The National Health Care for the Homeless Council defines medical respite as “acute and 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.” We have learned from experience with patients in the Bronx as well as from experts in the field that there is a hospital-homeless cycle of patients experiencing homelessness. When these patients are ready for discharge, if they are not provided appropriate shelter, they often end up on the street, where their medical condition does not improve. They then go back to the Emergency Department and may be readmitted, which starts the cycle again. Only if we change where they are discharged to—for instance, to a medical respite program—can we address their medical and social needs to break this vicious and expensive cycle.
Understanding the scope of respite services needed in the Bronx
In order to better understand the “medically homeless” population in the Bronx––defined as those whose housing needs are directly related to their health conditions––the Consortium developed and implemented a study to explore how a medical respite program may provide an innovative solution to improve people’s health, avoid unnecessary and expensive hospital stays, and move people into stable housing. In June of 2017 and February of 2018, we conducted a medical respite needs assessment in partnership with the Office of the Bronx Borough President and two Bronx Performing Providers Systems. All six acute Bronx hospitals–Montefiore Medical Center, BronxCare Health System, St. Barnabas Health System, and New York City Health + Hospitals North Central Bronx, Lincoln and Jacobi–participated in June and all but Lincoln Hospital participated in February.
Advocating for medical respite across New York City
In December, 2017, The Coalition for Housing and Health, led by LegalHealth, a division of the New York Legal Assistance Group (“NYLAG”) and the Immigrant Health and Cancer Disparities Center at Memorial Sloan Kettering Cancer Center (“Immigrant Health”), brought together those key stakeholders, including but not limited to City and State government, hospitals, managed care organizations, housing providers and legal advocates, to address this issue as a community. A Planning Group was organized from these diverse stakeholders and four work groups were created to focus on particular issues, with the goal of making preliminary recommendations to the Planning Group. Representatives of the Consortium participated in the Planning Group and all four workgroups. Recommendations for our model of medical respite in New York City were finalized in the fall of 2018 and in early 2020, NYLAG released its report, Homeless New Yorkers Need A Safe Place To Recuperate – Not The Street. In partnership with LegalHealth, the Consortium continues to advocate to bring medical respite to scale in New York City. As a result of our advocacy, City Council Speaker Corey Johnson included medical respite as a key recommendation in his January 2020 report, Our Homelessness Crisis: The Case for Change.