P&P August 2015

partnering for impact

By Mark Krug

The Nightingale Medical Respite Program

This article is a part of our ongoing series “Partnering For Impact.”Working with our partners at the National Human Services Assembly (NHSA), this section highlights innovative public-private partnerships around the country. leading to high rates of hospital re-admission as well. 1 While the Affordable Care Act (ACA) expanded the California Medical Assistance Program (Medi-Cal) coverage to include low-income single adults, T he Nightingale Medical Respite Program is an innovative program providing temporary housing, care, and services for homeless individuals being discharged from a local hospital or who otherwise need a safe place for recuperating from illness or injury. Located 50 miles north of San Francisco in Santa Rosa, Calif., the county seat and largest city in Sonoma County, the Nightingale Medical Respite Program is a creative program benefitting homeless individuals served by the program as well as the collaborating partners, namely, Kaiser Permanente, St. Joseph Health— Sonoma County, Sutter Medical Center of Santa Rosa, and the Sonoma County Department of Health Services (DHS). These partners collaborate and largely fund Catholic Charities of the Diocese of Santa Rosa, the program founder and operator, to operate the Nightingale Program. Individuals experiencing homeless- ness have disproportionate rates of acute and chronic illnesses, which in turn, drive high rates of hospital utilization. Lack of housing for this population complicates discharge planning and subsequent recovery,

to a hospital at three months and 12 months post-hospital discharge. 3 Catholic Charities’ Nightingale program provides 13 respite beds for homeless adults who are referred when discharged from the hospital or emer- gency room. Clients receive access to 24/7 bed rest, three meals a day, and clinical assessment, when necessary. As a temporary facility for homeless patients upon discharge from local hospitals who need a safe environment in which to recuperate, the Nightingale Program is the only program of its kind in the region. The Nightingale program gives the three main hospitals in Sonoma County—Kaiser, Sutter, and Memorial (a St. Joseph Health hospital)—the option of discharging homeless patients to the Nightingale shelter for recuperation. The costs of housing a patient through recuperation at Nightingale are significantly lower than the same length of stay in a hospital, and services at Nightingale are designed to reduce readmission rates for patients. Thus, the program is primarily funded by these three hospitals as it allows them to realize a savings in their treatment costs by reducing inpa- tient days, and they refer the majority of patients served by the Nightingale program. Charitable contributions and small support from DHS are also made to the program. The Nightingale respite beds are located at the Brookwood Health Center, a federally qualified health center (FQHC) and one of eight facilities operated by Santa Rosa Community Health Centers. Catholic Charities and the Health Centers have entered into an agreement for

and therefore most homeless indi- viduals, access to insurance by itself does not necessarily reduce hospital utilization. Local evidence indicates homeless individuals visit the emergency depart- ment and are hospitalized up to 10 times more often than low-income people with permanent housing. Following an emergency department admission, homeless patients have longer hospital stays, which cost an average of $2,500 more than hospital stays by patients with permanent housing. Programs that prevent or reduce hospital use by homeless patients produce better health outcomes for patients and reduce costs system-wide. Longer inpatient stays and higher emergency room utiliza- tion are a consequence of inadequate housing; people who are experiencing homelessness have no place for rest or recuperation after treatment or hospitalization. 2 Medical respite care focuses on post-acute medical care for homeless persons who are too ill or frail to recover from a physical illness or injury on the streets, but are not ill enough to be in a hospital or skilled-nursing facility (SNF). Medical respite, like Nightingale, is short-term residential care that allows homeless individuals the opportunity to rest in a safe envi- ronment while accessing medical care and other supportive services. The two most frequently cited benefits of Medical Respite Care are improvement in a homeless client’s quality of life and a reduction in hospital re-admissions. Early nationwide research shows that homeless patients who participate in medical respite programs are 50 percent less likely to be readmitted

Illustration by Chris Campbell

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