In Search of Respite Care and Sustainable Models


M Health Fairview and Our Saviour’s Community Services (OSCS) provide respite care for homeless individuals. Respite care delivers critical follow-up aid and emergency shelter for people who would otherwise be unsheltered after a hospital stay. Significant increases in unsheltered homeless populations, due to the COVID pandemic and Minnesota’s affordable housing availability crisis , has hospitals seeing increased emergency rooms (ERs) visits by individuals and families experiencing homelessness. ERs are one of the most expensive places for healthcare systems to provide care. “A patient may be well enough to be discharged, but in need of follow-up care,” said Jen Myers, system director of acute care management for M Health Fairview. “Our options were to discharge these patients to the street or keep them in the hospital for an extended period. Neither option was good.”

M Health Fairview recently completed its Community Health Needs Assessment – a process of working with community members, local nonprofit organizations, and public health departments to understand health needs and strengths. The assessment identified that access to affordable housing and homelessness services are community needs – which also affect patients receiving care at M Health Fairview hospitals.

At the same time, OSCS was reflecting on lessons they learned from their COVID pandemic emergency shelter work. Ideas like remaining open 24/7; providing on-site health support; and reducing bed capacity – so guests have privacy and security in their own rooms – all seemed valuable yet unattainable before temporary pandemic funding expanded OSCS shelter operations. “In a system often valuing the quantity of people served over the quality of those services, the pandemic provided the opportunity to demonstrate that single adult shelter models can be more dignified and service-rich with the right support from the community,” said Mike Huffman, Executive Director at OSCS. “By sharing resources and focusing on mutually beneficial goals, our partnership with M Health Fairview brings that vision of safe, dignified medical respite programming to reality.”

Providing medical respite care with intensive individualized support; 30 to 90 days of shelter; and case management services from OSCS all come with increased costs. –

Investments in services like these are necessary to help guests make progress toward their goals and establish sustainable places to call home.

M Health Fairview is helping with the medical respite model by leasing ten units at OSCS to serve individuals referred by ERs at M Health Fairview, University of Minnesota Medical Center, and St. John’s and Southdale hospitals. In addition to OSCS’ services, the M Health Fairview Community Advancement team provides nursing support, assists with relationship management, and identifies resources to fill identified gaps. “It’s a win-win situation, the hospital frees up beds for more critical patients and the patients are able to recover in a more relaxed setting where they get three meals a day and can work with a social worker to find resources to meet their other needs,” said Myers.

The results during the 4-month pilot phase were good. Twenty people were accepted to the respite care program. Of those who received care and services at OSCS, eleven have remained out of the hospital and emergency department, and four people accessed stable housing. The program has been extended through June 2023. Further evaluation will be done to capture the social and economic return on investment, and the expansion potential for the model. The partnership between M Health Fairview and OSCS is one that allows each to solve challenging problems and meet their missions more effectively, bringing together two systems that have overlapped but never formally connected.

Respite Care is in high demand from healthcare institutions. In fact there is a Recuperative Care Coalition made up of many healthcare organizations looking to expand use of Medicaid resources to support recuperative care services. To learn more or support the coalition’s efforts, reach out to Susie Emmert, Hennepin Healthcare System,

For additional case studies and models including Respite Care see GMHF’s Health & Housing case studies.

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