Transitional Care Respite for Homeless Patients: Program Development and Outcomes
Background: People who are homeless have longer lengths of stay in the hospital—a homeless patient is hospitalized for 7.2 days, compared to 4.8 for a patient who discharges to housing. Patients that are homeless who are discharged to a transitional respite program are 50% less likely to be readmitted to the hospital. In 2012, the Inland Northwest Transitional Respite Program began as a collaboration between local hospitals, homeless service agencies, and a school of nursing. It began with one bed for men, but now serves homeless men and women in Spokane, Washington who are discharging from area hospitals. Patients admitted to respite are not sick enough to remain hospitalized, but are not ready to be back on the streets. Respite beds provide a safe place for patients to recuperate and receive community services from visiting nursing services, mental health professionals, and housing experts. In addition to reducing length of hospital stays, transitional respite care has been shown to reduce hospital readmissions and emergency department visits among homeless populations.
Program Processes: Once approved for respite, the patient is discharged from the hospital to the shelter via cab. The respite guest is assessed by the RN, who is a care transitions coach, and admission paperwork is completed. The RN reviews hospital discharge instructions and medications with the respite guest. Respite guests are given a small, waterproof notebook in which to record current medications, health goals, and questions for their health care providers. While in respite, guests are encouraged to be engaged in their own health care. The guest identifies health goals and learns how to navigate the health care system as independently as possible.
Program Outcomes: A day of hospital care in our community costs approximately $2,200, compared to the $38 dollar charge of a day in respite. In 2013, respite provided 1,405 bed nights of care and served 100 men and women, saving area hospitals $4 million. Homeless patients who are receiving IV antibiotics can discharge to respite, decreasing the length of stay from 8 weeks to 3 days. In the first 8 months of 2014, 17 respite guests have been discharged from the respite program into permanent housing. Case studies will be presented that will detail the improved health, engagement in care, and quality of life that our respite guests experience as a result of enrollment in our transitional care program.
Future Plans: The Inland Northwest Transitional Respite Program will increase capacity to 40 beds in January 2015. The director is currently consulting on implementation of similar transitional respite programs in Washington, Alaska, and California. Further research will be conducted to determine the financial and social impact of respite care for the homeless.
The author is grateful to Providence Health & Services for support of this program.