Reducing preventable hospital readmission—especially among frequent users—is important for health care systems. New health care reform legislation further places attention on readmissions, and provides incen tives for systems of care that examine and demonstrate innovative and effective practices that reduce hospitalization among frequent users. Homeless populations suffer disproportionately high rates of chronic and infectious disease, mental illness, and substance use-related health problems. Homelessness is consistently associated with longer and repeated hospital stays and homeless individuals are disproportionately represented among frequent users of hospital care. Among people who are homeless, competing priorities, barriers to routine medical care, and challenges with medication adherence all represent risk factors for hospital use. In addition, post-discharge patients often return to environments that are sub-optimal for healing, and may face difficulty with medication management, routine follow-up, and adherence to after-care plans that increase likelihood of re-hospitalization. Medical Respite programs provide an alternative to street discharge for homeless patients. The Medical Respite model addresses specific needs of homeless patients by providing temporary housing and post-acute medical care for those who are too ill or frail to recover from a physical illness or injury on the streets, but are not ill enough to be in a hospital. To date, over 57 Medical Respite programs have been established in U.S. cities. While the capacity and level of service provision varies among these programs, they uniformly provide a safe and clean environment appropriate for healing and access to nursing and medical staff to assist patients with routine aftercare, wound care and medication support.
Effective strategies to reduce re-hospitalization include consistent patient education and seamless transition to community medical care. At Medical Respite these strategies are tailored to serve homeless patients who may not have a history of successful engagement with community based services. A recent review of Respite models across the U.S. noted that Medical Respite presents a critical window to engage homeless patients and make connections to community based medical care, social services and housing that can help patients continue successful transition. Among homeless populations, routine primary care, substance abuse treatment, and entrance into supported housing programs have all been shown to have independent, positive effects on likelihood of hospitalization.
The San Francisco Medical Respite is a 45-bed residential facility in downtown San Francisco, established in 2007 by the San Francisco Department of Public Health Housing and Urban Health Department (SFDPH). San Francisco Medical Respite accepts patient referrals from the city’s public hospital, San Francisco General Hospital (SFGH), the Veteran’s Administration Hospital, University of California and San Francisco (UCSF) Medical Center, and seven private community hospitals. As in other cities, homeless patients in San Francisco are disproportionately represented among high users of medical services, and SFGH staff estimate that up to 20% of inpatients are homeless on any given night. Due to the high number of homeless inpatients, Respite referrals are often triaged by both referring providers and Medical Respite staff. As a result, Respite serves patients who are among the most medically complicated, who are typically triply diagnosed (medical, psychiatric, and substance use) and who have multiple chronic medical conditions.
Onsite Respite medical staff (seven days a week and 24 hours on call) include registered and advance practice nurses, physicians and physician assistants, and medical assistants who, as a team, provide urgent and intermediate care, health education services, and referrals to primary and specialty care in the community. Community health workers provide support services as well as case management, under the supervision of social workers. Social workers individually assess all patients, and assist patients obtaining government issued identification, income benefits (such as Social Security Disability Insurance) and medical coverage (Medi-Cal or Medicaid). Where appropriate, social workers also assist patients in applying for supported housing (SFDPH also administers a supported housing program: Direct Access to Housing). Respite staff continue to follow up with patients throughout their medical treatment and discharge planning to make appropriate referrals and assist with patient appointments as needed. Discharge plans are reviewed by multi-disciplinary teams with an eye toward ensuring both that patients are medically ready for discharge and that referrals and follow up services are sufficiently in place to promote success in the community.
Taken from: Bauer, J., Wong, A.,Viloria, J., Schneidermann, M. “Leaving Before Discharge from a Homeless Medical Respite Program: Predisposing Factors and Selected Outcomes.” Journal of Health Care for the Poor and Underserved, 2012 Aug; 23: 1092–1105
Contributions to San Francisco Medical Respite can be made through http://www.catsinc.org/Donate_Now.html. In order for your gift to be directed toward the Respite Care program, please include the designation "Medical Respite”.
A few of the San Francisco Medical Respite Staff, pictured from left to right: Alice Moughamian, Cindy Lee, Rose Quinones, Michelle Schneidermann, Linda San-Miguel
For more information regarding the San Francisco Medical Respite, please contact Dr. Michelle Schneidermann, UCSF/SFGH Medical Director of the SFDPH Medical Respite & Sobering Center.