Background:
Homeless persons have higher rates of emergency department visits and acule care hospitalizations than housed populations. They account for excess costs per hospitalization, largely because of an increased length of slay. A study from New York City revealed an excess of 4.1 days per admission, accounlhg for an average excess cost of S2400‐S400Q per admission. Additionally, the hospital discharge of homeless patients can be complex and challenging. Often, they are discharged with prescriptions they cannot afford, instructions for bed rest and special diets they cannot cany out, and follow‐up care they cannot arrange. Medical respite care is one solution to address the health care gap of persons who may no longer meet the criteria for acute hospitalization but are still too sick to be discharged to the street.
Purpose:
To ensure a safe and timely discharge by providing a clean, safe living environment for homeless individuals to recuperate after discharge from the hospital.
Description:
The Santa Clara County Medical Respite Program in San Jose, California, consists of a successful partnership between 7 area hospitals, a local homeless shelter, and a federally funded health care for Ihe homeless program. The respile center contracts with a local nonprofit agency for 15 permanent beds in 7 semiprivate rooms in a homeless shelter. Clients can stay in the room all day to rest, in contrast to the regular shelter, which is closed during daytime hours. Hospital discharge planners identify patients who meet admission criteria. Referrals are then made on a first come, first serve basis. Program staffing consists of a nurse coordinator, social worker, psychologist, and physician, who are each critical team members in the coordination of the patient's care. While in the program, clients not only have a chance to improve iheir health status, bul also have an opportunity to establish income benefits and medical insurance and pursue housing options.
Conclusions:
The respite program has received more than 200 referrals in its first year of operation. Of these, 60% were accepted for admission. The most common diagnosis for those admitted were fractures, fool infections, and cancer. Of those who completed the program, more than 50% have been permanently housed (board and care, room rental, and subsidized housing), and another 20% have been discharged to transitional housing (drug and alcohol or mental health programs). No individuals have returned to the streets. Income benefits and medical insurance have also been successfully obtained by respile clients. Hospitals report cost savings through avoided bed days, decreased ED visits, decreased re hospitalizations, and retroactive Medicaid payments. Respite care is an innovative and effective solution for ensuring safe discharges of homeless patients.
Author Disclosure:
A, Kuang, none; C, Ho, none: G, Hull, none; L, Undo, none; J, Kohl, none; C, Mahan, none; M, Mitchell, none.