Host organization: The Health & Housing Consortium, Inc.
Background
About the Health & Housing Consortium, Inc.
The Health & Housing Consortium, Inc. (The Consortium) is a collaborative network of healthcare, housing, homeless and social services organizations, and government partners. Their shared goal is improving health equity and housing stability by fostering cross-sector relationships, informing policy, and building the capacity of frontline workers to support people with unmet health and housing needs. The Consortium supports frontline staff by providing information and support; helps connect organizations and staff across the health, housing, and social service sectors; and uses their platform to inform policy that will strengthen and integrate the healthcare and housing systems for vulnerable New Yorkers with health and housing needs.
Issue: Lack of safe discharge locations for patients without stable housing
New Yorkers experiencing homelessness or housing insecurity often also have complex medical and behavioral health needs. However, homeless services and housing systems are not equipped or adequately resourced to safely serve discharged patients with acute medical needs. There are currently a small number of medical respite interventions in New York that provide the level of care necessary to improve health outcomes for homeless and housing-insecure individuals. However, there is nowhere near the number of available programs needed to assist individuals in finding a safe place to recuperate after discharge or to find appropriate, permanent housing.
Medical respite
Medical respite programs offer post-acute care for people experiencing homelessness who are too ill or frail to recover from an illness or injury on the street or in shelter, but who do not require hospital level care. The short-term residential care in medical respite programs allows individuals the opportunity to rest, recover and health in a safe environment while accessing medical care and other supportive services, with the ultimate goal of discharge to appropriate and stable housing. The New York State Department of Health recently announced its approval for medical respite services to be paid for through Medicaid.
Approach
Opportunity
Upon the New York State Department of Health’s announcement of their launch of medical respite pilot programs for FY2022, the Consortium seized the opportunity in working with the National Center to highlight the benefits of medical respite and discuss New York State’s new regulatory advancement for medical respite and funding opportunities through Medicaid with stakeholders across New York.
Developed with the National Center, the goals for the Medical Respite Regional Convening were to:
- Provide real-time technical assistance to service providers interested in medical respite
- Facilitate networking and connections between different stakeholders with an interest in medical respite
- Identify and troubleshoot barriers for each stakeholder
- Share learning and best practices from current respite providers, funders, and referring agencies
- Amplify the voices and experiences of people who have gone through medical respite to inform future planning
- Increase knowledge of medical respite, including new regulatory advancements and funding opportunities
The Consortium’s long-term vision is to ensure that medical respite is widely available to anyone who needs it, regardless of legal or insurance status, or where they receive their care; that medical respite is adequately funded through a variety of sources and sustainable long-term; that the establishment and success of medical respite leads to other innovative programs to meet the full spectrum of care and services for people with unmet housing and health needs; and that there are sufficient and affordable permanent housing options for those leaving a medical respite program.
Process
The Consortium brought together a planning committee with interested stakeholders from hospitals, housing and homeless services providers, government, legal services, managed care organizations along with medical respite consumers. Having varied direct experiences with medical respite programs, the planning committee held three meetings to provide guidance in designing the two-day event and prioritizing key questions for the convening to address.
Event overview
The Medical Respite Regional Convening took place virtually on April 7-8, 2022 with the guidance of the planning committee and support by the National Center. Presentation slides and session recordings were made widely available. The Consortium brought together 210 professionals across 125 different organizations over 5 sessions. The sessions included an overview of medical respite and the New York State pilot program, breakout rooms by stakeholder group and by topic area, and a networking session.
Key takeaways of the convening included:
- Smooth and efficient referral pathways from health systems to respite programs are essential to a successful medical respite partnership. Health systems can centralize referrals through a designated small team such as inpatient social work or a housing team unit. At the same time, balancing supply of and demand for respite beds will be a challenge as education is scaled up; potential solutions include developing a respite providers collective to centralize referrals.
- Community-based organizations need technical assistance to develop respite programs. While the New York State Department of Health will provide $50,000 for technical assistance in their Medicaid medical respite pilot programs, there are opportunities to provide and develop additional resources to ensure that new medical programs have adequate staff, expertise, tools, supplies, referral pathways, and payment structures in place at the time of implementation.
- Eligibility limitations for medical respite programs as well as the lack of and barriers to housing opportunities after respite discharge among special populations are major challenges. Undocumented individuals will not qualify for medical respite under the forthcoming New York State pilot programs and have limited access to other financial benefits. For those experiencing long-term physical disability, chronic illness, or behavioral health needs, there are significantly fewer housing options (e.g., limited affordable housing with handicap accessible units as well as supportive housing and assisted living programs with narrow eligibility requirements).
Next steps
The Consortium made general information session recordings and presentation slides publicly available. We also organized a debrief session with the planning committee as well, who were in agreement that next steps will be better understood once New York State releases its regulations for the medical respite pilot program.
As of June 8, 2022, the Health & Housing Consortium awaits the New York State regulations, and anticipates future programming and advocacy surrounding the following challenges:
- Efficient management of referrals from hospitals and health plans to medical respite programs
- Technical assistance that effectively supports the development of new medical respite programs with community providers
- Pathways to appropriate long-term housing from medical respite programs based on the unique needs of each client
- Proper care for patients and clients without legal status
- Development of partnerships between medical respite providers, hospitals, and health plans
Possible actions will include: the development of a toolkit with medical respite best practices, educational activities and virtual tours to increase medical respite awareness among hospital social workers, coordinated efforts in providing open feedback on the regulations, and an organized presentation or town hall with New York State when regulations are released.