth Fund (2021)
- Some place to go when there’s no place to go a previous NACHC blog (2019)
- DC has only 46 medical respite beds for homeless individuals. AmeriHealth Caritas DC plans to change that by Street Sense Media (2019)