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Summary: The first known respite care facilities for homeless people emerged in the mid-1980s, but recent trends in health systems and services have driven their rapid proliferation across the country within the past decade. This report is the first attempt to describe these respite programs comprehensively.
Key words: Homeless, respite care, recuperation.
Homeless people experience health problems, especially chronic medical illness, with much greater prevalence than those who are housed, and suffer mortality rates three to four times higher than those of the general population.1,2 Lack of housing also creates major obstacles to obtaining necessary medical services and adhering to treatment. Studies have consistently shown homeless people rely heavily upon hospitals and emergency departments to address their needs, though these are often the medically least appropriate and most costly solutions.3 Current trends in the health care marketplace are exacerbating this problem. Uninsured rosters are at an all-time high, and health costs are rising; entitlement programs such as Medicaid remain inaccessible to most homeless people.4,5 Hospitals are discharging patients "quicker and sicker" as more procedures are provided on an outpatient basis, and community hospital beds are disappearing.6,7 These trends shift responsibility for after-care to families and communities. This causes a dilemma for hospital personnel preparing to discharge homeless patients who are no longer sick enough to justify a bed, but have nowhere to go to recuperate safely and sufficiently. Even simple directives for after-care, such as bed rest, wound care, use of a wheelchair, or nutritional requirements, cannot be followed by someone living on the streets or in shelters and relying on emergency food programs for meals. As a result, emergency homeless shelters already over capacity are seeing steady increases in the number of individuals entering directly from hospitals with after-care needs they are unable or ill-equipped to provide.
This phenomenon received media attention in 2007 when the Los Angeles Times reported a hospital van dropped off an acutely ill paraplegic homeless man on Skid Row in downtown Los Angeles, leaving him crawling on the street wearing a soiled hospital gown and a leaking colostomy bag.8 A follow-up story on the CBS news program 60 Minutes brought the Los Angeles story to national attention, but comparable dilemmas confront many towns and cities across the country.9-12...