Before You Launch: The First Steps in Building a Medical Respite Program
Medical respite care, also known as recuperative care, is acute and post-acute medical care for people experiencing homelessness who are too ill or frail to recover from a physical illness or injury on the streets, but who are not ill enough to be in a hospital.
These programs fill a critical gap between hospital discharge and long-term housing. As the field of medical respite care continues to grow, more communities are expressing interest in developing a program. While the need itself may be clear, determining how and where to begin can be challenging. The following framework outlines the initial steps and a practical starting point for program development.
1. The Framework for Medical Respite Care should be used to guide the development of medical respite programs by:
- Defining the philosophy of medical respite care and
- Articulating how the Guiding Principles, Standards for Medical Respite Care Programs, and the Models of Medical Respite Care are used in conjunction to provide quality care and an opportunity for recovery for people experiencing homelessness.
2. Review the Defining Characteristics of Medical Respite Care.
1. Assess current resources and services for the population:
- Identify all organizations that are currently providing health care and homeless services. Is there a medical respite care program already open, and if so, what services do they provide? Do they have the capacity to meet the demand for beds? How might a new program supplement or expand the medical respite resources already in place? Unsure if your community has a program? Check out the Medical Respite Care Directory.
- If there are other medical respite programs in your community, connect with them to learn about the services they provide and any remaining gaps or needs for another medical respite program in the community.
2. Engage with hospitals:
- Hospital collaboration is essential to the success of medical respite programs. Hospitals can provide patient referrals, collect and share data, and be a potential funding source for programs. Identify which hospitals are providing acute medical care to unhoused populations. Consider reaching out to different types of hospitals, including safety net hospitals, academic hospitals, and those that provide care to people on Medicaid and/or uninsured individuals. What efforts and resources do they already have in place to improve care for this population? Is this population a priority?
- Meet with the hospital(s) that could be a strong referral partner and may have data to show the need for medical respite care in the community.
A needs assessment can identify what gaps exist in community services. This can be developed by combining assessments from various organizations that would benefit from the creation of a medical respite care program. Consider multiple methods for collecting data and a variety of sources for engagement.
- Primary Data is data that program developers collect. Some examples include:
- Surveys
- Interviews
- Focus Groups/ Listening Sessions
- Secondary Data is data that is already available and was collected by another entity. Some examples include:
- Hospital records regarding care provided for people experiencing homelessness, including total number, length of stay, discharge locations, and top medical needs
- Community Health Needs Assessment (CHNA)
- Point-in-Time (PIT) Count
- Data from existing medical respite care programs in the community (if any)
- Use the data
- Compile data collected into a presentation or report to share with potential partners and collaborators
- Information collected will be important to inform the goal of the medical respite program and the services it will provide. Programs should be designed around the community’s identified needs. The gaps that are uncovered can also help determine which partners should be brought together and committed to supporting the project.
Engage potential partners in conversations early in the program planning process. Potential partners may include hospitals, shelter/housing providers, community health centers, behavioral health providers, people with lived experience, or any individual or entity that would benefit from the medical respite care program. Each potential partner will have a specific role in program development and operations.
- Hospitals: Hospitals can be a source of referrals, data, program funding, and medical care. They may also supply the patient with medications or prescriptions, provide specialty care, and complete follow-up lab work, specialized testing, or general medical services. A medical respite program can also serve as both a safe place for pre-operative/procedure prep and as a hospital discharge location, making this partnership vital for program operations and sustainability.
- Shelter/housing providers: Many medical respite care programs choose to operate in the shelter setting. This can be a potential location for a program and/or a referral source. Relationships with shelters and housing partners are also beneficial for identifying locations clients can be discharged to after a medical respite care stay.
- Community Health Centers/Federally Qualified Health Centers (FQHC): Health Centers can be a referral source or provide ongoing primary care after a medical respite care stay. Health Centers may also be the clinical partner that provides care to medical respite care clients either at their facility or on-site at the medical respite care program.
- Primary care providers (PCP): Clients should be connected to a primary care provider for ongoing clinical care after their medical respite stay. This can be offered through a local Health Center/FQHC or another primary care provider in the community. If the PCP is not at a health center, or the community does not have a health center nearby, programs will need partnerships with other PCPs to refer clients to for ongoing clinical care.
- Behavioral health (BH) providers: Programs should provide whole-person care, and a medical respite care stay is a great opportunity to get clients engaged with behavioral health care. BH services can be offered through on-site staff or by contracting with an outside agency, and clients should have access to services such as individual and group therapy, medication management, substance use treatment, medication-assisted treatment, and harm reduction services, among others.
- People with lived experience: The perspective of people with lived experience should be centered in all program development and ongoing operations. This population can participate in designing the physical space and identifying the services to offer within medical respite care. Employing peer support specialists once the program is open can help individuals referred to medical respite feel supported and build trust with providers. Peer support providers may be recovery coaches, peer advocates, and/or patient navigators.
Creating a planning group that meets routinely (e.g., monthly) to guide the process of utilizing the needs assessment data to design services, identify a facility, and secure funding. A planning group should include:
- Top-level decision makers in the operating organization (e.g., executive director)
- Front-line providers and practitioners who will be involved in program implementation
- Clients or people with lived experience of homelessness
- Representatives of hospitals or other entities that may be involved in referring to the respite program
- Other community members, such as staff from shelters, meal sites, or other homeless services programs
- People with expertise in behavioral health care and substance use treatment
Once committed partners are established, it’s time to dive deep into the program development process. The following resources can help define the specific components and operational details of program planning:
Technical assistance from The National Health Care for the Homeless Council (NHCHC) can provide additional guidance or details on published resources, connect you with peers and existing programs, and provide insight into your program development process.
If you are interested in technical assistance, please don’t hesitate to contact us.
- The Respite Care Providers’ Network (RCPN) offers a rich community of fellowship to support frontline administrators, clinicians, consumers, and advocates—and improve their care for those who need it most. Learn more about the RCPN and join NHCHC as an individual or organizational member.
- Join a National Health Care for the Homeless Council virtual event.
