Until recently in Colorado Springs, a homeless person emerging from heart surgery would almost certainly end up back on the streets before she was healed. Not surprisingly, she'd likely end up back in the hospital within days or weeks. And she may need to return multiple times, with infections and complications, due to a lack of follow-up consultation.
"When a patient leaves here, and is homeless, you do lose contact with them," says Connie Cassani-Beard, a licensed clinical social worker at Memorial Health System. "You can't call and see how they're doing."
Local physician's assistant Greg Morris is aiming to keep tabs on — and do more for — people like this. This month, he received 501(c)(3) nonprofit status for his fledgling program, Ascending to Health Respite Care.
The agency provides a safe place for homeless patients to rest, plus case managers who ensure patients make it to follow-up doctor's appointments and pick up needed medication. It also helps homeless patients access housing and jobs.
"That is the ultimate goal of any respite care," Morris says, "is to make that transition, that leap, from accessing the ER and the hospital repeatedly to permanent, supportive housing."
Officially, the program is just getting started, but it's actually been functioning for more than a year, mostly in a test capacity. Over the course of 12 months, ending in October, Morris ran the respite program with the cooperation of Memorial, which referred homeless patients after treatment.
Morris measured the program's outcomes during the test period. While he can house a recovering patient for less than $100 a day, a Memorial inpatient costs at least $1,640 a day, and often much more. "We can only go so far in the hospital, and he's taking the next step," Cassani-Beard says.
But he's basically doing it by himself. Ascending to Health doesn't have any budget — so far, its services have been paid for largely out of Morris and his wife's savings account.
Venita Pine, assistant vice president of administrative services at Peak Vista Community Health Centers, is one of a few locals who can remember the Springs' last respite-care program.
Operating from the upper floor of Peak Vista's clinic, it provided full medical care to homeless patients for a few years. Then, around 2003, the federal government cut funding for programs that blur the line between housing and health care.
"There was disappointment that we had to shut the program down," Pine remembers.
Morris too, remembers. As the longtime program manager for Peak Vista's Homeless Health Center (which is not connected to Ascending to Health), he had a deep understanding of how important respite was to his patients. So he began working to replace the respite program in 2009, "just trying to plug the hole."
He pulled together a team of volunteers and some sympathetic nonprofits. R.J. Montgomery Salvation Army New Hope Center gave space for offices and 14 patient beds. The homeless program at the Aztec Motel on Platte Avenue made four beds available for patients. A South Nevada motel agreed to rent rooms for additional patients at a good price. Catholic Charities is helping with food, hygiene products, clothing and wheelchairs.
In all, nonprofits gave $98,000 in-kind. Harbor House, which treats chronically homeless people with addictions, was among them.
"It's definitely needed in this community," Harbor program manager Katrina Vigil says. "... I don't think there will ever truly be enough beds for that."
A national story
Hospitals won't be filling the gap anytime soon. With recent reforms essentially putting an emphasis on "getting it right the first time," even some top hospitals that have readmitted Medicare patients have seen reimbursements lowered by as much as 1 percent. (Memorial was not penalized, but Penrose St. Francis Health Services took a .16 percent hit.) Facilities serving the underprivileged have often been hardest hit.
Respite programs offer a solution. In Los Angeles, a respite program saved hospitals $3 million annually, according to a 2010 report from the National Health Care for the Homeless Council. In Portland, Ore., the figure was $3.5 million; in Cincinnati, $6.2 million. Morris estimates that even his small test program may have saved Memorial roughly $482,000.
Because of savings like these — and a dearth of grant funding — some 48 percent of the nation's 63 medical respite programs now get funding from hospitals, according to the Respite Care Provider Network. ("Medical respite" programs generally go a step further than Morris' program, providing on-site medical care from nurses and doctors. Morris says adding such a medical-based program is a long-term goal.)
Later this week, Morris has a meeting with Memorial administrators, who he hopes will kick in some money. His savings account depleted, Morris won't be able to keep Ascending to Health going much longer without the help.