Title : Models of respite care and healthcare for the homeless in major U.S. cities
Abstract:
Respite care, or medical recuperative care, provides temporary shelter, case management, and medical care for people experiencing homelessness (PEH) who are recovering from acute illness or injury but do not meet the criteria for hospitalization. PEH often face extended hospital stays and delays in discharge due to non-medical reasons, primarily the lack of stable housing. Respite care facilities have been shown to significantly reduce hospital inpatient days, readmission rates, and emergency room visits, thereby saving hospitals substantial amounts of money annually and addressing the holistic needs of PEH. Recognizing the value of respite care, according to the National Healthcare for the Homeless Council, the number of programs in the United States has increased almost threefold in a decade, from 47 in 2013 to 123 currently. Historically, hospitals have discharged patients experiencing homelessness into traditional night shelters, which commonly require people to leave the facility during the day, forcing PEH into unsanitary conditions on the streets and on public benches, hindering necessary medical rest and recovery. Moreover, traditional shelter staff are often not trained to care for the wide range of medical conditions faced by PEH. Respite care looks to bridge this gap between healthcare and homelessness services, allowing hospitals to discharge patients to a safe environment where they can recover under the care of trained staff until finding permanent shelter. This study explores the development and impact of respite care in three major U.S. cities: Memphis, Boston, and Los Angeles. Twenty-six respite care facilities were surveyed, 6 interviews were conducted with program staff, and site visits to facilities in each of the 3 cities were piloted to gather both quantitative and qualitative insights. The data was operationally coded to identify common themes and variations in service delivery models. This study outlines each of the 3 cities’ model of respite care, their integration into the city-wide healthcare systems and other wrap- around services in the city. These models identify challenges and innovative approaches of respite care facilities guided by local policies, historical practices, and regional attitudes, revealing practices and potential strategies for addressing the healthcare needs of homeless populations across diverse urban settings. The findings indicate that effective integration of respite care into broader healthcare networks improve health outcomes for PEH and provides a template for other cities looking to develop similar programming.
