If you’ve ever been hospitalized, you know that the best part of the experience is getting to go home. But what happens if you’re homeless? For many, they return to the street or a shelter or the car from which they came, attempting to recover without the warmth and comfort of home. It’s a struggle but they have no choice. There are some who need more than being sent back to the street: people with open wounds, people with trouble walking after a stroke, people who have been hospitalized for so long that they need time to regain their strength. For far too long they’ve been sent to the street without concern for their outcomes. Otherwise they get sent to a nursing home for a week, that way the hospital has ‘done its duty,’ and then the nursing home sends them to the street. Either way, the homeless suffer and then often end up in the emergency room again.
There’s a little known network of providers around the country who are dedicated to filling this gap. Medical respite providers care for homeless people who are well enough to be discharged from a hospital but are not well enough to be on the streets. They can be located in homeless shelters, nursing homes, transitional housing or any other facility.
I know because I see patients at the respite care facility in Baltimore. Our respite care is located on the third floor of the city’s emergency shelter and we accept people from all over the greater Baltimore area. For the man with a large surgical wound on his abdomen medical respite care is a life saver. The hospital couldn’t keep him any longer because his acute health care needs had resolved but they couldn’t discharge him to the street with a wound that would be sure to become infected. Medical respite was the best option for him as it gave him a place to stay and heal until he was well enough to brave the streets.
For the man who had one of his arms amputated due to an infection, staying with us gave him the chance to have the surgical wound heal. Having that safe space was critical for his ability to learn how to care for himself so that he would be able to do so safely in the streets.
Respite care also brings down the cost of care. A day’s stay in respite care costs 5-10% the cost of a day as an inpatient. The availability of respite care decreases length of stay as an inpatient by over 4 days since patients can be safely discharged earlier in their stay. Respite care also decreases utilization of the emergency room and increases utilization of primary care.
Respite care is one of those rare birds in health care that simultaneously improves care and decreases costs. Addressing the needs of the most vulnerable in society should always be our priority and when it also saves us money, it should be a no-brainer.