Health officials hope the new program will ensure that homeless patients receive appropriate treatment and follow-up after leaving the hospital, while freeing up beds at Harrison Medical Center and reducing readmissions.
BREMERTON — Walter Jacque figured he was better off than most people without homes.
He had a pickup-truck cab he could sleep in at night, snuggled up with his service-dog Andy. It wasn’t comfortable or safe, but it kept him out of the elements.
His doctors were less optimistic.
“They told me the conditions I was living in were detrimental to my health and I should be in a shelter,” Jacque said. “But try getting shelter!”
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The 62-year-old Bremerton resident found himself in an all-too-common predicament: Coping with serious health problems but unable to find stable housing. He said he spent six days at Harrison Medical Center last spring for treatment of a heart condition, then checked back in last week with dehydration resulting from an illness.
After his second hospitalization, Jacque’s outlook changed for the better. A Harrison social worker helped place him in a new respite-care program established at Benedict House, a men’s shelter in the West Hills neighborhood. The program gives Jacque a safe place to recuperate and help him on a path toward long-term stability.
Joshua Waguespack with Catholic Community Services, which operates Benedict House, said the program is aimed a patching a hole in the safety net, providing homeless patients discharged from Harrison with the support they need to recover from injuries and illnesses while reducing their dependence on costly emergency-room visits.
“We knew we had to bridge the gap between housing and health,” Waguespack said.
Launched as a pilot project in July, the program was formed through a collaboration among Harrison parent company CHI Franciscan Health, Catholic Community Services and Peninsula Community Health Services.
Harrison pays for three shelter beds at Benedict House dedicated to respite patients. For now, because it’s housed at a men’s shelter, the program is only open to male patients. Eight completed the program this summer.
Supporters hope to keep adding beds in the county.
“Although it doesn’t solve the affordable-housing crisis in our area, it does put one more piece into the complex puzzle of health care for the vulnerable in our society,” Peninsula Community Health CEO Jennifer Kreidler-Moss said in an announcement for the program.
Goal for years
Health and social-services leaders worked for years to establish a respite-care program in the county. Creating housing for people discharged from hospitals was one goal of the Kitsap Community Health Priorities plan developed in 2014.
Kitsap Public Health District Community Health Director Katie Eilers, who helped coordinate the project, said staff at the hospital and local shelters knew people without stable housing were being discharged with little chance of successful recovery.
Tasks that can be simple for people with homes and families — such as following physicians’ instructions, keeping up on antibiotics, changing bandages or driving to checkups — become nearly impossible on the street. Homeless patients often cycle back through the emergency department.
“They experience a high level of suffering when they can’t have that care outside the hospital,” Eilers said.
People with nagging medical conditions are more likely to experience long-term homelessness, Waguespack with Catholic Community Services added. In a 2017 survey conducted by Kitsap County, 56 percent of respondents listed physical and mental-health problems as the primary reason for their homelessness.
“The sick and the vulnerable become chronically homeless,” Waguespack said, “and it takes a lot more investment as far as tax dollars to take care of the chronically homeless.”
The problem creates complex challenges for hospitals as well.
As a nonprofit hospital, Harrison’s mission includes providing care to everyone, regardless of their financial situation or housing status. Harrison Chief Nursing Officer Jeanell Rasmussen said people who are homeless frequently stay longer in the emergency department than their health conditions require because they don’t have a safe place to be discharged to.
In one three-month period — from October through December 2016 — Harrison provided 22,344 hours of “avoidable” inpatient care to patients who were healthy enough to be discharged, a total partially attributed to homelessness.
By providing respite care at Benedict House, health officials hope to ensure patients receive appropriate treatment and follow-up services after leaving the hospital, while freeing up beds at Harrison and reducing readmissions.
“It’s the best service for patients and the community,” Rasmussen said.
The Benedict House pilot project was modeled on a respite program Catholic Community Services established at its Nativity House shelter in Tacoma in 2017, in partnership with CHI Franciscan. The program was later expanded to accept discharges from MultiCare.
Waguespack said the respite services are open to patients experiencing homelessness and victims of domestic violence who are healthy enough to be discharged from the hospital but not healthy enough to recover on the street.
Those discharged into the respite care enter a 30-day program that provides them with round-the-clock lodging and support. At Benedict House, a community health worker from Peninsula Community Health Services assists patients in finding primary-care providers, obtaining health insurance, getting transportation to medical appointments, applying for food assistance and connecting to any other social services they may need.
Waguespack said patients who complete the monthlong program join the nonrespite population at Benedict House and continue participating in case management offered at the shelter as they progress toward a stable living situation.
“There’s a warm handoff,” he said. “We want them to feel that not only with what they’ve accomplished with their health getting better, they’re also graduating from the program and ready for their next steps.”
As an affordable-housing crisis adds to the ranks of the homeless in many cities across the country, hospitals and social-services organizations are looking for ways to safely transition vulnerable patients out of inpatient care.
“We’re seeing more and more communities developing respite programs,” said Julia Dobbins with the National Health Care for the Homeless Council in Nashville, Tennessee. “It’s definitely a gap in care that service providers recognize.”
The council provides training for groups that serve the homeless. Dobbins said training in respite care has become one of their most requested services.
Washington State Hospital Association CEO Cassie Sauer said collaborative programs like the one at Benedict House are a positive step to address a diverse and difficult public health concern.
Homeless residents are one of many patient groups that are more likely to remain in inpatient care longer than necessary because they face barriers transitioning to outpatient care. People with behavioral health conditions, people who live alone and a growing wave of seniors suffering from dementia are among those who will need safe housing and help managing their health conditions after they’re discharged from hospitals.
“It’s true that this is a hospital issue, but it’s also a community issue,” Sauer said. “We don’t have a coherent plan for addressing this.”
At Benedict House, Walter Jacque is simply focused on resting and feeling better. He hopes to eventually turn his passion for leatherworking into a business that will get him back on his feet. In the meantime, the respite program is meeting his simple needs.
“It’s shelter,” Jacque said. “At least I can lie down.”