Medical respite care, also known as recuperative care, provides a range of essential services for individuals experiencing homelessness who are recovering from illness, injury, or hospitalization. These programs combine short-term housing with access to medical, behavioral, and other critical services, helping to interrupt cycles of homelessness and hospitalizations. Evidence indicates that medical respite care reduces the likelihood of future emergency department (ED) visits and hospital readmissions and leads to lower overall patient costs. Additionally, medical respite care can serve as a bridge to interim and permanent housing and sustained connections to physical and behavioral health care providers.
How do medical respite programs work?
Referral to medical respite care often begins with discharge planners or case managers at hospitals who identify patients experiencing homelessness or who would otherwise benefit from a safe and stable environment to recover from a hospitalization. Medical respite programs typically offer:
- 24-hour access to a bed;
- Three meals per day;
- Transportation to medical appointments;
- Access to a phone;
- A safe space to store belongings;
- Regular wellness checks by medical respite staff; and
- Care coordination and case management, including to address health-related social needs (HRSNs).
Programs vary in the intensity of physical and behavioral clinical services offered on-site. Some facilitate referrals and transportation to appointments, while others fully integrate care on-site. Medical respite care is a flexible model, operating in various settings such as standalone facilities, temporary shelters, co-located within hospitals, nursing homes, or even motel or hotel rooms. Lengths of stay can also vary, with a recent national survey indicating that 31- to 45-days is the most common average length of stay among medical respite programs.
How is the policy landscape for medical respite care shifting?
Medical respite care was one of several services highlighted in November 2023 federal guidance on state options to address HRSNs through Medicaid. Particularly in states that expanded Medicaid under the Affordable Care Act, there is significant overlap between populations eligible for Medicaid and those impacted by housing insecurity and homelessness. As of September 2024, California, Illinois, Massachusetts, New York, North Carolina, and Washington have received federal approval for 1115 waiver demonstrations to reimburse for medical respite care through Medicaid. Historically, medical respite care has been financed through hospital contracts, grant funding, and private donations. These policy developments present a significant opportunity for medical respite providers to access more sustainable funding sources and for health plans and providers to directly connect more individuals to needed care.
What is the evidence behind medical respite care programs?
There is a growing body of evidence indicating the effectiveness of medical respite care at improving key patient outcomes, such as hospital readmissions and ED visits. This evidence aligns with what is broadly known about the resources and conditions needed for anyone, and particularly those with acute health conditions or a recent adverse health event, to rest, recover, and improve their health.
- Medical Respite Literature Review: An Update on the Evidence for Medical Respite Care ‒ This review published by the National Institute for Medical Respite Care examines the available academic and non-academic literature on medical respite care, identifying common program characteristics, medical profiles of individuals served, impacts on patient outcomes and costs, and recommendations for improving these programs. The review finds that receipt of medical respite care is generally associated with reductions in hospital and ED visits, increased use of outpatient care, and overall cost savings.
- Thirty-Day Hospital Readmission Among Homeless Individuals with Medicaid in Massachusetts ‒ This study analyzed hospital readmission rates among a sample of Medicaid members in Massachusetts. It found that discharge to medical respite care led to lower readmission rates among individuals who were frequently admitted to the hospital.
- Medical Respite for People Experiencing Homelessness: Financial Impacts with Alternative Levels of Medicaid Coverage ‒ This analysis estimates the financial effects of medical respite care programs, finding that the intervention could save approximately $2,000–$3,000 per hospitalization for a person experiencing homelessness. Additionally, it estimates that each dollar invested in medical respite offsets $1.81 in hospital costs.
What do medical respite care programs look like in practice?
The following Evidence-to-Action resource summaries offer insight into how medical respite programs are designed and implemented:
- Medical Respite Care Tool Kit ‒ This collection of resources from the National Institute for Medical Respite Care helps organizations plan and implement medical respite care programs. It includes detailed program development guides, case examples, and implementation tools.
- Providing Medical Respite Care to People Experiencing Homelessness: Yakima Neighborhood Health Services ‒ This blog post profiles a medical respite care provider in Yakima, Washington.
- How a Medical Respite Care Program Offers a Pathway to Health and Housing for People Experiencing Homelessness ‒ This case study explores a medical respite program operated by the California-based National Health Foundation.
- Too Healthy for the Hospital, Too Sick for the Streets ‒ This podcast provides a deep dive into medical respite care, featuring a person with lived experience of homelessness, two programs based in Washington D.C., and a Medicaid managed care organization newly providing reimbursement for medical respite.
