Design Considerations for the Development and Implementation of a Medical Respite for Older Adults Experiencing Homelessness in Metro Vancouver

Abstract

Background: Older persons with lived or living experience of homelessness (PWLEs) often live with complex physical and/or mental health conditions which are challenged by poor access to health services, especially primary care. To fill the gap in the continuum of care following hospital discharge for PWLEs, medical respite provides health and shelter support for PWLEs who do not have acute care needs that qualify for a stay in a hospital bed, yet are too sick or frail to recover on the streets or in a traditional shelter. Objective: This study examines how a medical respite could be designed for older PWLEs in Metro Vancouver, BC. Research Design: Using a community-based participatory research approach, in-depth interviews and focus groups were conducted with PWLE (n=15) and service provider (n=11) participants. Results: Participants offered rich suggestions about (a) the culture of the medical respite, (b) the physical design of a medical respite, (c) individuals who should be involved in medical respite delivery, (d) services a medical respite should provide, and (e) who the medical respite should serve. Conclusions: When designing a medical respite for older PWLEs, considerations include providing an environment where patients can rest, but also feel safe and be surrounded by persons who they trust and who care for them. Developing a medical respite that adheres to the tenets of trauma-informed and patient-centered care acknowledges the mistrust and traumatization that often accompanies homeless patients presenting to health care.

Hospital-to-Shelter/Housing Interventions for Persons Experiencing Homelessness

“…In addition to immediate recovery, medical respite programs provide opportunities for positive lifestyle changes (Pedersen et al, 2018). Notably, the physical design of the program space may be less important than the program features that enable 24/7 rest and support from a case manager, as evidenced in the present study and elsewhere (Canham et al, 2021;Ciambrone & Edgington, 2009).…”

“A right place for everybody”: Supporting aging in the right place for older people experiencing homelessness

“…Providers and OPEH alike reported desires for peer‐led programs and participatory design principles, complementing existing research (Canham, Humphries, Danielsen, et al, 2021). Although little evidence exists for OPEH, previous research has found peer‐led interventions and support to be beneficial for younger adults experiencing homelessness (Holland et al, 2016; Miler et al, 2020).…”

The effect of a non‐congregate, integrated care shelter on health: A qualitative study

“…The barriers to health experienced by the participants combined with severely limited housing options highlight an urgent need for dedicated programming designed to take care of people experiencing both complex medical needs and housing instability. Expanding programs like medical respite and permanent supportive housing have been shown to be successful in achieving those goals (Canham et al., 2021; Kinczewski et al., 2021). In addition, this study highlights the gap in prevention services for those at risk for homelessness, as a onetime response to an ongoing problem, is not sufficient.…”