Your SlideShare is downloading. ×
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply
  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide


  • 1. Medical Respite Everywhere: Building our Future Respite Pre-Conference Institute: National Health Care for the Homeless Conference & Policy Symposium JUNE 2, 2010 SARAH CIAMBRONE LESLIE ENZIAN, MD ADELE O’SULLIVAN, MD Respite Care 101: An introduction for new providers or for programs that want to develop a respite program
  • 2. Goals for this session
    • Understand Respite Care and its history and context
    • Explore models of respite care
    • Review common characteristics of respite programs
    • Learn how respite care is delivered and why it is an essential component of the continuum of health care services for the homeless
    • Overview of admission, stay and discharge planning
  • 3. Goals continued
    • Learn how other programs have done it
    • View existing programs as resources
    • Learn about the Respite Care Provider’s Network
    • Learn how to get involved
  • 4. Context for Respite Care
    • Emergency shelters typically provide night shelter only
    • Guests arrive late afternoon
    • Line up for meal and shower
    • Emergency cot for the night
    • Shelters open doors at about 6am and guests are discharged to the street
  • 5. What happens when you are sick and homeless?
    • Shelters send all guests to the street in the early morning
    • Few have lobby privileges
    • Frequent and unnecessary use of emergency rooms
    • Exhaustion associated with making it through the day: no easy access to bathroom, bed, food, medication while feeling lousy
  • 6. Patient Story
  • 7. How would I walk the streets from early morning to late at night?
  • 8. Or climb into a top bunk at an Emergency Shelter?
  • 9. What is respite care as it applies to health care for homeless individuals?
    • Medical (“home care”) to a person who has no home
    • For persons who are “Too sick for shelter, not sick enough for hospital”
    • Respite care is an essential part of the continuum of health care services for homeless post-acute and chronically ill patients
  • 10. Medical times have changed
    • Hospital LOS is getting shorter
    • Hospitals are only for the very sick
    • Procedures which used to mean weeks in bed are now day surgeries or procedures
    • Day surgeries and day procedures are not scheduled for patients who do not have a safe place to recover
    • What is the average LOS in Boston?
  • 11.
    • Medical Respite Care fills the void in services.
    • Does Not Compete with existing programs that already care for patients who are homeless (nursing homes, rest homes, state hospitals)
    • Establish the niche and know the limits but remain flexible
    • Who will be served?
    • Define Admission Criteria to meet the needs
    If Respite Care is a substitute for Home Care for those without a home, what level of care does Respite provide?
  • 12. What is Respite Care as it applies to health care for homeless individuals? “Home healthcare for those without a home”
    • Medical/nursing (“home care”) to a person who has no home
    • Short term (LOS <3 weeks) for resolution of illness
    • For persons who are “Too sick for shelter, not sick enough for hospital”
    • Resource for hospitals, decreasing admissions and LOS
    • Respite Care is an essential part of the continuum of health care services for the homeless post-acute and chronically ill people of our cities and towns and rural communities
    • Not housing, but may link folks to housing resources
    Health Care & Housing Are Human Rights
  • 13. Definition of Respite Criteria (defined in Chicago at 1 st Gathering of Respite Care Providers Network 2000)
    • A service for ill or injured
    • Specialized service
    • A short term service
    • An innovative service
    • Wholistic care
    • A collaborative model
    • Consumer driven
    • (A continuum of respite programs)
  • 14. Ready for discharge from hospital 2010?
    • Hospital LOS brief. Hospitals only for the very sick
    • Reliance on home care for all when discharged from hospital
    • Families become care givers
    • Range of Care at home now includes IV therapy, PT/OT, peritoneal dialysis, oxygen, transfer to & recovery from chemotherapy, radiation, preparation for colonoscopy, pre-procedure prep, post procedure recovery, evaluation
    • How does one do this without a home?
    Health Care & Housing Are Human Rights
  • 15. Definition of Respite Care
    •   The concept of respite care is to provide a place of rest from the street for those persons who need 24-hour-a-day acute and post-acute care in a safe and dignified healing environment.
    • To provide recuperative care for homeless persons who are too sick for the streets or shelter, but not sick enough for the hospital.
  • 16. Defining the Scope of Care and Range of Services
    • Ideally dependent on the needs of the patients served, community needs
    • Practically dependent on funding, resources, space
    • What is reasonable? What defines the basic level of care needed for medical respite program?
    • Who are those that require this care?
  • 17.  
  • 18. Prevalence of Common Chronic Illness
  • 19. Respite Care does not compete with existing services or programs
    • If eligible for other programs or services, patients should go there:
    • nursing homes,
    • State Hospital
    • DMH Respite
    • Respite Care for Homeless patients fills the gap in services
    • Pressure on beds is high, so if eligible for other program, patient should go there
    • Acute medical care (by a nurse, physician, physician assistant, and/or nurse practitioner)
    • Medication (storage, dispensing, rarely pharmacy)
    • Case Management (benefits acquisition, housing placement, health education, etc.)
    • Onsite or referral for mental health/substance use treatment
    • Transportation
    • Food
    • Security
    • Laundry
    • In-kind (pastoral care, activities, haircuts, clothing)
  • 21. Core respite services offered
    • A safe place to prepare for procedures, recover from illness, trauma and surgery
    • Recuperate with medical monitoring
    • Nursing care varies from a few hours to 24/7
    • Medical care varies from a few hours /week to daily
    • Medical Detoxification for some programs
    • Support services may include: food, laundry, transportation, mental health support, medications, security, case management, referral to specialty care
  • 22. Flexibility in the model of respite care
    • Flexible model which continually changes and adapts to the needs of our patients
    • Expands to include a place for patients to spend the day, transportation provided
    • Flex the walls to fill the gap in services, whatever that may be
  • 23. McInnis House to and from housing
    • A safe place for patients to transition to housing and Housing First programs
    • A place to return to recover when newly housed and vulnerable
    • A place where one is known and belongs
  • 24. Models of Respite Programs
    • Free standing facility
    • Shelter based beds where guest stays in bed to rest
    • Nursing component, medical component
    • Motel rooms with medical monitoring
    • Family Respite (motel, family shelter)
    • Contracted service in a board and care facility
  • 25. MEDICAL SERVICES TYPE OF FACILITY Non-health care facility Health care facility Refer to shelter beds Motel/hotel vouchers Contract with board & care facility Shelter-based Respite unit Free-standing respite unit
  • 26. Two Primary Models with Numerous Variations Combining….
    • range of intensity and type of services with
    • different facility options
    • Freestanding respite units
    • Shelter-based models
  • 27. Leslie to compare portland, utah, etc as illustrations
  • 28. Leslie Respite Program Development
    • While essential, medical respite care is rarely funded
    • Most new and developing programs are shelter based
    • Even with a stand alone facility, there will be the need for shelter based respite care to supplement the needs
    • Lead in to Adele who will have one slide on funding- laying out the spectrum of possibilities referencing presentation later in the day.
  • 29. Adele: Licensure and her experience with pursuing funding and her program
  • 30. Advantages of a Free Standing Program
    • Ability to provide more comprehensive services– medical and non-medical with a more intense level of acuity
    • Respite program controls policies and procedures, and defines scope of care
    • Respite program controls environment (health and safety issues)
  • 31. Challenges of a Free Standing Program
    • Identifying adequate funding to support needed services and operations
    • Takes time
    • Finding an appropriate facility
    • Possible licensing and zoning issues
    • Possible conflict from neighborhoods (if a new facility)
  • 32. Advantages of Shelter Based Medical Respite Model
    • Uses expertise of existing programs (shelters for beds, health program for services)
    • Reduces facility costs by utilizing existing facility
    • May eliminate need for special licensing (depending on state law)
    • Encourages coordination and collaboration between agencies
    • Helps to demonstrate the argument for the need for respite care
    • Hospitals and other stakeholders benefit from having a safe place to discharge a patient to, may come to the table for the development of stand alone facility or expanded program
    • Demonstrates outcomes in making the argument for respite programs
  • 33. Challenges of a Shelter Based Medical Respite Care Model
    • Shelters and health programs may have differing philosophies- ongoing tension
    • Possible conflict over admissions policies and control of the beds
    • Health care program has little control over health and safety issues in shelter environment
    • Services are more limited, patients have to be quite stable, some patients are too sick to be in this model
    • Sobriety is challenged in a shelter where others are misusing substances
  • 34. Admission Criteria
  • 35. Re-Admission Criteria
    • Past experience at respite provides information about future stays
    • Patients with known past difficulties at respite: incorporate this into treatment plan to assure success with next admission
    • Treatment agreements, limit visitors, outside appointments, random urine screening
  • 36. Conditions of Stay for Patients
    • Structure of the day
    • Expectations of patients
    • Behavioral management
  • 37. Respite Care History
    • NYC Dr. Brickner’s Infirmary
    • Barbara McInnis House, Christ House and Interfaith House 1993
    • In 2000 10 Bureau of Primary Care respite programs
    • RCPN
    • Now 50 programs?
  • 38. Respite programs 2009
  • 39.  
  • 40.  
  • 41. Me to do Focus on hospital relationships and community partner
    • Hospital Rounding at two major hospitals in Boston
    • Fast Track from ED to respite
    • Evening and weekend ED admissions to reduce hospital admissions of homeless patients who do not require hospital level of care
  • 42. Balancing the need with census
    • Filling the beds
    • Assuring the mission
    • Balancing the needs with available beds
    • Pre-booked commitment to day surgeries or endoscopy
    • Shelter and hospital partners needs
  • 43. Medical stay-in beds
    • Care provided by HCHP shelter clinics provides discharge options with day rest prior to regular shelter beds
        • Medical stay in beds (men)
        • Medical stay in beds (women)