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Across the country, unhoused patients struggle to heal after being discharged by hospitals to shelters and the streets. They have no help with managing medications, locating dialysis and other equipment and keeping follow-up appointments. While their conditions range from diabetes to amputations to cancer, they all share a strong likelihood of ending up back in the hospital — again and again.

In Cleveland, there's another option: a medical respite facility called Joseph & Mary's Home. It provides unhoused residents with private rooms and medical services for up to 90 days. But the care goes far beyond healing. Joseph & Mary's Home, a ministry of the Sisters of Charity of St. Augustine and the Sisters of Charity Health System, works with residents to ensure they're released into permanent, stable housing.

"We often say our job is to get people back to health and forward to housing," says Beth Graham, executive director of Joseph & Mary's Home. "We view housing as essential to health, stability and long-term wellness."

Joseph & Mary's Home recently took stock of its men's facility, known as Joseph's Home. In its current three-story space, the sole elevator can barely fit one wheelchair. Nine of 11 rooms are on the second floor, and the only handicap-accessible bathrooms are on the first. Earlier this year, Joseph & Mary's Home launched a capital campaign to move the facility.

"The old location has served us well," Graham says. "But we are seeing a constant uptick in the median age of our residents, and more and more physical disabilities."

Changing lives
In the 1990s, one of the sisters was a social worker at a Sisters of Charity Health System hospital. She told the others about the many unhoused patients who had nowhere to go after hospital discharge.

"She kept talking about how they had no ability to get well," says Sr. Judith Ann Karam, Sisters of Charity of St. Augustine congregational leader. "No environment that would enable them to take their medications, to eat right, to get the sleep they needed."

Working together, the sisters and the hospital system identified the grounds of a former Sisters of Notre Dame convent in downtown Cleveland as a suitable shelter location. With financial help from the U.S. Department of Housing and Urban Development, Joseph's Home opened in 2000 as an 11-bed transitional facility for men, a common model at the time. Along with private rooms, residents received meals and some medical supervision and participated in educational and goal-setting activities and an ongoing recovery program. But there was no steady emphasis on finding permanent housing, so the model kept residents in place, sometimes for a couple of years, and prevented new people from moving in.

In more recent years, the care model at Joseph's Home has shifted to a medical respite that follows the National Health Care for the Homeless Council's Standards and focuses on integrated, whole person care and long-term stability.

In 2022, Mary's Home opened in what had been a Catholic school on the same grounds as Joseph's Home. It offers 10 beds for women. Both the new women's and the existing men's residences — by then designated as medical respite facilities — adopted the goal of finding residents permanent housing. Upon settling in, residents engage with social workers to locate income, including from Social Security, disability, veterans' and Supplemental Nutrition Assistance Program benefits, as well as from jobs. A donation program helps with deposits and first month's rent when residents are able to move out. Even after residents leave, staff check up on them periodically to ensure their payments are current and they're doing well, overall.

"From our understanding of Catholic social teaching, we want to meet the needs of the individual," Sr. Karam says. "But we also wanted to systemically change a person's life."

'Tremendous success story'
Joseph & Mary's Home takes in about 100 people each year. They must be over 18, and their unhoused status verified by the Cuyahoga County Centralized Coordinated Intake agency. But not every unhoused person wants help. Some who've become used to instability balk at the idea of respite care, according to Joseph & Mary's Home medical director Michael Seidman.

Seidman thinks back to a woman he calls J.K., who suffers from chronic obstructive pulmonary disease. He met her through a mobile medical unit that visited the shelter where she stayed for many years. Living in crowded conditions, she constantly picked up viruses. Even a cold exacerbated her breathing difficulties.

"But she knew the shelter, and she was comfortable there," Seidman says.

J.K., 68, frequently ended up in the hospital. Being discharged to a shelter with no medical supervision made it difficult for her to keep up with her medication regimen. After one hospitalization, a nurse told her about Mary's Home, and she agreed to try it. There, she not only recovered but thrived, especially enjoying her art therapy sessions. She began making drawings with hearts and flowers for her caregivers.

"Almost from Day 1, they worked with her on housing," Seidman says. "It was like, 'OK, you're here now; where are you going to go next?'"

J.K. wasn't sure about making another change, but with encouragement, she finally found an apartment that suited her needs. She also located a friend from the shelter who had a car and could drive her to the grocery store. "A tremendous success story," Seidman says.

While she's only been in her apartment for a couple of months, J.K. is poised for a long-term positive outcome. Of the 67% of Joseph & Mary's residents who move out into stable housing, 90% remain in their new homes six months later.

"Yes, we work on getting people to their medical appointments and follow up to ensure they take their medicine — and all that's very important," Seidman says. "But it's also the respect people feel when they come to Joseph & Mary's Home that's therapeutic."

A growing need
It takes about $1.4 million to operate Joseph & Mary's Home every year. Seventy percent comes from individual gifts, foundation or corporate grants and event revenue, and 30% from grant contracts with public sector funders.

A capital campaign known as A New Home for Healing supports renovations for the new Joseph's Home. Helping to inspire community support is a matching gift of $150,000 from the Sisters of Charity of St. Augustine. To date, the campaign has raised more than $2.5 million.

"We're very grateful for the support of the community, city, county and state," says Graham. "And that they recognize people experiencing homelessness with serious medical issues need a safe place."

The new site for Joseph's Home is in the same building as Mary's Home, a one-story structure. Renovations include a main doorway capable of handling multiple wheelchairs as well as gurneys. Every restroom will have roll-in showers with hand-held shower heads and seats. Each room will include an adjustable bed. Halls and doorways will have handrails, knobs will be lever-style and signage will include Braille. Construction began Nov. 11; completion is expected in summer 2025.

Statistics suggest the need for medical respite facilities is growing. Between 2022 and 2023, federal data shows the number of unhoused individuals in the United States increased 12% for a total of nearly 724,000 on any given night — roughly the population of Denver.

Baby boomers — those 64 and older — are driving the trend, says Dr. Timothy Barnett, president of Cleveland Clinic Lutheran Hospital, which frequently refers unhoused patients to Joseph & Mary's Home. As this large generation ages, there are statistically more people living on the streets or in shelters. At the same time, Barnett says, social services that help people access medical care and nutritious food are dwindling.

"Also, because of the two to three years where we had deferred care or non-care because of the pandemic, we're now seeing people with more advanced medical problems," he says.

Homelessness in and of itself accelerates aging, according to a 2019 University of Pennsylvania study. Researchers found that housing instability — and its attendant lack of health care access — can age a person 20 years beyond their chronological age.

A new chance
One hundred thirty-three cities, predominantly on the east and west coasts, offer some form of respite care, according to the National Alliance to End Homelessness.

Joseph & Mary's Home is the only facility of its kind in northeast Ohio.

"I want to emphasize just how important it is for a vulnerable population with true medical issues to recover and get support," Barnett says. "And then, to work on getting permanent housing options to give them a new chance in life."