Medical Respite: Practicing Stewardship For The Unhoused
DOI:
https://doi.org/10.65539/9a0fja52Keywords:
Medical respite, unhoused population, undomicilied, healthcare systems, healthcare costs, healthcare inequitiesAbstract
Medical respite programs provide short-term housing and clinical support for unhoused patients who are too ill to recover safely on the streets or in shelters but no longer require hospitalization. This perspective reviews the clinical, financial, and systems-level benefits of medical respite, including reduced readmissions, fewer emergency department visits, improved outpatient follow-up, and lower hospital costs. Despite these benefits, access remains limited by insufficient funding, variable eligibility criteria, administrative complexity, and low provider awareness. Using New York City and other state programs as examples, the authors argue that expanding medical respite requires increased investment, streamlined referral pathways, and stronger clinician advocacy. Medical respite represents a patient-centered and cost-effective approach to safe discharge planning, health care stewardship, and improved care for unhoused patients.
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1. Our history. Boston Health Care for the Homeless Program. Accessed October 19, 2025. https://www.bhchp.org/about/our-history/
2. Levi R. Medical respite offers refuge for homeless people recovering from illness. NPR. May 30, 2022. Accessed October 19, 2025. https://www.npr.org/sections/health-shots/2022/05/30/1099760410/homeless-medical-respite
3. Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA 2001;285:200-206. doi:10.1001/jama.285.2.200
4. Shepard DS, Shetler D. The business case for medical respite services.
5. Greysen SR, Allen R, Lucas GI, Wang EA, Rosenthal MS. Understanding transitions in care from hospital to homeless shelter: a mixed-methods, community-based participatory approach. J Gen Intern Med 2012;27:1484-1491. doi:10.1007/s11606-012-2117-2
6. Kertesz SG, et al. Post-hospital medical respite care and hospital readmission of homeless persons. J Prev Interv Community 2009;37:129-142. doi:10.1080/10852350902735734
7. Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 2009;301:1771-1778. doi:10.1001/jama.2009.561
8. Biederman DJ, Gamble J, Wilson S, Douglas C, Feigal J. Health care utilization following a homeless medical respite pilot program. Public Health Nurs 2019;36:296-302. doi:10.1111/phn.12589
9. How a medical respite care program offers a pathway to health and housing for people experiencing homelessness. Accessed October 5, 2025. https://www.commonwealthfund.org/publications/case-study/2021/aug/how-medical-respite-care-program-offers-pathway-health-housing
10. Alan, Ennabe M, Withers J, Joshi N, Weinand M. Addressing healthcare disparities in homeless neurosurgical patients: a comprehensive literature review on strategies for equitable care and improved outcomes. Surg Neurol Int 2024;15:49. doi:10.25259/SNI_549_2023
11. Brocht, Sheldon P, Synovec C. A clinical description of strategies to address traumatic brain injury experienced by homeless patients at Baltimore's medical respite program. Work 2020;65:311-320. doi:10.3233/WOR-203083
12. Buchanan, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. Am J Public Health 2009;99 3. doi:10.2105/AJPH.2008.137810
13. Buchanan, Doblin B, Sai T, Garcia P. The effects of respite care for homeless patients: a cohort study. Am J Public Health 2006;96:1278-1281. doi:10.2105/AJPH.2005.067850
14. Beieler M, et al. Successful implementation of outpatient parenteral antimicrobial therapy at a medical respite facility for homeless patients. J Hosp Med 2016;11:531-535. doi:10.1002/jhm.2597
15. Biederman J, Sloane R, Gamble J, Sverchek C, Daaleman TP. Program outcomes and health care utilization of people experiencing homelessness and substance use disorder after transitional care program engagement. J Health Care Poor Underserved 2022;33:1337-1352. Accessed October 8, 2025. https://muse.jhu.edu/pub/1/article/862421
16. Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL. Hospitalization costs associated with homelessness in New York City. N Engl J Med 1998;338:1734-1740. doi:10.1056/NEJM199806113382406
17. Shetler D, Shepard DS. Medical respite for people experiencing homelessness: financial impacts with alternative levels of Medicaid coverage. J Health Care Poor Underserved 2018;29:801-813. doi:10.1353/hpu.2018.0059
18. Feigal J, Park B, Bramante C, Nordgaard C, Menk J, Song J. Homelessness and discharge delays from an urban safety net hospital. Public Health 2014;128:1033-1035. doi:10.1016/j.puhe.2014.06.001
19. Biederman DJ, Harker M, Schmid L, Sloane R, Langan E, Taylor DH. Cost-effectiveness of a homeless care transition program: Durham Homeless Care Transitions. N C Med J 2022;83:454-460. doi:10.18043/ncm.83.6.454
20. Bauer J, Moughamian A, Viloria J, Schneidermann M. Leaving before discharge from a homeless medical respite program: predisposing factors and impact on selected outcomes. J Health Care Poor Underserved 2012;23:1092-1105. doi:10.1353/hpu.2012.0118
21. Basu, Kee R, Buchanan D, Sadowski LS. Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Health Serv Res 2012;47:523-543. doi:10.1111/j.1475-6773.2011.01350.x
22. The 2024 Annual Homelessness Assessment Report (AHAR) to Congress. Part 1: Point-in-time estimates of homelessness. December 2024.
23. NYC Health + Hospitals announces more than 1,100 patients served by medical respite, which offers short-term housing and access to medical care. NYC Health + Hospitals. Accessed October 5, 2025. https://nychealthandhospitals-appservice-east-us.azurewebsites.net/pressrelease/nyc-health-hospitals-announces-more-than-1100-patients-served-by-medical-respite-which-offers-short-term-housing-and-access-to-medical-care/
24. Medical Respite Care Directory. National Health Care for the Homeless Council. Accessed November 2, 2025. https://nhchc.org/medical-respite/directory/
25. Rabell L. The rising trend of specialized recuperative care: programs designed for vulnerable populations. National Health Care for the Homeless Council. Accessed February 20, 2026. https://nhchc.org/resource/the-rising-trend-of-specialized-recuperative-care-programs-designed-for-vulnerable-populations/
26. Walton MT, Mackie J, Todd D, Duncan B. Delivering the right care, at the right time, in the right place, from the right pocket: how the wrong pocket problem stymies medical respite care for the homeless and what can be done about it. Med Care 2024;62:376. doi:10.1097/MLR.0000000000001998
27. Medical respite programs: a critical service for individuals experiencing homelessness. ASPE. Accessed October 5, 2025. http://aspe.hhs.gov/reports/medical-respite-programs
28. Medical respite program guidance on referrals, assessments, and service plans. Accessed October 5, 2025. https://www.health.ny.gov/health_care/medicaid/redesign/sdh/guidance/referrals.htm
29. Medical Respite Program. Accessed February 20, 2026. https://www.health.ny.gov/health_care/medicaid/redesign/sdh/respite.htm
30. Biederman DJ, et al. Identifying patients experiencing homelessness in an electronic health record and assessing qualification for medical respite: a five-year retrospective review. J Health Care Poor Underserved 2019;30:297-309. Accessed October 8, 2025. https://muse.jhu.edu/pub/1/article/717747
31. Recuperative Care (Medical Respite). L.A. Care Health Plan. Accessed October 19, 2025. https://www.lacare.org/providers/community-supports/recuperative-care
32. Medical Respite/Care Coordination Pilot Project. Coalition on Homelessness and Housing in Ohio. May 2024.
33. Report to the Legislature: Respite and Stabilization Report. Washington State Department of Social and Health Services. October 2024.
34. Mayor Eric Adams, NYC Health + Hospitals CEO Dr. Katz announce expansion of innovative program to keep more medically vulnerable homeless New Yorkers out of shelters. NYC Health + Hospitals. Accessed October 5, 2025. https://www.nychealthandhospitals.org/pressrelease/mayor-eric-adams-nyc-health-hospitals-ceo-dr-katz-announce-expansion-of-innovative-program-to-keep-more-medically-vulnerable-homeless-new-yorkers-out-of-shelters/
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Copyright (c) 2026 Ariana Coba Clementel, Jacob Carter (Author)
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