Seattle - King County medical respite program
Edward Thomas House – Medical Respite at Jefferson Terrace
Operated by Harborview Medical Center's Pioneer Square Clinic
Health Care for the Homeless Network
The Medical Respite Program provides homeless individuals a safe place to recover from acute injury or illness. Short-term shelter, nursing and behavioral health services are the key elements of medical respite's recuperative care. Respite staff use the opportunity provided by daily contact with clients in a safe and structured setting to provide primary medical care, psychosocial assessments and case management services to link clients with housing, ongoing substance abuse and mental health treatment, housing placement and other needed services.
Photo credit: Seattle Housing Authority
The goals of Medical Respite care include:
- Resolving presenting medical problems;
- Providing psychosocial assessments and appropriate referrals for entitlements, medical, mental health and substance abuse services; and,
- Initiating the process of housing stabilization.
The Respite Program is a collaborative project between Health Care for the Homeless Network (HCHN) and Harborview Medical Center's Pioneer Square Clinic. The program facility is located on the 7th floor of Jefferson Terrace, 800 Jefferson St, on First Hill in Seattle. Jefferson Terrace is a residential high rise owned by the Seattle Housing Authority.
Respite is a round-the-clock program of housing and care. Medical practitioners, nursing and mental health staff are present 12 hours/day, seven days/week. Non-clinical evening and night staff assure a safe and quiet environment for clients. The average length of stay in Respite is three to four weeks. Clients' stays are not expected to exceed six to eight weeks.
Referrals are screened by program admission staff to determine if they are appropriate for the program. A referred client must meet all of the Admission Criteria listed below:
Admission criteria: (Client must meet all)
- Homeless* (see definition below)
- Acute medical problem requiring short-term respite care
- Referred from a health care facility/provider in King County
- Medically and behaviorally stable (not a risk to self or others, appropriate for group setting)
- Independent in mobility, transfer, feeding, not known to be fall-risk at this time
- Agreeable to admission and receiving care from Respite staff
- Must have a primary care provider and a scheduled follow-up appointment
- Wheelchair or walker use
- Urinary incontinence with care management plan in place
- Need for limited assistance with showers, dressing, grooming, redirection for mildly confused patients, cueing for medication administration
- Post-contagion/treatment - Hepatitis A, impetigo, TB or influenza
- Alcohol/Drug: From hospital – CIWA < 10
- From outpatient – No DT/seizure expectation
- Methadone – administered at community site
- Bowel prep, 24 hour urines, pre-surgical procedures
- Chemotherapy – administered at community site
- CPAP use
- IV infusion - QD or BID orders (PICC lines must be in place at admission)
- Insulin dependent diabetic
- Wound care – up to TID dressing change
- Wound VAC, if small and attached
- Portable oxygen use
- Fecal incontinence
- Registered sex offenders [Level 2 or 3] (Respite will screen)
- Contagious air-borne respiratory illness
- Weight more than 500 lbs
Definition of homelessness:
Homeless patients referred to respite must have:
- no stable living environment in which to recuperate, and
- no other community placement options available or appropriate for the person.
Information about an individual's living specific living arrangements is central to the process of classifying someone as homeless. Homeless means that their regular living situation(s) includes sleeping in/on:
- Outside / on the street
- Transitional housing
- Abandoned buildings
Doubled-up, living with friends or relatives, or "couch surfing" does not qualify as homeless status. Other placement options for persons who are doubled up can be discussed with Respite staff.
Respite referral guidelines
Who can make a referral:
A social worker, registered nurse, or health care provider (MD or ARNP) may call to initiate a referral and check on bed availability. Individuals may not self-refer.
When to refer:
Referrals are accepted by either the respite admission staff from 8:00 a.m. to 4:30 p.m. Monday through Sunday. Patients evaluated for respite after 4:30 p.m. should be referred on the following morning.
Making a referral:
- Contact the Harborview Operator at 206-744-3000 to page the Respite Admission staff person to determine if bed is available and review the referral.
- If a bed is available and the referral appropriate, complete the Respite Referral Form and fax Respite at 206-744-5233.
- Submit all required information including a STAT Discharge Summary.
Respite Admissions staff will review the referral form to determine if the patient meets respite admission criteria. Further follow-up clarification of medical issues may be requested. After this review, the referring person will be notified as to whether the patient will be admitted to respite program.
Clients must arrive at Respite between 7:30 AM and 4:30 PM (weekdays) and 11 AM and 4:30 PM (weekends) to assure time to complete the initial nursing assessment and admission process. (Nursing staff is available 12 hours/day.)
The time of admission will be coordinated with the respite staff and will depend on the volume of admission scheduled for that day.
Referring health care provider responsibilities
Adequate supply of oral medications and necessary supplies:
Referring providers must send a one week supply of oral medications (or enough to last until schedule follow-up appointment) and needed supplies with the client at admission. (IV medications are provided directly by the Harborview Pharmacy by agreement with referring medical center.)
Schedule follow-up medical appointment:
At referral, clients must have follow-up appointments scheduled for their current acute illness/injury.
Identify client's health care home:
At referral, clients must have an identified health care home that will provide ongoing primary care, including social service needs. A follow-up appointment with the client's primary care provider must be made at the time of referral.
Referring hospital-based health care providers must be available for phone consultation to the respite physician and/or nursing staff for the duration of services.
Respite clients are housed in studio rooms with two or three individual beds to each room. Each room has a private bathroom with shower and individual lockers for safe storage of personal items. A client may be isolated in a single room in response to specific care needs.
Clients share meals in the facility's community rooms and have access to laundry facilities and telephone. Respite also provides a regular series of therapeutic and/or recreational activities throughout the week focusing on life skills, housing readiness and recovery.
For questions regarding the referral guidelines and process, please contact Annie Taylor, Respite Program Manager at 206-744-5206, or firstname.lastname@example.org
Edward Thomas House: What's in a Name?
Ed Thomas lived on Seattle streets and in shelters for two decades, cautiously avoiding contact with shelter staff members. Living with serious mental illness, Ed lived an isolated life, avoiding care and offers of help. Without a regular source of health care, Ed received his care in hospital emergency rooms. He came to Medical Respite to recover from leg wounds in 2004. Ed's s stay in Respite was a turning point in his life. Respite nurses gave Ed a space with privacy and brought music to share, Ed connected positively with Respite staff. The respite stay also offered Ed an opportunity to engage with his case manager. Upon discharge from respite, Ed obtained his first apartment and has remained stably housed since then. He has maintained a connection to his primary care physician and has not been hospitalized or visited the emergency room since his respite stay.
Medical Respite at Jefferson Terrace is named in Ed Thomas' honor. His life and experience stands an inspiration to others living homeless on our streets, Respite staff and others working to end homelessness in our community.