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SAN ANTONIO
MEDICINE

Respite Care for San Antonio’s Homeless

By Tori Brucker, Ryan Daly, Thomas Damrow, Thelmari Raubenheimer

The emergency room is a community’s med- of discharged patients who may not have al- identifying ways to assist those “high-utilizers”
ical safety net, often caring for the uninsured ternative housing options. Cumulatively, of behavioral and medical health systems, fol-
with no guarantee of payment. Low-income these factors frequently prevent the orchestra- low-up with patients recently discharged from
populations, including our city’s homeless tion of a safe and cost-effective discharge plan a hospital setting and providing dedicated
population, increasingly rely on the emergency for the homeless patient. As a result, hospitals respite/recovery beds and step-down facilities
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department for basic primary care. typically are forced to absorb the costs of for chronically ill individuals.
Healthcare needs of the homeless are com- medical care and the patient is often left with This call to address the issue of homeless
parable to those of the general population, no options other than a return to the streets. healthcare comes at an important time as the
however, their circumstances often result in There is a consequent high likelihood of read- city of San Antonio works to allocate the influx
more acute presentations and require ad- mission due to inadequate healing. of local and federal funding resources towards
vanced measures to be taken during their treat- Fortunately, many cities are beginning to tackling homelessness. Given the success and
ment and continuation of care. The American explore new ways in which the homeless com- benefits of respite care programs, the city's ex-
Hospital Association found that hospital ad- munity can be helped after discharge. Pro- ploration of this method of homeless care
mission rates are five times greater amongst the grams such as respite care are an example of could greatly contribute to their future strategy.
homeless, and that these patients remain in the an intervention showing promising results.
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hospital for an average of four days longer. Respite care stands apart from traditional References:
These extended stays result in increased costs shelters in that it provides post-hospital care 1. Health Research & Educational Trust. (2017,
without subsequently improved healthcare to homeless patients who are not sick enough August). Social determinants of health series:
outcomes. A study measuring hospital read- to remain in the hospital, but still require Housing and the role of hospitals. Chicago, IL:
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mission rates amongst the homeless found that monitoring and basic healthcare services. Health Research & Educational Trust. Ac-
homeless individuals have a 30-day readmis- Medical respite programs have been shown to cessed at www.aha.org/housing
sion rate of 22% as compared to 7% among reduce future hospital admissions, 90-day 2. Saab, D., Nisenbaum, R., Dhalla, I., & Hwang,
matched control patients from low-income hospital readmissions and hospital length-of- S. W. (2016). Hospital Readmissions in a
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backgrounds with similar primary reasons for stay among homeless patients. Many also Community-based Sample of Homeless
admission. Significant contributors to the offer social services and housing placement as- Adults: a Matched-cohort Study. Journal of
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poorer outcomes amongst this population are sistance that eases these patients’ transition General Internal Medicine, 31(9), 1011–1018.
a return to adverse living conditions, a lack of from the streets to stable housing situations. doi: 10.1007/s11606-016-3680-8
3. Tomita, A., & Herman, D. B. (2012). The Im-
patient follow-up and difficulties with care co- While respite programs alone are not a solu-
pact of Critical Time Intervention in Reducing
ordination that collectively decrease compli- tion to the challenges the homeless popula-
Psychiatric Rehospitalization After Hospital
ance resulting in many patients “falling tion faces on discharge, they present a clear
Discharge. Psychiatric Services, 63(9), 935–
through the cracks.” With the discouraging in- opportunity to improve health outcomes,
937. doi: 10.1176/appi.ps.201100468
formation about readmission rates and costs mitigate healthcare costs and transition
4. Doran, Kelly M, et al. “Medical Respite Pro-
of care in mind, the question arises as to what homeless individuals into reliable housing.
grams for Homeless Patients: a Systematic Re-
hospitals and communities could do to miti- Currently, San Antonio community organ-
view.” Journal of Health Care for the Poor and
gate this burden and improve health care out- izations work tirelessly to provide food and
Underserved., vol. 24, no. 2, pp. 499–524.
comes for our homeless neighbors. housing to the nearly 3,000 homeless individ-
5. South Alamo Regional Alliance for the Home-
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The current approach to discharging home- uals living within Bexar County. Despite
less (SARAH). (2019). Retrieved from
less patients is both challenging and complex. these efforts, post-hospital discharge care for https://www.sarahomeless.org
The tasks of securing patient funding, estab- the homeless remains extremely challenging. 6. Strategic Plan to Respond to Homelessness in
lishing follow-up connections and locating Implementation of new projects to tackle San Antonio and Bexar County. December
stable housing places significant burden on homeless healthcare have the potential to 2020. Retrieved from https://www.sananto-
hospitals and their staff. Many local shelters drastically improve the health of our local nio.gov/Portals/0/Files/HumanServices/Ho
are already operating at maximum capacity homeless population and help the city melessServices/StrategicPlan.pdf
and few are properly equipped to house and progress towards decreasing homelessness
care for homeless individuals, post-discharge, here in San Antonio.

who typically require more attentive care and In December of 2020, the city released its

specific follow-up services. To add to these 5-Year Strategic Plan to Respond to Home-
difficulties, some shelters have acceptance cri- lessness in San Antonio and Bexar County. (L-R) Tori Brucker, Thomas Damrow, Thel-
teria, such as physical ability and medical This plan outlined a broad expansion of mari Raubenheimer and Ryan Daly are all
clearance, that excludes a significant number homeless aid programs with specific focus on OMS III’s at UIWSOM.

38 SAN ANTONIO MEDICINE • May 2021