The Cottage: providing medical respite care in a home-like environment for people experiencing homelessness

Abstract

Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia. Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage. Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support. Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality. Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions. Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.

Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

“…Our results show a need for community 'stepdown' services that provide ongoing care. Observational studies have found that step-down services are associated with reduced readmissions, [28][29][30][31] and a trial of GP-led management of discharge in the UK found reduced street homelessness and improved quality of life. 32 Hospital patients who are experiencing homelessness have extreme rates of emergency readmission after discharge, reflecting poor housing and ongoing community care that is designed around the needs of people who have stable housing.…”

Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments

“…The ideal discharge option for hospitals with big local street sleeping populations, such as large inner-city hospitals, is a Medical Respite Centre (MRC); a supportive recovery environment can provide follow-up healthcare as well as social supports, including connecting people to housing or other accommodation. Having a medical respite option enables the safe and timely discharge of homeless patients, at a significantly cheaper cost per day than a hospital bed or repeated ED presentations [55,56]. Originating in the US, there are now over 120 respite centres for the homeless there, and now three in Australia, two affiliated with St Vincent's Hospitals in Melbourne [55] and Sydney [57], and most recently, a 20-bed facility in Perth, Western Australia that has around the clock medical care on-site [58].…”

“…Having a medical respite option enables the safe and timely discharge of homeless patients, at a significantly cheaper cost per day than a hospital bed or repeated ED presentations [55,56]. Originating in the US, there are now over 120 respite centres for the homeless there, and now three in Australia, two affiliated with St Vincent's Hospitals in Melbourne [55] and Sydney [57], and most recently, a 20-bed facility in Perth, Western Australia that has around the clock medical care on-site [58]. Evaluations of MRCs have shown substantial reductions in ED presentations and unplanned admissions by people experiencing homelessness [59]; hence a strong economic rationale, as well as a humane solution to avert discharges back to the street.…”