Sara Keith, Colorado Coalition for the Homeless manager of patient activities and volunteers, talks with Casey Capper outside the John Parvensky Stout Street Recuperative Care Center in Denver. Capper experienced homelessness after an injury cut
short his plans for a snowboarding career and his sister died. He got help at the center to stabilize his life.
When people who are homeless are admitted to the hospital, what happens when they are healthy enough to be discharged but still have post-acute care needs? How can they safely recover when they don't have a home? These are questions that had long vexed
Denver-area hospitals amid rising homelessness. A 75-bed recuperative care and medical respite facility that the Colorado Coalition for the Homeless opened
in Denver in early 2023 is providing an answer.
Hospitals that lease beds in the coalition's John Parvensky Stout Street Recuperative Care Center can discharge qualified patients who are homeless to those beds. Once there, patients receive help meeting post-acute care needs, accessing social services
and securing housing.
Grivetti
Intermountain Health is one of the health care partners that has been discharging unhoused patients to the center. That system's Saint Joseph Hospital in Denver leases 10 beds. The remaining Intermountain Health hospitals in the Denver area together lease
six respite beds. Those facilities are Good Samaritan Hospital in Lafayette, Lutheran Hospital in Wheat Ridge and Platte Valley Hospital in Brighton.
Michelle Kelly-Jones, Saint Joseph manager of case management, says people who are homeless can face many gaps in care as they try to recover from their medical conditions after discharge. She says through the respite center, the Colorado Coalition can
help people bridge those gaps. Todd Grivetti, Intermountain regional director of operations for care management, says the respite center sets the hospitals' discharged patients up for success. He says the center's work aligns with Intermountain's
purpose, which is to "improve the health of those who live in our communities."
Since being helped by the center and its owner, the Colorado Coalition for the Homeless, Capper is rebuilding his life. He no longer lives on the streets.
Unsafe conditions
According to the Colorado Coalition, people who are homeless have rates of serious illness — including diabetes, heart disease and HIV/AIDS — that are about three to six times those of people who are
housed. People who are homeless have hospital stays that are on average nearly twice as long as people who have homes.
Kelly-Jones adds that people who are homeless are particularly vulnerable to conditions like frostbite and to burns from the fires they set or the devices they use to stay warm.
If people who are homeless are discharged from a hospitalization with nowhere to go, they are at very high risk of readmission. She says that is because it can be difficult for them to adhere to the medical instructions given at discharge if they are
living on the streets. For instance, they may be unable to keep a wound clean and dry so it heals. They may not be able to safely store medicines that require refrigeration. And they can struggle to keep track of follow-up medical appointments and
to find transportation to get to them.
Patchwork of options
Kelly-Jones explains that prior to 2023, there were few good options for unhoused patients who were cleared for discharge.
Many patients who are homeless are uninsured. Grivetti says many may not know whether they are eligible for Medicare or Medicaid, or they may not know how to apply. It can be an arduous process to enroll, he says. With no insurance, many unhoused patients
are ineligible for reimbursement for post-acute care, so rehab facilities may not want to admit them. Or rehab facilities may not accept them because there is no specified location where they can be discharged.
Kelly-Jones adds that prior to 2023 there was just a patchwork of shelters that hospitals could discharge to, and those shelters usually had a waitlist. The shelter beds that were available did not have any clinical staffing. It was common for shelters
to send patients back to the hospital because the shelters couldn't care for them. This was especially true of patients discharged on oxygen.
The Colorado Coalition for the Homeless runs multiple health care, housing and social services hubs in the greater Denver area. These are spaces at some of its facilities.
All on board
Kelly-Jones says the coalition had been keeping metrics on all of this, particularly on the lack of shelter space for discharged patients and the high readmission rate for high-acuity dischargees.
Since its 1984 founding, the coalition had built up a portfolio of nearly two dozen transitional living and supportive housing complexes, plus a network of federally qualified health centers and social services throughout Colorado, mostly in Denver. With
none of its facilities equipped to handle the needs of discharged hospital patients, the coalition came up with the respite center solution.
Funded by the city of Denver and philanthropists as well as by the hospital leases, the respite center offers around-the-clock care from a nursing staff of up to 20 people during daytime hours and up to five overnight. The center provides meals and snacks
and access to laundry facilities and community rooms. And patients can get additional care at the adjacent federally qualified health center. They also can get on-site social service support, including behavioral health care, substance abuse treatment,
job training and help pursuing long-term housing.
When the coalition made local hospitals aware of this idea early on, says Grivetti, "we all jumped on board."
The coalition requires hospitals to lease beds in order to discharge to the respite center. In addition to Intermountain, several other health systems including CommonSpirit Health are lessees.
Grivetti says Intermountain pays about $600,000 per year to lease the 16 beds. The solution has been so valuable that he says Intermountain will gladly increase its count if given the chance.
Hope Prebble, a medical assistant at the health care facility at the John Parvensky Stout Street Recuperative Care Center, assists clients, who have access to nearby health care and social services.
Trusted network
Grivetti says the Denver-area Intermountain hospitals have on average about nine discharged patients who are using the respite program at any given time. Patients usually stay at the respite from two to three weeks,
and during that time coalition staff seek to get them into services and stable housing.
According to statistics from Grivetti, altogether Intermountain's Denver-area hospitals have discharged 170 patients to the respite center since its opening. About one-third of these patients have completed a program for "ideal discharge" from the center.
This includes entering into stable housing or long-term care and, when applicable, reuniting with family and/or accessing substance abuse treatment.
Grivetti adds that statistics show that patients who are homeless and who are discharged to respite have a readmission rate of 12.8%, as compared to the national average of 17.7% for patients who are homeless being readmitted.
Kelly-Jones notes that she attributes much of this success to the trusted network of partners that has formed through this work. The coalition and its hospital partners have connected through an electronic record of sorts, and they stay in constant contact
about the patients who move between the partner hospitals and the respite center. She says patients come to know and trust these organizations. Additionally, the fact that the coalition has preexisting outreach, health and social services that local
unhoused people are familiar with helps with the trust factor. It also promotes continuity of care, she notes.
To illustrate the importance of this interconnection, she describes a recent inpatient who was homeless and nearing the time for discharge. He told Kelly-Jones who his social worker was at the coalition, and she was able to quickly connect with that person
and confirm that the patient already was in the system. This eased the discharge planning for everyone involved.
Grivetti says the partnership with the respite center has resulted in improved health outcomes and better social supports for many Intermountain patients. He says the coalition and its partners "have been very successful — we've helped patients
stay out of the hospital."
He says the respite center "allows patients to be in a safe environment to get the care they need."