By Carey L. Biron
WASHINGTON - Henry Jones had been living on the streets of Washington, D.C. for more than a decade when his health finally started failing.
Sick, suffering from alcoholism, and increasingly unable to walk, he sought to check into an emergency room in the U.S. capital — but intake workers there refused to admit him, he said, because he did not have an acute condition.
He was at risk of falling through a major hole in the social safety net.
A case worker told him he could go to a shelter, where he could at least get a bed for a few nights. Or he could try another option: a small organisation that offered medical services to the homeless, as well as a place to simply rest.
Jones went with the second option, an organisation called Christ House that gave him medical care and a bed to sleep in. Later, it helped him stop drinking, get a permanent home — and even a job.
"Being on the street, people look down on you, thinking that's the way you're going to live the rest of your life," said Jones, who now works at Christ House.
"And that's what makes Christ House much different from any other place: The people help you get back up on your feet," he told the Thomson Reuters Foundation, sitting next to the showers that he oversees for use by homeless people.
Founded in 1985, Christ House was one of the first places in the country to offer a service that is increasingly being embraced in cities nationwide: medical respite, or recuperative care, which seeks to fill a gap between what emergency rooms and shelters can provide.
"This is a gray area: If you're housed, you'd be discharged from a hospital and given instructions to stay off your feet," said Julia Dobbins of the National Health Care for the Homeless Council (NHCHC) umbrella group, which published standards on the issue in 2016.
"But people without homes don't have a safe, clean place to recover, and that's a gap in care," she added.
While homeless shelters exist across the United States, these typically close during the daytime, Dobbins said: "We criminalise homelessness in this country, so people can't lay around — they have to be up and moving."
Respite facilities offer rest and recuperation, but also give workers a chance to see what support patients might qualify for, connect them to other services, and generally offer them "time to think about what is the next step in their life," she said.
Christ House said it is an unusually expansive operation, offering 24-hour medical care, housing and more.
Medical director and co-founder Janelle Goetcheus recalled one resident last year who before coming to the centre had been living on a park bench near a local hospital — and going back and forth for cancer radiation treatment.
Christ House gave the man a place to stay during his treatment and facilitated his trips to the hospital.
Some patients' needs are straightforward, said Goetcheus: for instance, a woman has surgery on her leg and needs a place to mend for a few weeks, the type of rest she would not be able to get at a shelter or on the street.
Other cases are far more complicated, involving multiple acute and chronic illnesses and mental health problems, often exacerbated by years of sleeping rough, substance abuse and lack of medical attention.
Goetcheus said that since the early days when Henry Jones came to the organisation, the health problems plaguing Washington's homeless population have worsened.
This is particularly true for the increasing numbers of homeless elderly people, those with mental health problems and undocumented migrants, for whom complex medical care is often impossible, she added.
"For the hospitals, there is a lot of pressure to have very discreet (specific) admissions for acute medical needs and then get people discharged," she said. "So more people are ending up on the street.
STRUGGLE FOR FUNDING
Medical respite programmes have grown by about a third since 2012, going from 60 to 80 initiatives nationwide, according to the NHCHC.
Yet nationally, programmes vary widely, with little agreement even on what medical respite means, although that is starting to change.
But there is growing consensus among researchers that the approach appears to offer significant cost savings for hospital systems and public coffers.
In one 2018 study, researchers with Brandeis University in Massachusetts found that respite programmes could save several thousands of dollars per hospital patient by cutting down on expensive readmissions.
As yet, however, long-term funding remains the single biggest obstacle for respite programmes, according to health and homelessness experts.
Most respite projects have an average of three funders, said Dobbins, and the vast majority of respite centres are unable to bill the federal government as medical providers, so they depend on philanthropy and a patchwork of public and other funding sources.
Sean Barry, a spokesman for the American Hospital Association, said the industry group does not have a public stance on medical respite, but noted it has referenced "improved care transitions and reduced readmissions" as two benefits of such programmes.
The federal government does support respite programmes, to some extent.
A spokeswoman for the Centers for Medicare and Medicaid Services said that although respite programmes are not covered as a matter of course, states can apply for federal assistance under Medicaid - a joint federal and state health program for the poor - on a case-by-case basis.
'REALLY DIFFICULT PLACE'
Interest in respite is growing significantly, said Dobbins, whose office oversees a respite network of more than 1,000 members, up from 840 in 2015.
A respite initiative at Portland's Central City Concern, a non-profit, will soon include a specific focus on mental health — a factor that is largely missing among respite programmes, Dobbins said.
Central City Concern, which has been running a respite care project since 2005, will seek to take in patients who have been newly discharged from psychiatric hospitals.
But a coordinator stressed that mental health inevitably underpins their work anyway.
"Anywhere there's homelessness, we should be expecting there is need for mental health support," said Jordan Wilhelms, a programme manager with Central City Concern.
The vast majority of the organisation's patients have mental health issues, often undiagnosed, Wilhelms said.
"We're looking to catch folks at a really difficult place in their life" and help them start to make progress toward their own goals, he added, which are usually finding housing, treatment and a community.
"And without a layer of access to mental health support, those things are pretty well undercut," Wilhelms said.
Ultimately, he said, the new mental health focus will be another opportunity to make connections with people who do not have many in their lives.
"That's part of the magic" of the respite approach, he said.