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