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Chapter 16 Medical Respite Care for Homeless People: A Growing National Phenomenon Suzanne Zerger Bruce Doblin Lisa Thompson Homeless people experience health problems, especially chronic medical illness , with much greater prevalence than those who are housed, and they suffer mortality rates three to four times higher than those of the general population ., Lack of housing also creates major obstacles to obtaining necessary medical services and adhering to treatment. Studies have consistently shown that homeless people rely heavily upon hospitals and emergency departments to address their needs, though these are often the medically least appropriate and most costly solutions . Current trends in the health care marketplace are exacerbating this problem . Uninsured rosters are at an all-time high, and health costs are rising; entitlement programs such as Medicaid remain inaccessible to most homeless people., Hospitals are discharging patients “quicker and sicker” as more procedures are provided on an outpatient basis, and community hospital beds are disappearing., These trends shift responsibility for aftercare to families and communities. This causes a dilemma for hospital personnel preparing to discharge homeless patients who are no longer sick enough to justify a bed but have nowhere to go to recuperate safely and sufficiently. Even simple directives for aftercare, such as bed rest, wound care, use of a wheelchair, or nutritional requirements, cannot be followed by someone living on the streets or in shelters and relying on emergency food programs for meals. As a result, emergency homeless shelters already over capacity are seeing steady increases in the number of individuals entering directly from hospitals with aftercare needs they are unable or ill-equipped to provide. Suzanne Zerger, PhD, is the senior associate in research for the Center for Social Innovation, and former coordinator of the National Respite Care Providers’ Network. Bruce Doblin, MD, is an associate professor at Northwestern University Medical School, an instructor at the School of the Art Institute of Chicago, and founding medical director of Interfaith House, and has a private practice in internal medicine and palliative and hospice medicine. Lisa Thompson, DNP, APRN-BC, is a psychiatric nurse practitioner and the former respite care coordinator for the Colorado Coalition for the Homeless Respite Care Program. 174 Zerger, Doblin, and Thompson This phenomenon received media attention in 2007 when the Los Angeles Times reported that a hospital van dropped off an acutely ill paraplegic homeless man on Skid Row in downtown Los Angeles, leaving him crawling on the street wearing a soiled hospital gown and a leaking colostomy bag. A follow-up story on the CBS news program 60 Minutes brought the Los Angeles story to national attention, but comparable dilemmas confront many towns and cities across the country.– Far less attention has been paid to an escalating community response to this hospitalsto -streets gap in health care for homeless people: the development of medical respite care services, occasionally termed infirmary or recuperative care., The first known medical respite care services for homeless people cropped up in the mid-1980s, but the trends in health systems and services described above have led to rapid proliferation of such services across the country in the past decade . The existence of homeless medical respite care was recognized by a limited federal pilot initiative, which funded 10 emerging respite programs beginning in 2000, but the services remain ineligible for either Medicare or Medicaid reimbursement . In 1999, a group of respite care providers convened in Chicago and subsequently formalized their collaboration by creating the national Respite Care Providers’ Network (RCPN) to support nascent respite programs and advocate for sustained funding. Although their services differed, RCPN members reached consensus that medical respite refers to acute and postacute medical care for homeless people too ill or frail to recover from illness or injury on the street but not ill enough to be in a hospital.* This report summarizes findings developed by a task force of the RCPN from a survey of respite programs. Medical respite programs and facilities differ from one another in availability of funding and community resources. Models of care range from collaborative arrangements with local shelters or motels and visiting clinical teams to stand-alone facilities with 24-hour medical care. The limited body of research suggests not only that these respite options provide a viable and humane option for hospitals and other institutions seeking to discharge their homeless patients but also that they are cost effective, reduce hospital readmissions, and have important social support and service-networking benefits for clients.– Because respite care is typically provided by...

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