Watch the 2016 Achievement Citation Award Video for the Transitional Respite Care for the Homeless Program
By KIM VAN OOSTEN
Photos by CHRIS RYAN
SPOKANE, Wash. — It's nearly 1 p.m. here at the House of Charity on a rainy, cold day. For the fourth time the announcement to collect personal items before the facility closes for the afternoon is heard by the hundred or more homeless people still accessing showers, laundry, haircutting, counseling and medical clinic services in the bustling building. For all but the 24 men who are part of the Transitional Respite Care for the Homeless Program of Providence Health Care, it's off to find another place to stay out of the raw weather until late in the day, when they'll seek a bed here or elsewhere.
The men in the respite program can stay warm and dry 24 hours a day inside Catholic Charities Spokane's House of Charity. They get three meals a day, non-intensive nursing care and instruction to help them take charge of their health and medication management. The respite program offers a level of care from an on-site nurse similar to what a patient might receive from an attentive family member.
And participants can remain in the respite program until they are medically ready to be out on the street again. The program aims to prevent complications of illness and injury, improve the opportunity to heal, and stop the revolving door admissions to the emergency department and hospital.
In the absence of the respite alternative, some of these recovering patients likely would have been kept in the hospital longer, to ensure a safe discharge. Others may have had no alternative other than a return to the street in a weakened condition. They would have been at high risk for relapse and rehospitalization.
In its respite program, Providence Health Care found a way to reduce suffering, save lives and cut health care spending. At its core, the program delivers on Providence's mission to reveal God's love for all, especially the poor and vulnerable, through compassionate service.
For its innovative, collaborative approach to providing homeless patients a place to recuperate after discharge from the hospital, Providence Health Care received CHA's highest annual honor — the Achievement Citation. The award was presented last month at CHA's 2016 Catholic Health Assembly in Orlando, Fla.
Providence Health Care's emergency department at Providence Sacred Heart Medical Center sees about 80,000 people each year; about 5 percent of those patients are homeless. Fragile of mind, body and soul, and often with varying degrees of mental illness and addiction, many of the homeless men and women accessing care at the emergency department are seeking primary care, but others seek treatment for deep and intractable wounds, infections such as cellulitis, broken bones, and uncontrolled diabetes or other serious, chronic health concerns.
Before the respite program, some homeless individuals were presenting at the emergency department upward of 60 to 100 times a year, said Elaine Couture. She is regional chief executive for Providence Health Care, a subsidiary of Providence Health & Services and Providence Sacred Heart's parent.
Couture said the catalyst for the respite program came from discussions among an emergency department physician, Providence social workers, and several employees of Catholic Charities. As the conversation progressed, Providence recognized it could improve upon its plan for discharging homeless patients into housing.
Providence started the respite program in November 2013 with just one bed in the Catholic Charities shelter; now there are beds for 24 recuperating patients. (Providence runs the only completely free medical clinic in Spokane at the shelter.) Providence also has four respite beds for women at Hope House — a shelter for women in Spokane.
"Housing is one of the best treatments we have in all of medicine," said Dr. Darin Neven, who practices emergency medicine at Providence Sacred Heart and helped start the program. "We need to be able to write a prescription for that housing and have some place that can actually fill the prescription."
Couture started her medical career as a registered nurse and she too understands the challenges faced by homeless patients.
"There were many times when I was at the bedside that I knew that when we discharged people … they had no place to go and that they would end up going out on the street," she said. "Imagine yourself, your bed that night is going to be out on the streets. To me, that's not serving people."
The respite program in its first full year showed that innovative housing solutions can create better health for homeless people. In addition to better care for a vulnerable population, the program reduces the overall cost of care by lowering the number of ambulance calls, emergency department visits and inpatient stays, Couture said.
The Henry J. Kaiser Family Foundation estimates that, in 2014, a Washington state hospital would have spent $3,189 per day to care for an inpatient. The respite program provided about 3,500 nights of care that year to almost 200 men and women who were discharged from Providence hospitals and other local health care entities in Spokane. In 2015, 225 new admissions were seen through November.
Once in the program, people can elect to work with a counselor to access community resources including a connection to primary care, housing and other social services; warrant reversal and ID renewal; health education; and behavioral health services.
"It's a job being homeless," said Pete Lockwood, who is the program coordinator at the House of Charity and the operations manager for the respite program. It's a job to figure out how you are going to get off the street when a lot of housing communities require a reliable source of income, he said. To get a job, homeless people have to figure out where and how they can be contacted by prospective employers, and they have to find a secure place to store personal items while they are at work. "There are just so many questions — it's rough."
Once in the respite program, Lockwood said clients have the time to think more long-term. "You've opened up a new world to them because they don't have to worry about that day-to-day struggle anymore," Lockwood said. "It changes everything about a person."
Patients like Steve T., a participant in Providence Health Care’s Transitional Respite Care for the Homeless Program, are able to stay warm and dry in the afternoons when other homeless men must leave the House of Charity homeless center for the streets of Spokane, Wash.
Pete Lockwood is program coordinator at the House of Charity and the operations manager for the respite program.
Lockwood surveys sleeping quarters for respite patients at the House of Charity. Having a safe place to recuperate relieves patients of the daily struggles of life on the streets. That security “changes everything about a person,” he said.
Cory P., a patient at Providence Sacred Heart Medical Center in Spokane, is briefed about the transitional respite care program at the House of Charity where he would recuperate off the streets.
Bishop William Stephen Skylstad, bishop emeritus of Spokane, hands out toiletries and other items to people who come to the House of Charity to shower, do laundry, eat lunch or see a clinician at the on-site clinic run by Providence Health Care. He volunteers at the shelter once or twice a week.
Freed from the daily exigencies of life on the street, Richard E., left, and Sam S. are seeking permanent housing with assistance from House of Charity staff while recuperating in Providence Health Care’s Transitional Respite Care for the Homeless Program.
Homeless men and women nap and congregate in the lobby area of the House of Charity after lunch and before they must leave the shelter for the afternoon. The shelter and homeless center provide mental health counseling, case management, toilet facilities, meals and other necessities of daily living to men and women, but only men may overnight in the shelter.
Respite patient Steve C. spends time with Rocco, a certified therapy dog who comes to the House of Charity daily with owner Lockwood, the respite program operations manager.