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Respite News
A Quarterly Newsletter for Members of the Respite Care Providers' Network
November 8, 2022
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| NIMRC Resource Highlights
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Research involving individuals experiencing homelessness can be particularly challenging, and this challenge often leaves gaps in the literature around the effectiveness of programs and interventions for this population. Although growing, medical respite is an even smaller subset of care within homeless services. The Medical Respite Literature Review conducted in 2021 identified 45 unique articles from 2010-2021 published on medical respite care.
Fortunately for the field of medical respite care, there are programs, providers, and researchers with the capacity and dedication to grow our collective knowledge and ability to provide quality, evidence-based care. We are dedicating this issue of the RCPN Newsletter to highlight the more recent research published in the field of medical respite care.
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Notably, our former RCPN Steering Committee Chairperson, Donna Biederman, was part of, and facilitated, three of the most recent studies:
- Differences in Clinical Outcomes of Adults Referred to a Homeless Transitional Care Program Based on Multimorbid Health Profiles: A Latent Class Analysis
Overview: This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups. Available here.
Full citation: Smith, C. M., Feigal, J., Sloane, R., & Biederman, D. J. (2021). Differences in clinical outcomes of adults referred to a homeless transitional care program based on multimorbid health profiles: A latent class analysis. Frontiers in Psychiatry, 12, 780366. https://doi.org/10.3389/fpsyt.2021.780366
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- Use of Health Care Utilization as a Metric of Intervention Success May Perpetuate Racial Disparities: An Outcome Evaluation of a Homeless Transitional Care Program
Overview: This study explored race-based differences in disease burden, health care utilization, and mortality for Black and White persons experiencing homelessness (PEH) who were referred to a transitional care program, and health care utilization and program outcomes for program participants. Available here.
Full citation: Nohria, R., Biederman, D. J., Sloane, R., & Thibault, A. (2022). Use of health care utilization as a metric of intervention success may perpetuate racial disparities: An outcome evaluation of a homeless transitional care program. Public Health Nursing, 00, 1– 9. https://doi.org/10.1111/phn.13121
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- Program Outcomes and Health Care Utilization of People Experiencing Homelessness and Substance Use Disorder after Transitional Care Program Engagement
Overview: Transitional care and medical respite programs facilitate a safe transfer for PEH from the acute care to community setting. Many medical respite programs practice harm reduction strategies that can increase the opportunity for positive program outcomes for PEH with SUD. This transitional care and medical respite program evaluation explored program outcomes, health care utilization patterns, and comorbid conditions of persons with and without SUD.
Available here.
Full citation: Biederman, D. J., Sloane, R., Gamble, J., Sverchek, C., & Daaleman, T. P. (2022). Program outcomes and health Care utilization of people experiencing homelessness and substance use disorder after transitional care program engagement. Journal of Health Care for the Poor and Underserved 33 (3), 1337–52. https://doi.org/10.1353/hpu.2022.0116
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Additional recent publications that contribute to the field of medical respite care include:
- Evaluation of Bundled Interventions for Patients with Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection
Overview: Our study aimed to examine the effect of a multipronged approach (including infectious disease [ID] and addiction specialty care, case management services, and MOUD treatment) on clinical cure and linkage with outpatient addiction treatment for patients with OUD experiencing homelessness who utilize a medical respite facility. Available here.
Full citation: Beieler, A. M., Klein, J. W., Bhatraju, E., Iles-Shih, M., Enzian, L., & Dhanireddy, S. (2021). Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection, Open Forum Infectious Diseases, 8(6), ofab285. https://doi.org/10.1093/ofid/ofab285
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- Program Evaluation of a Recuperative Care Pilot Project
Overview: A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals. Available here.
Full citation: Lawson, L. V., Bowie, B., & Neufeld, M. (2021). Program evaluation of a recuperative care pilot project. Public Health Nursing, 38(1), 93–97. https://doi.org/10.1111/phn.12834
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- Design Considerations for the Development and Implementation of a Medical Respite for Older Adults Experiencing Homelessness in Metro Vancouver
Overview: This study examines how a medical respite could be designed for older people with lived experience in Metro Vancouver, BC. Available here.
Full citation: Canham, S. L., Humphries, J., Danielsen, C., Small, S., & Bosma, H. (2021). Design Considerations for the Development and Implementation of a Medical Respite for Older Adults Experiencing Homelessness in Metro Vancouver. Medical Care, 59(Suppl 2), S146–S153. https://doi.org/10.1097/MLR.0000000000001335
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In case you missed it: Addressing Cognition and Addressing Dementia in Medical Respite Care
Webinar recordings and hand-outs available here.
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Dear RCPN Members,
Happy November! My name is Joey and I’m on the Implementation Research Team (IRT) with the Council. Our team serves the Council and NIMRC in several ways: connecting with researchers and clinician-scientists, creating resources that support health centers and medical respite programs to better use their data, and more. I’ve been lucky to support some of NIMRC’s activities around research, data, and program outcomes. Having the chance to learn about the work you all are doing to provide person-centered, high-quality services in your communities has been a highlight in my time at the Council. After every opportunity to connect with this group—whether individually or by listening in on network meetings—I walk away grateful and inspired.
Research and Medical Respite Care (MRC) make a great combination. As shown by our 2021 Literature Review, we’ve tracked a body of literature corroborating the profound value of MRC—including improved outpatient care utilization, decreases in hospital readmission rates, improved connections to social services and supports, and more. As you read in this newsletter, MRC research continued to expand in 2022, with studies emerging as recently as this summer.
We’re thrilled by this research for many reasons. First, with MRC at an inflection point of rapid growth, it’s more important than ever to have an evidence base around interventions and models that reflect the compassion at the heart of MRC. Additionally, thanks to the funding opportunities made available in recent years, we are well aware of the tangible benefits that can be unlocked when the value of MRC is analyzed and communicated.
Looking toward the future, NIMRC and the Council are poised to play an active role in MRC research. We can provide a national stage for emerging MRC research and help facilitate partnerships between academic institutions and individual programs. Through the Council’s Practice-Based Research Network (PBRN) and Research Committee, we can provide opportunities for researchers to support one another’s work and even publish white papers that highlight their findings. We are lucky to have leading researchers among RCPN, PBRN, and Research Committee, and are looking forward to growing these networks in the coming years. What an exciting time to be invested in MRC and MRC research! Please don’t hesitate to reach out if you are interested in chatting or connecting more.
I'm thankful for this MRC family and hope to get to work more with you all in the future. Have a wonderful November.
Warmly,
Joseph Kenkel
Research Associate - Implementation Research Team
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| | Respite Kudos & Accomplishments
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Congratulations to several programs for their significant expansion and new buildings for their medical respite care space! These programs include:
- Interfaith Community Services for their new 106 bed facility in Escondido, CA
- The Hennepin County Health Care for the Homeless Program for their new medical respite space in partnership with Catholic Charities in Minneapolis, MN! Learn more about their new space here: Endeavors Medical Respite-Youtube Video
- The Colorado Coalition for the Homeless medical respite program for opening their new 75 bed facility in Denver, CO! Learn more about their new space here, with photos below:
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Christa Signor (NHCHC), Andy Grimm (CCH), Miriah Nunnaley (CCH)
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| Activities & Opportunities
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In 2007, the Research Committee of the National Health Care for the Homeless (HCH) Council and HCH Clinicians’ Network created the nationally focused HCH Practice-Based Research Network (PBRN). The Council is revamping our PBRN and has convened a bi-monthly workgroup to outline the priorities and structure of the PBRN moving forward. If you would like to be part of the re-launch workgroup, contact the Director of Research, Alaina Boyer.
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Submit a Proposal for the NHCHC National Conference
The National Health Care for the Homeless Council is now accepting abstracts for the 2023 NHCHC National Conference. The Council looks forward to highlighting research in the HCH field moving toward Justice and Leading with Lived Expertise. More details for suggested tracks and instructions to submit can be found here. The deadline to submit abstracts to the Council is December 2, 2022.
We also welcome submissions for abstract reviewers. Those interested in reviewing abstracts for the 2023 NHCHC Conference should complete the Reviewer Submission Form found here. Submissions to review should include name, affiliation, email and area(s) of expertise. The deadline to submit applications to review is Friday, November 18th. Please contact Events Manager, Brett Poe, with any questions.
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| | From the Medical Respite Community
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Rocky Mountain Refuge for End of Life Care Six-Month Milestone for Innovative New Shelter Serving Denver Area Unhouse Neighbors with a Terminal Illness
Denver, Colorado - August 31, 2022:
The Rocky Mountain Refuge for End of Life care opened its doors last February in the middle of a frigid winter. After six months, we are nearing the end of a hot summer. In that time as the cycle of the seasons has evolved, our unhoused neighbors continued their own cyclical rhythms, dealing with the relentless challenges of shelter, food, safety, health, and connections with others. Untold numbers of them died on the streets, under bridges, in tents, and, if they were lucky, in emergency or palliative care hospital rooms.
The difference now is that some of those terminally ill neighbors were able to come to the Refuge and find a safe place to make the final transition from this life. In this place, they found a refuge many hadn't experienced in a long time, if ever.
They came to a place where their personal and hygienic needs were met, where hospice services were provided, where they didn't need to worry about their next meal, and where caring people learned their names and wanted to know their life stories. In short, they had a home they could come into and depart from at ease.
The story of Rocky Mountain Refuge for End of Life Care began nearly five years ago when some friends imagined providing a safe place for unhoused folks to receive hospice care. The founding board members realized that as Denver’s population of unhoused people was aging there were increasing numbers of individuals who were left to face their last days alone — in environments that lacked dignity and without the full support of hospice care.
People with terminal illnesses but no stable home have very few options. Emergency rooms, often a last resort for people on the street, are the most cost-prohibitive and least effective setting possible. Rocky Mountain Refuge can provide care for our friends at a fraction of the cost of multiple admissions to hospital ER or palliative care rooms.
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The Refuge is the first shelter of its kind in the Denver area and one of only a few nationwide. Hospice agencies are designed to assist in a person's home and do not typically provide their own shelters, or if so, have very few beds. If a person has no home is estranged from family, hospice agencies struggle to provide care. Denver's homeless shelters meet immediate, short-term needs while hospice patients need individual custodial care for weeks, with privacy and stability that shelters are not designed to offer.
The Refuge operates as a specialized shelter that fills this gap in care services. Our staff and volunteers operate as an extension of someone's family giving basic care such as help with laundry, personal hygiene, and companionship. No one who comes to us is alone in their final journey.
The Refuge’s hospice agency partners provide the skilled nursing, medication, and physician services which may be needed to care for our residents. This improvement in care is done at a lower cost than repeated admissions to hospital ER rooms or admission to temporary critical care facilities.
Often the most powerful relationship an unhoused person may have is with their pet. We understand that and have a relationship with Maxfund no-kill shelter to accept the pet of a person who is coming to us. They can rest easy knowing we will take good care of their beloved pet.
We offer shelter for end-of-life care regardless of a person's race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status.
Information about the Refuge's services for and impact on terminally ill unhoused neighbors, as well as ways to help, can be found at https://rockymountainrefuge.org/.
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The awareness of medical respite care and medical respite programs across communities has grown! Many of our respite programs have been featured in the news, in addition to articles that identify medical respite care as a key intervention for people experiencing homelessness.
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- Colorado Coalition for the Homeless and their new facility is highlighted for their work in medical respite care, with a grand opening that occurred in October.
- Kaiser Permanente discusses the importance of medical respite care, and features Colorado Coalition for the Homeless.
- Clallam County secured funding for a 2 year pilot of a Medical Respite Program.
- Lower Columbia CAP was featured for their medical respite work, and recently receiving a grant from Kaiser Permanente to expand their work in Vancouver, WA. Two other local programs also received grant funding through Kaiser's Medical Respite Initiative: Share in Clark County received $300,000 to support becoming a medical respite Medicaid provider and for technical assistance, and Central City Concern in Portland received $100,00 to support data analysis infrastructure to measure service outcomes
- Interfaith Services in Escondido, CA was highlighted for their work in medical respite care, as well as providing family shelter.
- The INN Between in Salt Lake City, UT was featured for their work in providing end-of-life care for people experiencing homelessness.
- Multiple medical respite programs, along with Senior Policy Director Barbara DiPietro, were featured in this article supporting the movement for Medicaid to consider inclusion of medical respite as a benefit.
If you have a news story recognizing a medical respite/recuperative care program, please share it with us by emailing Samantha at smarco@nhchc.org.
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| | Respite Care Providers' Network Information
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- If you are not already a member, please join the Respite Care Providers Network (RCPN). The mission of RCPN is to improve the health status of individuals who are homeless by supporting programs that provide medical respite and related services. Follow this link for more information and to join the RCPN.
- Is your medical respite program profile in the NIMRC directory up to date? Complete this program profile form to update your information and view the directory here.
- Does your program need technical assistance? Please contact Julia, Caitlin, Stephen, or Christa to request a TA meeting to help address your program’s needs!
- Additional resources for medical respite/recuperative care can be found at www.NIMRC.org.
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