Seattle - King County medical respite program
Harborview Medical Center's Pioneer Square Clinic
Health Care for the Homeless Network
The Medical Respite Program provides short-term nursing and recuperative care for homeless clients with an acute medical diagnosis. Respite staff use the opportunity provided by daily contact with clients in a safe and structured setting to provide psychosocial assessments and case management services to link clients with housing, on-going primary medical care, substance abuse and mental health treatment and other needed services.
The program has the following objectives: 1) Resolve presenting medical problems; 2) Provide psychosocial evaluation as needed and appropriate referrals in the area of housing status, entitlements, physical health, mental health and substance abuse; and, 3) Initiate the process of housing stabilization.
The Respite Program is a collaborative project between Health Care for the Homeless Network (HCHN) and Pioneer Square Clinic. Pioneer Square Clinic is a satellite clinic of Harborview Medical Center. HCHN contracts with two local shelters to provide shelter, case management, food and laundry services. Seventeen beds for men are located in the William Booth Center (Salvation Army shelter) and five women's beds are located at the YWCA. Respite services are offered 7 days a week. The shelters provide non-clinical staff 24 hours per day. Both shelters provide emergency and transitional housing which is available to appropriate clients after discharge from the respite program.
Referrals are screened by an admission nurse or the on-call physician to determine if they are appropriate for the program. Patient must:
- Be homeless
- Have an acute medical illness
- Be medically stable
- Be independent in Activities of Daily Living and medication administration
- Have independent mobility
- Be continent
- Be willing to see a Registered Nurse every day and comply with medical recommendations
- Be able to arrive within set admission hours
- Must not require benzodiazepines in the 24 hours prior to respite admission
- Cannot require IV lines
- Cannot be a significant behavioral problem in a group setting
- Cannot have active domestic violence issues
Nurses see patients 1-2 times per day for monitoring of medical problems, wound care, medical education, TB testing and Pneumovax administration. Respite staff strive to establish primary care while patients are in the respite program to increase the likelihood of successful engagement. Clients receive a psychosocial screening and subsequently, referrals resulting from the screening. The respite staff psychiatrist is available to perform assessments and treatment. A chemical dependency counselor sees clients to help motivate them towards treatment goals and facilitate transfer into a treatment program.
Respite referral guidelines |
Who can make a referral:
A social worker, registered nurse, or health care provider (doctor or nurse practitioner) may call to initiate a referral and check on bed availability. Patients may not self-refer.
When to make a referral:
Referrals are accepted by either the admitting nurse or attending physician of the day from 7:00 a.m. to 5:30 p.m. Monday through Sunday.
Patients evaluated after 4:30 p.m. should be referred on the following morning.
How to make referrals:
- Contact the HARBORVIEW OPERATOR at 744-3000 to page the admitting person of the day.
- If a bed is available and the referral is thought to be appropriate, the medical provider must complete the respite referral form (or provide the referral information over the phone on weekends).
- The completed respite referral form can be faxed to Pioneer Square Clinic Monday through Friday at 206-744-1561.
- On weekends or holidays the provider will need to page the admitting respite attending (206-744-3000) to provide patient history or to fax a referral form to their home.
What happens next: The attending physician will review the referral form to determine if the patient meets respite admission criteria. Further clarification of medical issues may be requested. After this review, the referring person will be notified as to whether the patient can be accepted into the respite program. The time of admission will be coordinated with the admitting nurse or respite nursing staff. Clients to be admitted must arrive at the YWCA no later than 4:00 p.m. or at the William Booth Center no later than 5:00 p.m. as there is no nursing staff available after hours to complete the admission process. Earlier arrival times may be necessitated depending on the volume of referrals. If the client is in need of a primary care provider, the respite attending can arrange for these services to be provided through Pioneer Square Clinic.
Health care provider responsibilities |
It is expected that the client's primary care provider will maintain primary responsibility for the client's long term care including medical social service needs and will be available for phone consultation to the respite attending for the duration of services. Respite beds are set up in a shared space. For men, there is one private room available with a private bathroom. This room is intended for patients with emesis, diarrhea, colonoscopy preparations, hepatitis A, or impetigo. The program is unable to accept patients who are in the contagious phase of an infectious disease with respiratory transmission. For questions regarding the above guidelines, please contact Ed Dwyer-O'Connor, 206-744-1500.
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