You've spent weeks with your client getting to know him and his quirky idiosyncrasies. You've nourished him back to health, seen his natural glow return, and you want nothing more than to send him to a nice, clean apartment where he can have a fresh start. Unfortunately with limited opportunities for rental assistance and a limited stock of affordable housing, you face the inevitable; you watch him walk out the door heading off to nowhere. In this issue we feature strategies employed by three different medical respite programs to increase housing opportunities for their clients. While these strategies are not a panacea for our housing crisis, they are replicable models that may be useful in your own work to increase housing opportunities for your clients.

Cincinnati: Medical Respite Housing

The Center for Respite Care, in alliance with their local Continuum of Care (CoC) network, launched a HUD-funded rapid rehousing program for people with medical disabilities. Eligible clients being discharged from the medical respite facility are placed in apartments of their choosing throughout the area, and then assisted in filing for disability and other benefits.

A HUD grant pays the rent, deposit and utilities for up to 24 months until the client has income (generally through SSI benefits acquired during their stay) and is stable enough to be self-sufficient.  During their stay, medical respite staff provides intensive medical case management as well as traditional case management. These case managers coordinate all of the clients' medical needs, including medications, medical appointments, surgeries, recovery needs, as well as mental health and substance abuse treatment.

Clients are gradually weaned from the intensive support as they become more sufficient in managing their own care. At the end of their time in the Respite Housing Program, staff help them move to low-income housing.

Over 90% of housing clients remain stably housed at exit from the Respite Housing Program; 89% of clients leaving the program have income, and 93% exit with non-cash benefits.

Los Angeles & Orange County Supportive Housing Program for Medical Respite Graduates

The Illumination Foundation, which operates three medical respite programs (one in Orange County and two in Los Angeles County), recently applied for and was awarded HUD Supportive Housing Program (SHP) funds. The funding will support 20 scattered site apartments for single adults and families being discharged from the Illumination Foundation's Medical Respite Programs. Fifteen of the units are designated for adults who have disabilities (individuals must have an SSI/SSDI application in process or must be already receiving benefits to be eligible.)

Prior to leaving the medical respite program, individuals who are transitioning into the Supportive Housing Program participate in a 2 day orientation to learn good neighbor etiquette and skills for managing a household. Participants receive a certificate after completing the orientation.

Once in an apartment, participants work closely with case managers to meet goals related to health, housing, and community integration. Participants pay 30% of their income while participating in the Supportive Housing Program and are able to stay for up to two years.

Minneapolis: Health Supported Housing  

Catholic Charities of Saint Paul and Minneapolis, which established a 5-bed medical respite program in 2011 in collaboration with North Memorial hospital and Medica (a regional Health Plan), was recently awarded a contract that expands the program to 89 beds in its existing location, a transitional living facility, and adds an intensive housing component.

Patients identified as homeless and in need of medical respite care are referred to the new Health Supportive Housing Program by one of two housing navigators employed by Hennepin Health, a local Accountable Care Organization. Once in the program, patients work closely with an onsite nurse, who functions much like a care coordinator and oversees care plans.  Patients who need intensive onsite clinical care (e.g., wound care) are able to access home health services. After completing the nursing care plan, nurse encounters become less frequent and patients begin working more closely with case managers to kick-start the transition into permanent housing.

The contract is part of Minnesota's Group Residential Housing (GRH) program, a state program administered by counties. The contract pays a per person per month base rate for room and board (up to $877) and a separate rate for supplemental services (up to $483).  The supplemental service payments help support the cost of the full time nurse and several case managers.  

The housing goals of the Health Supportive Housing program are to move clients into permanent housing and prevent clients from reentering county homeless shelters. Health related goals include connection to primary care, reduction in unnecessary hospital utilization, connection to mainstream benefits, and improved quality of life.

Connecticut Passes Legislation Supporting a Medical Respite  

Pilot Program

This past June, Connecticut Governor Dannel Malloy signed a bill to fund a 5-year medical respite pilot program. The pilot program aims to lower state Medicaid costs related to unnecessary hospitalizations of homeless persons. The program, based out of New Haven, will be jointly administered by Yale-New Haven Hospital and Columbus House, a 501(c)(3) non-profit agency serving people experiencing homelessness. The twelve-bed program, which opens this month, will include twenty-four hour supervision, referrals to health care providers, and case management services.

Click here to read the text of the bill.

Flu season is upon us and medical respite programs need to be prepared to protect patients and staff from the virus. Here are some things that you can do:

1. Offer vaccinations to patients. Contact your local health department or federally supported health center about becoming a vaccination site. 
2. Promote cough etiquette and hand washing among staff and patients. Post flyers in common areas and in bathrooms. Make sure washable containers are available for tissue disposal and provide sanitizer if soap and water is not available. A variety of free flyers and other great Flu resources (including resources in Spanish) can be found at: www.flu.gov/resources.
3. Educate staff and patients on influenza like illness (ILI).     ILI = fever ≥100° accompanied by a cough and/or sore throat (in the absence of a known cause other than influenza.)
4. Treat ILI aggressively. If a patient is experiencing ILI, staff should be notified immediately and the patient should be seen for a medical evaluation. Cohort patients who have ILI and isolate them as best as possible.
5. Have a plan for addressing ILI. Do not allow your facility to become overwhelmed by patients who have ILI.Talk to your local shelter partners about opportunities to cohort patients at their shelter facility and offer medical assistance.
6. Participate in community pandemic influenza planning.  Talk to your local health department about your community's pandemic influenza plan and what your site can do to be prepared.

Resources for all of the points above are available on the National Health Care for the Homeless Council's Influenza page.

England Moves Forward to Provide Post-hospital Care for People Experiencing Homelessness

In the last issue of Respite News, we described England's new health initiative to ensure adequate post hospital care for people experiencing homelessness.   The National Health Service (NHS) has begun distributing funds. Here is a glimpse of how funds are being used.  

• Cornwall: £65,000 (roughly $104,000) to develop a hospital discharge homelessness prevention protocol, with training and a full-time worker dedicated to the project.  An additional £84,000 (roughly $135,000) has been awarded to lease, furnish and maintain two-bedroom apartments.
• Winchester:  £69,889 (roughly $112,000) for an aftercare outreach service.
• Fareham: £270,900 (roughly $434,000) to convert two apartments into residential medical respite care units.