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Give Me Shelter, Give Me Healing Addressing the Many Needs of the Homeless Story by Leo Adam Biga | Photos by Brock Stillmunks
An ambulance pulls up to Siena Francis House as community members look on.
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hether home means an improvised living space, a dedicated shelter or couch surfing, the homeless often seek primary health care in ERs. But admitting the homeless as patients poses a problem. Even after treatment, their hospital stays may extend in lieu of a stable home for post-acute care recovery. Hospital beds get tied up in the process. That’s an issue anytime but is especially challenging in a tripledemic. In response, the Charles Drew Health Center and Siena Francis House launched the Health & Dwelling Medical Respite Program, which includes sending a Charles Drew mobile unit to visit Siena’s campus twice a week. The program, which began in August, stems from an area Health & Housing Coalition that charted how well-being is adversely affected by unstable housing, making follow-up care problematic and resulting in high
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readmissions. A task force from Siena Francis, Charles Drew, CHI Health, The Wellbeing Partners, Metro Area Continuum of Care for the Homeless (MACCH), CyncHealth and Unite Nebraska put data behind “a problem that has long been known to us,” said CHI Chief Medical Officer Dr. Cary Ward. Joy Doll, formerly with Project Homeless Connect Omaha and now vice president, community programs, at CyncHealth, noted “growing community concern that hospitals essentially house people at a very expensive rate and shelters call ambulances for guests recently released from the hospital and send them right back for care.” “From the patient perspective,” she added, “there’s not much dignity or positive experience in that. Everyone in the homeless continuum of care knew about this situation and no one felt good about it.”
February 2023
The medical respite program is a “safety net” addressing the issue, Doll said, at a time when COVID-19, RSV and flu cases overwhelm medical facilities. “Outpatients in the hospital who don’t need to be there make it much more difficult to get people in that need to be hospitalized,” Ward said. “Hospitals want to keep those beds open and have them only for people who truly need hospitalization. That’s critical.” The bottom line speaks loudly. “Hospital care is very expensive,” Ward said. “If someone needs regular visits from a nurse, it’s not difficult if the patient has a home. If a person is homeless, there’s often no good place for them to go that we feel is safe for them to get the care they need, which makes it difficult to discharge them.” It’s a medically complex population, even more so for older adults, who comprise a growing
segment of the homeless. The chronically homeless tend to readmit, thus creating a cycle that drains resources. Pre-pandemic deliberations among homeless responders noted a medical respite gap. “Shelters said they need a way to work with the health systems, and health systems said they need a way to work with the shelters,” Doll said. “That really led to the birth of this concept.” No one could see the problem’s dimensions and solutions until the players started working together. “We were all seeing it differently from our lenses,” said Kenny McMorris, president and CEO of Charles Drew Health Center. Organizers studied medical respite models around the country for guidance. The Wellbeing Partners CEO, Aja Anderson, a public health expert who wrote the grant that