Brother Francis Shelter Medical Respite Program

Providence Alaska Medical Center, Alaska Regional Hospital, Alaska Native Medical Center

Anchorage, AK
November 2017

Overview
Three of Alaska’s largest hospitals collaborated to open Anchorage’s first medical respite unit and clinic for the homeless. Through a partnership with Providence Alaska Medical Center, Alaska Regional Hospital and Alaska Native Medical Center, Catholic Social Services opened the 10-bed unit for recently discharged homeless residents in hopes of accelerating their recoveries. At the back of Brother Francis Shelter, the largest emergency shelter in Anchorage, the medical respite area has five double occupancy bedrooms, a small common room with large plastic rocking chairs, a kitchen and two offices for a case manager and program manager.

The new services supplement support for homeless residents through a separate partnership among Providence Alaska Medical Center and nine United Way agencies. The medical center has contributed more than $1 million since 2014 with the goal of elevating the health status of the homeless residents. The intent is to take a client-centered approach to serving the homeless rather than an agency-based focus. All of the participating agencies are connected electronically and seek to provide health care, emergency food, shelter, case management and other social services in a coordinated fashion.

The medical respite program started as a pilot project with two designated beds in October 2015, and then quickly grew to four. The pilot’s eligibility did require patient-guests to be able to care for themselves and be willing to share space. Providence, while serving as the primary referring body to medical respite beds, connected patients in the hospital to the shelter; together they determined whether the program was a good fit. Some of the 19 patient-guests who stayed there received home health care services, nurses who changed bandages on wounds, or physical therapists. Others just had a space to rest while healing from pneumonia or a broken bone. Brother Francis Shelter provided 820 nights of shelter in a respite bed during 16 months of the pilot project.

During the pilot phase, Providence provided care to patients through nursing and therapy visits to the patients. This gave the partners time to figure out details like visiting protocols and compliance with Medicare requirements. Over the course of 2016, Providence Alaska Medical Center, Alaska Regional Hospital and Alaska Native Medical Center collaborated to turn the pilot project into a program. The Brother Francis Shelter Medical Respite Program is able to accommodate 10 patient-guests from all three major hospitals’ inpatient beds or emergency departments. It is staffed with a case manager and program manager. Taking a social services model to respite, the space facilitates recuperation. Patient-guests have access to three meals daily, a semi-private bedroom and case management services to support their healing and later obtain housing. Providence Alaska Medical Center has provided $100,000 to rapidly rehouse patient-guests.

Impact
The medical respite program at Brother Francis Shelter has a goal of housing, and of the 19 patient-guests who participated in the pilot program, 14 – or 73 percent – did not return to homelessness after receiving services. The program to date (March 29, 2017, to Sept. 30, 2017) has received 64 referrals and accepted 44 patient-guests, of which 32 were admitted and received services. Primary diagnoses were wound care (9), fractures (5), non-weight bearing injuries (5) and recuperation from surgery (4). Of the 28 patient-guests who exited the program, 14 – or 50 percent – were discharged to permanent housing.

Lessons Learned
Wounds are more easily infected without running water, and overcoming an illness and healing an injury are harder without some place to recuperate and rest in the day. Lack of adequate space and time for healing leads to higher rates of re-entry into hospitals, more medically unnecessary use of hospital beds and greater stress on emergency department services. The goal of the program is health and ultimately housing. Health problems can be a path to homelessness and can extend homelessness; this is something homeless services providers see often.

Starting the pilot small enabled individualized care for every patient from both the medical and shelter sides. Also, a highly flexible and responsive process was vital to taking the first steps as they decided to just do it after developing a preliminary plan. There were challenges in providing care, but the best way to get the pilot going was to just start. During the pilot, one of the biggest decisions made was to plan for the discharge from day one; stressing that medical respite is only temporary housing enabled permanent housing to be the goal. Case management services working with patient-guests on a permanent housing plan is an integral part of the program and is used as a benchmark of success.

Future Goals
The lack of an extensive waitlist shows that the program is meeting a need. However, the current model has limitations – individuals with substance dependencies and behavioral health needs currently cannot to be served. In March 2016, a daytime clinic operated by South Central Foundation also opened at Brother Francis Shelter. An on-site urgent care clinic, which can serve all Brother Francis Shelter guests and other people seeking services, has proved to be an invaluable partnership. Future goals could include some behavioral health services at Brother Francis Shelter.

Contact: Deb Seidl
Director, In-Home Services
Sisters of Providence Health System
Telephone: 907-212-6563
Email: deborah.seidl@providence.org