Certified medical respite care (MRC) programs have voluntarily completed a rigorous process to demonstrate a high degree of fidelity to nationally recognized principles, standards, and expectations in the field of medical respite care.  A detailed description of this systematic process can be found in the document, Guidebook: Certification for MRC Programs, which can be downloaded from this webpage. The primary components and activities of the certification process involve completing assessments, submitting evidence, and hosting a site visit to demonstrate:

• Acceptable fidelity to the Guiding Principles for MRC.
• Acceptable fidelity to the Standards for MRC Programs.
• Meaningful engagement of clients, incorporating their perspectives into program operations.

Further, certified MRC programs are committed to ongoing quality improvement and engagement in peer-to-peer learning with the community of MRC providers across the nation.

Notices:

Certification is awarded to medical respite care (MRC) programs that demonstrate alignment to the principles and standards established by the National Healthcare for the Homeless Council (the Council), according to the Council's scoring methodology. The certification program aims specifically to enhance the quality and consistency of services offered by MRC programs. It does not indicate endorsement or approval of the provider institution as a whole, nor is it a guarantee of client safety or the nature or efficacy of healthcare services provided to clients.

The Council is not a government regulator and has no legal authority over MRC operators. The Council has no obligation to investigate or remediate complaints against certified MRC programs, regardless of their nature or source. The Council does not address reports of abuse or other unlawful behavior; these allegations should be reported to law enforcement or other appropriate government entities.

Medical respite care (MRC), also referred to as recuperative care, fills an important gap in the health services continuum, offering short-term residential programming where people experiencing homelessness can rest, recover, and heal in a safe environment while accessing medical care and other supportive services. The field of MRC is growing rapidly, and health systems, managed care plans (MCPs), and policy makers at all levels of government are increasingly recognizing the value of MRC. Many states are in various stages of exploring and/or implementing Medicaid reimbursement mechanisms for MRC services. As the field continues to evolve, there is an increasing need to clearly define characteristics, quality standards, and oversight of MRC programs. A carefully-designed certification process from a trusted national voice can meet these needs and safeguard the dynamic and innovative work done by MRC operators. It can also prevent unintended consequences that may arise if government agencies institute prescriptive licensure processes.

As the preeminent initiative dedicated to expanding access to high-quality MRC nationwide, the National Institute for Medical Respite Care (NIMRC) is uniquely equipped and positioned to design and implement this voluntary certification process for MRC programs. Building on 30-plus years of knowledge and expertise accumulated by the National Health Care for the Homeless Council (NHCHC) and the Respite Care Providers' Network (RCPN), NIMRC was launched in 2020 as a special program of NHCHC to strategically advance and elevate the field of MRC. In 2022, our team at NIMRC began to carefully consider the implications and explore the feasibility of creating such a certification process by interviewing dozens of key informants representing MRC programs, hospital systems, MCPs, state officials, and more. These interviews provided resounding affirmation that there is appetite for a certification specific to MRC; particularly one that is reliable, inclusive, pragmatic, and does not compromise access to this life-saving intervention. We then carefully conducted two phases of testing in 2023 and 2024 to ensure that our certification process functions as intended. The results and learnings from these successful tests can be found in the document, Findings: Testing Certification for MRC Programs, which can be downloaded from this webpage.

To be eligible for certification, MRC programs must meet the following requirements:

• The program has actively served MRC clients for a minimum of one year.
• The program has a current, accurate profile in NIMRC's Directory of MRC Programs.
• The program has capacity to designate a small team of staff members to complete the certification process. The MRC program's certification team should be prepared to spend roughly 40-60 total hours on certification activities over a six-month period.
• Note: The amount of time spent completing the certification process may vary widely between MRC programs. Well-established programs with robust policies and procedures may need substantially less time, while other MRC programs may require more time to institute new practices and create new materials.

When determining whether your MRC program is prepared to seek certification, we strongly recommend that you read our Guidebook: Certification for MRC Programs, which can be downloaded from this webpage. The Guidebook describes core activities associated with the certification process. It also provides insight into the minimum expectations and assessment scores required for certification.

Importantly, MRC programs do not need to meet all of the expectations for certification on day-one. We have intentionally designed the six-month certification process to be a supportive and collaborative opportunity for growth, with NIMRC offering guidance, resources, technical assistance, and peer connections to help MRC programs improve and succeed. In fact, the 15 MRC programs from our testing phases improved, on average, from 88% fidelity to the Standards for MRC at baseline to 96% fidelity at the conclusion of the certification process. The document, Findings: Testing Certification for MRC Programs, which can be downloaded from this webpage, describes participants’ experience during the certification testing phases and the resulting benefits to their MRC programs.

Note: NIMRC has also created a pathway toward readiness for certification for new MRC programs (i.e., programs under development or with less than three years of operation). When such programs do not yet feel prepared to become certified, NIMRC can offer training opportunities and resources to move them forward in their journey. We can also provide documentation affirming that such programs are engaged with NIMRC and actively working toward certification in the future. If this applies to your program and you are interested in learning more, please email certification@nhchc.org.

As we launch this new certification initiative, we anticipate that there may be greater demand for certification than NIMRC has the capacity to meet at a given time. We plan to open periodic application windows, during which, MRC programs can electronically submit an interest form to seek certification (found on this webpage).

The first application window will open at 12pm (Central Time) on April 1st, 2025 and will close at 12pm (Central Time) on April 15th, 2025.

MRC programs who submit interest forms can expect to hear from our NIMRC certification team within two weeks of the application window closing. MRC programs assigned to an open spot will receive orientation materials and an invitation to a consultation meeting where NIMRC certification specialists will address preliminary questions, provide additional information about the process/expectations, and confirm the MRC program’s intention to seek certification.

When applicable, eligible MRC programs may be notified that all available spots have been filled. We will keep such MRC programs well-informed about future application windows, so they can re-apply at the next opportunity. They may also be placed on a temporary waitlist in case a new spot unexpectedly becomes available.

We appreciate your grace and patience as we navigate this complexity.

A detailed description of the certification process can be found in the document, Guidebook: Certification for MRC Programs, which can be downloaded from this webpage. However, the infographic below illustrates a high-level overview of the core components of the certification process.

Currently, we are able to operate the certification program without charging any fees to MRC programs, thanks to the financial support of our sponsors.

A note for the future: NHCHC absorbs substantial costs to operate this certification program (personnel, technology, travel expenses, etc.). We do anticipate that we will need to charge fees to MRC programs (or their funders) for certification and renewal at some point in the future. However, we are committed to supplementing any such fees with other funding streams and exploring every avenue to minimize direct costs to MRC program operators.

MRC programs who successfully complete the certification process will be certified for a period of three years, at which point, they will need to renew their certification (and every three years thereafter). We expect the renewal process to be significantly less time-intensive than the initial certification process because certification materials that were previously submitted will serve as a starting point to be updated and revised.

Additionally, NIMRC will send certified MRC programs a simple verification form to complete each year. The purpose of this form is for certified MRC programs to affirm that they continue to provide MRC services reasonably consistent with those offered when they successfully completed the certification process. They will simply indicate whether there have been any substantive changes (as defined in the Guidebook) that meaningfully and indefinitely impact their MRC services. In the event that substantive changes have occurred, our NIMRC certification team will help navigate this and ensure that the MRC program's certification status is current and accurate. This annual verification supports our aim to maintain the integrity of the certification program over time.

Due to the great variation among MRC programs, descriptive information around the specific bundle of services provided in a given program is an important element to augment the baseline certification. The Models of Medical Respite Care provide a categorical system that keeps the certification broadly relevant while also providing sufficient detail about a particular program's services and clinical capacity to be useful for funders and referrers when structuring partnerships and agreements.

MRC programs pursuing certification will complete an Inventory Tool to demonstrate their alignment with a given Model of Care. This tool will also provide ample flexibility to describe variations from the default items, additional services provided, and other salient information about their service-delivery methods.

Importantly, a program's model of MRC does not impact scoring for certification, and any of the four models can embody excellent fidelity to the Standards and Guiding Principles, while delivering effective and high-quality care.

A certified program’s Model of MRC can be viewed here: Find a Certified Medical Respite Program.

Certification is determined based on the services and supports that clients have direct access to in a MRC program, and these services and supports may be provided through collaborative partnerships between multiple organizations. NIMRC's certification applies to the MRC program, as a whole, and is not necessarily tied to the services of one specific organization. There are multiple possible approaches to capturing organizational partnerships in the certification process, based on the nature of the relationship.

A substantial portion of MRC programs partner with other community organizations that provide a defined set of services to MRC clients onsite. Such collaborations allow MRC programs to offer as comprehensive a menu of services as possible to their clients. There is a mechanism built into the certification process for documenting and recognizing these kinds of agreements between organizations.

In other instances, MRC programs may truly be jointly overseen and operated by multiple organizations (for example, a clinical provider and a shelter/housing provider). In such cases, we will recommend that one organization take primary, formal ownership and responsibility for completing the certification process, while including the other organization as a Joint Venturer. In the initial consultation meeting, NIMRC certification specialists will answer questions and discuss various considerations to help such MRC programs make an informed decision on how they'd like to proceed. Thus, we will encourage representatives from each partnering organization to attend this consultation meeting.