March 20NEW HAVEN Yale New Haven Health has been working for years to solve the question of what to do when a patient should be discharged home to recover, but they have no home to go to.
"Obviously, there's a special interest in taking care of people who are most vulnerable," said Paula Crombie, director of social work at Yale New Haven Hospital. "The data is showing we're making a significant difference in the lives of the patients."
The Medical Respite program, run primarily by Yale New Haven Health and Columbus House, recently celebrated its third year, and statistics show that the initiative is working in reducing the number of emergency room visits and the length of hospital stays for the homeless population in the city.
In 2016, the hospital recorded the rate of readmission for homeless patients, most of whom use Medicaid as their primary insurer, within a month of their previous visit as 16.7 percent. That number is down from the 50.8 percent rate recorded by a former Robert Wood Johnson Clinical Scholar, Kelly Doran.
In addition, the average length of stay at the hospital for patients experiencing homelessness has fallen from 8.6 days to 7.1 days, from 2014 to 2016, Crombie said.
The Medical Respite Program was launched in October 2013. Housed at Columbus House, there are 12 single rooms for eligible patients who need a place to recover from an illness or surgery but are homeless, according to Alison Cunningham, chief executive officer of Columbus House. She said the program is completely separate from the shelter on the floors below.
The program is geared to help the patient, said Tom Williams II, the coordinator of the program at Columbus House. He said no patient is forced to be admitted to the program or forced to stay if they are uncomfortable with the rules or have a mental health or substance abuse problem that keeps them from complying with the rules, Williams said.
"You want their goals to drive their recovery," Williams said. "At the end of the day, it has to be patient-centered."
Patients in the program are allowed to stay on site all day, contrary to shelter clients, who must leave during the day, and they are served three meals a day, Cunningham said. There is also staff supervision on the floor 24 hours a day and a visiting nurse comes a couple of times a week, she said.
Patients are also connected with caseworkers at the Columbus House to help find them housing once they leave the respite program, she said.
"That's the value we bring to the program," she said.
For Helen Carolowitcz, 53, having access to the Medical Respite Program has meant she can have more time with her grandchildren, she said.
"I believe I might have saw spring and that would have been it," said Carolowitcz, who has been a resident on the third floor of Columbus House while undergroing chemotherapy. "I needed a safe haven to lay my head down... This place has saved my life."
The chemotherapy leaves her too exhausted to be out walking the streets every day while shelters are closed, she said. Carlowitcz had been homeless for about five months and was living in a shelter in Waterbury before her most recent surgery at Yale New Haven Hospital in December, she said.
The number of patients who have participated in the program has increased steadily every fiscal year, according to data provided by Michael Ferry, a clinical social worker for Yale New Haven Health. While there were 53 Medical Respite patients in 2014, that number rose to 89 in 2016. There have been more than 200 patients who have participated in the program since it began in October 2013, Ferry said.
Some patients return more than once to the program, such as Brian Wilkins, 47, who is a resident in the respite program for the second time as he continues to struggle with liver problems. Wilkins said he is thankful he's had a place to recover after extended hospital visits while he's been homeless for the last year.
Crombie said she hopes to expand eligibility for the respite program and the number of beds so more people can take advantage. She would also like to be able to provide a physician at Columbus House, in addition to visits by nurses a couple of times a week. She said often people who are homeless use the emergency room for primary care or simply someplace warm to sit. But those who are undergoing surgery or have major health problems can now be moved out of the hospital faster because there is someplace safe where they can go and recover.
The state Department of Housing contributes $400,000 a year to help run the program, said Steven DiLella, the director of the individual and family support projects unit for the state Department of Housing.
DiLella said the ultimate goal for the state DOH and hospitals is to reduce medical costs and this program is beneficial in doing that as it has shown it can reduce the number of visits to the hospital for the homeless population.
"They need some sort of medical intervention that would be tough to administer if they were living on the street," DiLella said. "Upon discharge, they have no home to go to."
Dan Arsenault, a spokesman for the state DOH, said Gov. Dannel Malloy has shown he is dedicated to preserving the DOH budget because of his commitment to combatting homelessness. Investing in the homeless population ultimately saves the state money, Arsenault said, as it cuts down on other costs associated with caring for the homeless population.
Other partners in the effort include Continuum Home Health, Cornell Scott Hill Health Center, the state Department of Social Services, the National Health Care and Homeless Council, New England Home Care, Partnership for Strong Communities, and Visiting Nurses of South Central Connecticut.
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