We Must Ensure Access to Medical Respite Beds for Those Who Need Them Most

On June 15, 2017, the Committee on Human Services heard testimony on the Homeless Service Reform Amendment Act of 2017 — a bill introduced by the Chairman on behalf of the Mayor to help bring the existing law into alignment with Homeward DC, the District’s strategic plan to end homelessness. The Committee heard testimony from nearly 40 stakeholders. As the only medical respite service provider in the District, Unity is uniquely positioned to share perspective on the medical respite amendments to the Homeless Services Reform Act (HSRA).

Medical respite is an invaluable resource. Currently, Unity operates 33 beds for men at Christ House and 12 beds for women at Pat Handy. This extraordinarily limited resource is designed to assist the city’s most medically vulnerable residents who are experiencing homelessness. Christ House, founded in 1985, is one of the Nation’s first medical respite facilities and continues to serve as a role model for developing respite programs throughout the country.

The medical respite services at Pat Handy, which began just last year, provide medical respite services for women for the first time in DC’s history. The medical respite beds at Pat Handy operate on a different and equally innovative model that reflects the collaboration of DHS, N Street Village and Unity Health Care.

Medical respite services save lives. They also save the city from spending significantly more funds on emergency services. The literature on this topic clearly shows that homeless populations with access to medical respite services make fewer trips to the ER, and spend fewer days in hospitals when admitted.

With the advent of My Health GPS and its intended goal of reducing unnecessary ER visits and hospital admissions, now is the time to expand rather than diminish this vital service. To be clear, I am not advocating for less spending on healthcare; I am a physician doing everything I can to help those experiencing homelessness avoid unnecessary ER visits and prolonged hospital stays.

The District has shown tremendous leadership in adopting HSRA. It is an extraordinarily important law that protects the rights of Unity’s patients. Yet, HSRA can be strengthened with amendments to protect medical respite from being managed as if it were just another form of shelter services.

The law and amendments maintain the many valuable protections in HSRA, while empowering medical professionals to make the difficult and critical decisions about who needs medical respite the most at any given time. Medical respite beds are different from shelter beds. If the decisions to admit and discharge patients from medical respite services are governed by HSRA, it will effectively end this service in DC.

As a physician treating homeless patients for the past eight years, I have seen medical respite save lives. I have used it to treat a person’s most critical needs — get their diabetes or blood pressure under control, connect them to medical specialty care that they desperately need, assist them through chemotherapy for their cancer to name a few. During a patient’s stay, they also have the opportunity to connect with social services, obtain identification, benefits, and sometimes get connected to housing.

Medical respite will not solve all the problems that confront an individual when they come in for care. Some folks may heal from an acute illness but may continue to struggle with the challenges they faced prior to coming to respite. They may still face homelessness, poverty, addiction, and chronic illness.

As much as DC has prioritized ending chronic homelessness and making homelessness brief and non-recurring, we have a long way to go. Until we have addressed poverty as a whole in the city, medical respite cannot be expected to solve these problems itself.

Though we always make our best effort to find a safe place to discharge a patient, whether to inpatient substance abuse treatment program or more stable housing, there are times when we have discharged patients who are medically stable back to their prior living situation whether that be the street or shelter. Many of these patients, now connected to medical care and social services have eventually gone on to find permanent supportive housing.

I have one patient I’ll call Joe who lived in Rock Creek Park for thirty years. He has severe chronic obstructive pulmonary disease (COPD) and no medical insurance. Try as we might, Unity could not get him to go to the Social Security office to get his card and verify his identity to obtain medical insurance.

When he developed a severe ulcer on his lower leg, he finally agreed to go to Christ House where he not only got his Social Security card and medical insurance, but also got connected to a pulmonary specialist at George Washington University Hospital for his COPD. Our social services team was able to prioritize him for housing through the coordinated entry program. However, at the time of his discharge from Christ House, he had not yet been matched for housing.

Once his leg ulcer had healed and he had been appropriately connected to medical and social services, he was discharged. Because he did not want to go to a shelter, he was discharged back to his encampment in Rock Creek Park. However, because of all the connections he had made while in medical respite, he was ultimately matched to housing within several months of leaving Christ House.

He now has his own apartment, medical insurance, and a pulmonologist. His COPD is much better controlled now that he is living indoors, but for those occasions when he has a COPD exacerbation, he now has a nebulizer machine and a place to plug it in. For Joe, we couldn’t find him housing while he was in medical respite, but we certainly laid the groundwork, got him connected and ultimately were an essential piece of him getting the housing he so deserves.

Unity remains committed to working with our partners to increase our ability to provide medical respite service — to provide medically appropriate care and also to decrease unnecessary ER visits and hospital admissions. But without amendments to the HSRA this will not be possible.

Catherine Crosland, Physician and Director for Medical Homeless Outreach Development at Unity Health Care