Medical Respite Care Research Articles

Delivering the Right Care, at the Right Time, in the Right Place, From the Right Pocket: How the Wrong Pocket Problem Stymies Medical Respite Care for the Homeless and What Can Be Done About It.

Delivering the Right Care, at the Right Time, in the Right Place, From the Right Pocket: How the Wrong Pocket Problem Stymies Medical Respite Care for the Homeless and What Can Be Done About It.

Addressing healthcare disparities in homeless neurosurgical patients: A comprehensive literature review on strategies for equitable care and improved outcomes.

Homelessness is a growing concern in the US, with 3.5 million people experiencing it annually and 600,000 on any given night. Homeless individuals face increased vulnerability to 30-day hospital readmissions and higher mortality rates, straining the healthcare system and exacerbating existing disparities. This study aims to inform neurosurgeons on evidence-based strategies to reduce readmission and mortality rates among homeless patients by reviewing the literature on the impact of medical respite on 30-day readmission rates. The study aims to gauge the efficacy of medical respite in reducing hospital readmissions and improving health outcomes for homeless individuals. A comprehensive literature search was conducted across PubMed, Embase/Medline, and Cochrane databases, as well as consulting the National Institute for Medical Respite Care and the Department of Health Care Access and Information. Ten articles were chosen from an initial 296 to investigate the impact of respite programs on readmission rates among homeless patients. Homeless patients experience high readmission rates due to various factors. Interventions such as respite programs and a comprehensive approach to healthcare can lower these rates. Collaboration between hospitals and medical respites has proven particularly effective. Inadequate healthcare for homeless individuals leads to increased readmissions, longer hospital stays, and higher costs. Medical respites are a viable solution, but limited resources hamper their effectiveness. Therefore, it is crucial to facilitate cooperation between hospitals, respites, and other entities. Future research should focus on disparity in neurosurgical procedures and explore alternative services. An interdisciplinary approach is key to addressing healthcare inequalities.

Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.

Patients with medical and social complexity require care administered through cross-sector collaboration (CSC). Due to organizational complexity, biomedical emphasis, and exacerbated needs of patient populations, interventions requiring CSC prove challenging to implement and study. This report discusses challenges and provides strategies for implementation of CSC through a collaborative, cross-sector, interagency, multidisciplinary team model. A collaborative, cross-sector, interagency, multidisciplinary team was formed called the Buffalo City Mission Recuperative Care Collaborative (RCU Collaborative), in Buffalo, NY, to provide care transition support for people experiencing homelessness at acute care hospital discharge through a medical respite program. Utilizing the Expert Recommendations for Implementing Change (ERIC) framework and feedback from cross-sector collaborative team, implementation strategies were drawn from three validated ERIC implementation strategy clusters: 1) Develop stakeholder relationships; 2) Use evaluative and iterative strategies; 3) Change infrastructure. Stakeholders identified the following factors as the main barriers: organizational culture clash, disparate visions, and workforce challenges related to COVID-19. Identified facilitators were clear group composition, clinical academic partnerships, and strategic linkages to acute care hospitals. A CSC interagency multidisciplinary team can facilitate complex care delivery for high-risk populations, such as medical respite care. Implementation planning is critically important when crossing agency boundaries for new multidisciplinary program development. Insights from this project can help to identify and minimize barriers and optimize utilization of facilitators, such as academic partners. Future research will address external organizational influences and emphasize CSC as central to interventions, not simply a domain to consider during implementation.

Medical respite posthospitalization for adults experiencing homelessness: Erratum.

Erratum In a manuscript that was published in the March 2023 issue, there were errors in the printed and original version online. • Page 48, “Introduction,” paragraph 3, 1st sentence should read: “This article describes how one community coalition that included nurses as members assessed community needs when no medical respite care was available.” • Page 49, “Participants,” paragraph 1, 3rd sentence should read: “The shelter facility staff recommended these participants to the investigators as meeting those inclusion criteria.” • Page 50, Results, paragraph 1, 3rd sentence should read: “The mean age of these participants was 50 years old.” • Page 50, under “Participants,” should read: “The third group consisted of homeless shelter staff interviewed by the investigators. The researchers followed up on any who volunteered to be interviewed. The homeless shelter directors in the midwestern community were asked through electronic mail from the coalition directors to participate in the study and were interviewed about the experience of receiving guests from healthcare facilities.” These errors have been corrected in the online version of the manuscript. Nursing2023. 53(5):60, May 2023.

The effect of medical respite services on hospital readmissions for those experiencing homelessness

A clinical decision report using: Kertesz SG, Posner MA, O’Connell JJ, et al. Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons. J Prev Interv Community. 2009;37(2):129-142. https://doi.org/10.1080/10852350902735734 for a patient experiencing homelessness.

Care coordination Experiences of Low-Income Parents of Children and Youth with Special Health Care Needs: An Exploratory Study.

To explore parent perspectives on barriers, facilitators, and priorities related to coordinating care for children and youth with special health care needs (CYSHCN). Thirty-nine parents of Medicaid-eligible CYSHCN participated in focus groups and completed a brief survey about their child's health insurance coverage, access to specialized services, and need for support with service coordination. Survey data were analyzed using descriptive statistics. Focus group data were analyzed by multiple independent coders using an approach that combines inductive reasoning with predetermined coding strategies. Sixty-seven percent of parents reported that they needed care coordination support. Qualitative data were organized into three main themes: the work of caregiving; the impact of caregiving on multiple aspects of parents' lives; and caregivers' needs related to emotional acceptance, service referrals and navigation, and developmental transitions. Findings support importance of services such as medical homes, care coordinators, peer navigators, respite care, and transition planning.

The connection between Down syndrome and Alzheimer disease

AbstractBackgroundIndividuals with Down syndrome (DS) face unique aging issues. Often the serious consequences of Alzheimer’s disease in individuals with DS are misunderstood and inadequately addressed due to a lack of understanding and sparse resources. This presentation explores research in medical advances, education, programming, housing, and transitioning.MethodThis presentation is a review of literature and research examining the relationship between Down syndrome (DS) and Alzheimer's disease.ResultOver the past 40 years the life expectancy of people with Down syndrome has more than doubled from 25 years in 1983 to 60 years in 2020 due to advances in cardiac surgery, medications, updated treatments, and the elimination of inhumane institutionalization. As a result, ever increasing numbers of people deal with the issues faced when people with DS experience premature age related changes. While memory loss is an early predictor of AD in the general population, according to the Alzheimer’s Association (2020) people with DS are more likely to experience other symptoms such as a reduction in being social, decreased enthusiasm for usual activities, a decline in focusing ability, sadness, fearfulness or anxiety, irritability, uncooperativeness or aggression, sleep disturbances, adult onset seizures, changes in coordination, and or increased excitability.ConclusionImplications for professionals include becoming knowledgeable of the signs of AD in clients with DS. Essential to the planning and implementation of effective medical interventions as well as programing is the development of medications, strategies and behavioral supports to ease transitions, the creation of resources for families and care givers, and the recognition of the growing demands of older adults with DS. Families are frequently ill prepared for the increased demands put upon them as a result of AD symptoms in their loved one with DS. Accessing state, federal, and privately funded services may be unknown, unavailable, and/or difficult. In addition, proper diagnosis and reliable information may not be readily available. These families are often in dire need of sound medical advice, financial, emotional, respite care, and physical assistance.

Mixed methods analysis of a national implementation of a medical respite program in transitional housing settings for veterans experiencing homelessness

ABSTRACT Hospital to Housing (H2H) is a Department of Veteran Affairs (VA) program providing medical respite care to veteran's experiencing homelessness. The program partners community organizations providing transitional housing with local VA facilities delivering medical care for post-hospitalization veterans for clinical stabilization and ultimately, permanent housing. The program was launched October 2017 at 43 sites. Using mixed methods, we aim to assess participant health services utilization and community partner perceptions and experiences with the implementation of the program. We collected 90-day pre/post-enrollment health care utilization data for the first 200 H2H enrollees and conducted semi-structured interviews with six community organizations. Veterans enrolled in H2H had a significant decline in utilization of emergency department and inpatient care (67.0% vs. 39.5%, p < 0.01) and a significant increase in primary care utilization (47.5% vs. 78.0%, p < 0.01). The greatest barrier to implementation was concern of patient complexity while the greatest enabler was the perceived value/benefit of the program. Our findings suggest a community-partnered low intensity medical respite model for select lower acuity populations is feasible to operate and can substantially redirect care away from acute care settings and increase primary care and social services engagement.

Post-hospital medical respite care for homeless people in Denmark: a randomized controlled trial and cost-utility analysis

Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This leads to more frequent and expensive use of health care services. Medical respite care enables an opportunity to recuperate after a hospitalization and has shown a positive effect on readmissions, but little is known about the cost-effectiveness of medical respite care for homeless people discharged from acute hospitalization. Therefore, the aim of the present study was to investigate the cost-effectiveness of a 2-week stay in post-hospital medical respite care. A randomized controlled trial and cost-utility analysis, from a societal perspective, was conducted between April 2014 and March 2016. Homeless people aged > 18 years with an acute admission were included from 10 different hospitals in the Capital Region of Denmark. The intervention group (n = 53) was offered a 2-week medical respite care stay at a Red Cross facility and the control group (n = 43) was discharged without any extra help (usual care), but with the opportunity to seek help in shelters and from street nurses and doctors in the municipalities. The primary outcome was the difference in health care costs 3 months following inclusion in the study. Secondary outcomes were change in health-related quality of life and health care costs 6 months following inclusion in the study. Data were collected through Danish registries, financial management systems in the municipalities and at the Red Cross, and by using the EQ-5D questionnaire. After 3 and 6 months, the intervention group had €4761 (p = 0.10) and €8515 (p = 0.04) lower costs than the control group, respectively. Crude costs at 3 months were €8448 and €13,553 for the intervention and control group respectively. The higher costs in the control group were mainly related to acute admissions. Both groups had minor quality-adjusted life year gains. This is the first randomized controlled trial to investigate the cost-effectiveness of a 2-week medical respite care stay for homeless people after hospitalization. The study showed that the intervention is cost-effective. Furthermore, this study illustrates that it is possible to perform research with satisfying follow-up with a target group that is hard to reach. ClinicalTrials.gov Identifier: NCT02649595.

Thirty-Day Hospital Readmission Among Homeless Individuals With Medicaid in Massachusetts.

National efforts are underway to reduce hospital readmissions. Few studies have used administrative data to provide a global view of readmission among people experiencing homelessness, who often utilize multiple hospital systems. To examine the 30-day hospital readmission rate and factors associated with readmission following discharge among homeless Medicaid members in Massachusetts. We analyzed medical record and Medicaid administrative data for 1269 hospitalizations between 2013 and 2014 for 458 unique patients attributed to Boston Health Care for the Homeless Program. Generalized Estimating Equations were used to investigate factors associated with readmission. Of all hospitalizations, 27% resulted in readmission, more than double the average national Medicaid readmission rate. Leaving against medical advice was associated with increased readmission, while having a Health Care for the Homeless primary care practitioner was associated with reduced readmission. Among the most frequently admitted individuals, being discharged to medical respite care was associated with reduced readmission. To break the readmission cycle, health care providers serving homeless individuals could focus on assuring access to medical respite care and extending outreach efforts that increase primary care engagement. This may be especially important for accountable care systems, as safety net providers increasingly assume financial risk for patients' total cost and quality of care.

The Cottage: providing medical respite care in a home-like environment for people experiencing homelessness

PurposeCo-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia.Design/methodology/approachThis mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage.FindingsClients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support.Research limitations/implicationsThe paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality.Social implicationsMRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions.Originality/valueThere is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.

Homeless people's experiences of medical respite care following acute hospitalisation in Denmark.

The aim of this study was to explore homeless people's health perspectives and experiences of a 2-week medical respite care programme following acute hospitalisation. There is a high level of health inequality when comparing the health status of homeless people to the general population, including increased mortality and morbidity. Homelessness predisposes an increased risk of infectious disease, cancer and chronic illness, such as diabetes and cardiovascular disease. Moreover, homeless people have a higher frequency of acute hospitalisation than general population estimates. In order to facilitate the transition from hospitalisation back to life on the streets, homeless people who were acutely hospitalised in the Capital Region of Denmark were offered 2weeks of medical respite care from the day of discharge by a non-governmental organisation. This is a qualitative study with a phenomenological hermeneutical approach based on narrative interviews of 12 homeless people who received medical respite care from 1 March 2016 to 30 September 2016. Data were collected through individual semi-structured interviews and analysed according to Lindseth and Norberg's presentation of Paul Ricoeur's theory of interpretation. The analysis identified four themes: (i) basic needs are of highest priority; (ii) a safe environment provides security and comfort; (ii) social support is just as important as healthcare; and (iv) restitution facilitates reflection. The findings indicated that the medical respite care centre provided a place of rest and restitution following hospitalisation, which made room for self-reflection among the homeless people regarding their past and present life, and also their wishes for a better future. This study also indicates that a medical respite care stay can contribute to the creation of a temporary condition in which the basic needs of the homeless people are met, enabling them to be more hopeful and to think more positively about the future.

A place to heal: a qualitative focus group study of respite care preferences among individuals experiencing homelessness

ABSTRACTHomeless patients have longer hospital stays than housed persons due, in part, to a lack of safe discharge locations. Respite care for homeless individuals decreases hospital length of stay and readmissions rates. This study aimed to develop client-centered recommendations for medical respite care. We conducted four focus group interviews (n = 25 participants) between August 2010 and February 2013 of homeless adult residents in Minnesota. Four domains of respite care were identified from content analysis of interviews: physical, relational, facilitation, and amenities. Novel recommendations include (a) a facility equipped to address mental health and substance dependence needs, (b) a standardized training protocol for respite staff, (c) the creation of a patient advocate, and (d) the creation of a respite case manager to facilitate post-discharge instructions and connection to primary care and social services. These new and actionable recommendations could help inform policies and the development of future medical respite care facilities.

Differences in Perceived Need for Medical, Therapeutic, and Family Support Services Among Children With ASD.

Identifying racial and ethnic differences in perceived need for treatment among families of children with autism spectrum disorder (ASD) will improve understanding of disparities in care seeking. We described racial and ethnic differences in perceived need for services that children with ASD and their families frequently use. We conducted bivariate analyses of racial and ethnic categories and perceived need for 6 common services used by children with ASD as found in the 2005 to 2006 (n = 2123) and the 2009 to 2010 (n = 3055) National Survey of Children With Special Health Care Needs data sets. Multivariate logistic regressions within concatenated data sets were conducted to examine associations between racial and ethnic category and perceived service needs while controlling for predisposing, enabling, and child factors. Compared with caregivers of white non-Hispanic children with ASD, caregivers of Hispanic children reported less need for prescription medications in adjusted multivariate analyses. Caregivers of black non-Hispanic children with ASD reported less need for prescription medications and for child and family mental health services than caregivers of white non-Hispanic children. Both English-speaking Hispanic caregivers and black non-Hispanic caregivers reported greater need for occupational, speech, and physical therapy than white non-Hispanic caregivers. No racial or ethnic differences were found in perceived need for specialty medical care or respite care. Caregivers of children with ASD from different racial and ethnic backgrounds may differentially perceive need for different types of care. Their perceptions may in turn affect how they prioritize and seek care, independent of their child's specific needs.

Homelessness and discharge delays from an urban safety net hospital

Objectives Homelessness is associated with increased morbidity and mortality, as well as increased rates of hospitalizations. Once hospitalized, homeless patients have longer hospital stays than housed persons, and hospital costs have been found to be increased for homeless patients. We sought to describe hospital discharge delays for nonmedical reasons and their relationship to the housing status of participants. Study Design Retrospective chart review of admissions and discharges between January 1 and June 30, 2009 at a large, urban safety net hospital. Methods All inpatients who experienced discharge delays for nonmedical or external causes were participants, and the main measures included length of and reasons for discharge delay. Results Persons identified as homeless constituted 106 (42.9%) of the discharge delays. Homeless patients were younger, more likely to be male, and more likely to be uninsured than housed patients. The unadjusted median number of delay days was significantly longer for homeless (8 days) than housed patients (4 days) (p Discussion Among patients without psychiatric diagnoses who are medically ready for discharge, homeless patients experience more frequent and longer discharge delays than housed patients. Medical respite care has the potential to decrease unnecessary hospitalization days and improve access to after-hospital services that have proven to be beneficial for this population. Further prospective study of discharge delays may help to establish the cost-effectiveness of respite care.

Integrated care for homeless people in hospital: an acid test for the NHS?

British Journal of Hospital MedicineVol. 74, No. 9 EditorialIntegrated care for homeless people in hospital: an acid test for the NHS?Nigel Hewett, Alex Bax, Aidan HalliganNigel HewettSearch for more papers by this author, Alex BaxSearch for more papers by this author, Aidan HalliganSearch for more papers by this authorNigel Hewett; Alex Bax; Aidan HalliganPublished Online:18 Nov 2013https://doi.org/10.12968/hmed.2013.74.9.484AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References DH Office of the Chief Analyst (2010) Healthcare for Single Homeless People. Department of Health, London Google ScholarHewett N Halligan A Boyce T (2012) A general practitioner and nurse led approach to improving hospital care for homeless people. BMJ 345:e5999 Crossref, Medline, Google ScholarHomeless Link, St Mungo's (2012) Improving Hospital Admission and Discharge for People who are Homeless. http://homeless.org.uk/sites/default/files/HOSPITAL_ADMISSION_AND_DISCHARGE._REPORTdoc.pdf (last accessed 25 June 2013) Google ScholarKing's Fund (2013) Urgent and Emergency Care: A review for NHS South of England. www.southofengland.nhs.uk/wp-content/uploads/2012/05/Kings-Fund-report-urgent-and-emergency-care.pdf (last accessed 25 June 2013) Google ScholarMorrison DS (2009) Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. Int J Epidemiol 38: 877–83 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited byHomelessness: the imperative for a public health response21 September 2020 | Australian and New Zealand Journal of Public Health, Vol. 44, No. 5Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation21 November 2019 | BMC Health Services Research, Vol. 19, No. 1The Cottage: providing medical respite care in a home-like environment for people experiencing homelessnessHousing, Care and Support, Vol. 22, No. 1Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants8 December 2017 | International Journal of Environmental Research and Public Health, Vol. 14, No. 12 1 September 2013Volume 74Issue 9ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 18 November 2013 Published in print 1 September 2013 Information© MA Healthcare LimitedPDF download

Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.

Medical Respite Care for Homeless People: A Growing National Phenomenon

The first known respite care facilities for homeless people emerged in the mid-1980s, but recent trends in health systems and services have driven their rapid proliferation across the country within the past decade. This report is the first attempt to describe these respite programs comprehensively.

Medically Fragile Children Challenge Medical Home Concept

Medically Fragile Children Challenge Medical Home Concept

The Joint Commission home care contracted services survey process.

Mary M. Friedman, MS, RN, CRNI, is a Joint Commission surveyor. Ms. Friedman may be reached at (770) 650-7414; fax: (770) 650-7415; e-mail: [email protected] Editor’s Note: The survey process can be confusing for Joint Commission-accredited providers. However, if you know what to expect during the survey, the home care or hospice organization can be prepared for the actual survey and have better survey results. This month’s column focuses on the basic survey process for home care and hospice organizations that contract with individuals or organizations to provide services on their behalf. Hospice programs typically have many different types of contracted providers for a variety of services. Therefore, discussion of the hospice survey process for contracted home medical equipment, pharmaceutical services, and inpatient and respite care will occur in the subsequent two Accreditation Strategies columns in the May and June issues. We appreciate your feedback on these topics and welcome other questions you may have about Joint Commission topics.