When Homeless Patients Leave the Hospital, They Have No Place to Go. A National Respite Program Could Change That.

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April 12, 2021. By Steven Himmelberg.

Steven Himmelberg
2021 J. Bradley Wilson Schweitzer Fellow

John was 40 years old, homeless, and in need of a hip replacement. He was easily able to get one, that wasn’t the issue. The problem lies in that he was discharged to the street without a house, a car, rehabilitation services, or any of the resources most people have in this situation. The joint replacement subsequently failed and had to be removed. Now this man was left without a home, without a hip, and confined to a wheelchair. He is but one of many experiencing a tragic problem that could be solved with a medical respite program.  

Unfortunately, this is just one of many stories I saw while working at IFC Community House Clinic. Now, as a UNC medical student and J. Bradley Wilson Schweitzer Fellow, the gaps within our health system are becoming more apparent and I’m in the unique position where I can address them by connecting homeless patients to housing prior to discharge.

However, there are so many patients that need help. Within our country there are over half a million individuals experiencing homelessness and I think it comes as no surprise that these individuals bear the brunt of health complications. With higher rates of acute and chronic illnesses, homeless individuals incur higher rates of hospitalization and issues with recovery due to their lack of housing and of resources. So why haven’t we done anything to change this? 

After a serious hospitalization people can require substantial long-term care before they’re healed; these are things like home health nursing, rehabilitation services, and mental health counselors among other services. For most, these are not a barrier in the recovery process, but for our half a million fellow Americans who are experiencing homelessness it is an almost insurmountable wall to living a healthy life. When you don’t have a home, how are you to access a home health nurse for daily wound-care? How can your fractured leg heal with no place to stay and no weekly rehab? This is the harsh reality for many patients experiencing homelessness and it leads to a vast increase in hospital readmission rates, post-operative complications, and disease progression.

 Fortunately, there are Medical Respite programs cropping up over the country that allow a temporary housing structure upon a patient’s discharge for individuals experiencing homelessness, where they can receive the care that they need in order to heal. Not only are medical respites good for humanity, but they also serve the interests of the business side of healthcare. Research shows that hospitals can return a net savings of $5,000 per individual admitted to a medical respite program and that patients admitted to a medical respite program will require 50% fewer hospital readmissions during a 90-day period than those who are discharged to the streets or a shelter. Even throughout a 12-month period, one study showed individuals who accessed a medical respite program are two and a half times less likely to be re-hospitalized compared to their counterparts discharged to the streets or shelter.  

The question remains why aren’t there more medical respite programs? Hospitals across the country should consider partnering with payers and managed care organizations to fund a medical respite facility. Or, in states without Medicaid expansion, like North Carolina, they should consider funding medical respite centers themselves. Long-term not only would hospitals save money that could be allocated elsewhere, but it would also produce positive health outcomes in your community. So people like John with the hip replacement could have avoided being wheelchair bound today.

Stephen Himmelberg is a J. Bradley Wilson Schweitzer Fellow and UNC School of Medicine student.