Alaska Medical Respite Program
Alaska Medical Respite Program - Anchorage, Alaska
Catholic Social Services of Alaska; Providence Alaska Medical Center; Alaska Regional Hospital; Alaska Native Medical Center; Alaska Native Tribal Health Consortium; Southcentral Foundation
“We need to know more about the kinds of programs that help those experiencing homelessness get back on their feet. And we need to know more about the types of programs that help states reduce the cost burden of homelessness. Targeted health interventions are a way to do both.”
Homelessness. It threatens human dignity and wellbeing. And it’s not just a moral issue. It’s also a major public health crisis. People who don’t have consistent and adequate shelter are at greater risk of disease, infection, and abuse. In fact, a 2019 report from the National Health Care for the Homeless Council reported that people who experience homelessness are more likely to suffer from serious adverse health conditions like diabetes, hypertension, heart attacks, HIV, Hepatitis C, and substance abuse disorders. And on average, those experiencing homelessness die 12 years sooner than the general U.S. population.
This is crushing, but it makes sense. People living in homelessness experience the near-constant stress of uncertainty and survival—the close quarters, noise, and insecurity of homeless shelters providing little respite. Their lives are chaotic. And lonely. And too often forgotten.
The National Coalition on Homelessness and Poverty reports that 3.5 million Americans experience homelessness every year. And some states are worse than others.
Homelessness in Alaska is particularly concerning. According to Statista, Alaska has the 8th highest homelessness rate among US states. It also boasts some of the harshest weather conditions in the Union. Not only is shelter a basic human right, in Alaska—where sub-zero winter temperatures are the norm—it’s necessary for survival. But as a state, Alaska lacks the infrastructure needed to properly support people who are homeless. And to make matters worse, Alaska’s budget for homelessness relief was cut significantly in 2019.
We need to know more about the kinds of programs that help those experiencing homelessness get back on their feet. And we need to know more about the types of programs that help states reduce the cost burden of homelessness. Targeted health interventions are a way to do both.
Because homelessness often leads to chronic health problems, those experiencing homelessness tend to have longer and more frequent hospital stays than the general public. Research by Doran et al (2013) found that over 70% of homeless patients discharged from the hospital were readmitted or visited an emergency room within 30 days of their release. Not only are hospitals ill-equipped to meet the unique needs of homeless patients, they’re also reluctant to discharge them to the streets. Patients stay longer, and long, frequent stays are expensive. When homeless patients are discharged, many cycle through jails and homeless shelters, eventually returning to the hospital. Without access to the basic care needed to make a full recovery, this costly cycle continues. And so does poverty.
The medical respite program offered by Catholic Social Services of Alaska provides basic rest and care for homeless patients discharged from three area hospitals. As part of the program, patients receive three meals a day and are allowed to rest in their beds during daylight hours, unlike most homeless shelters. The program is designed to help bridge the gap between patients who are too healthy to stay in the hospital but too sick to recover on the streets.
Does access to a medical respite program improve the health outcomes of homeless patients? Does it reduce the public costs of homelessness?
- Individuals who participate in the medical respite program will have shorter hospital stays, fewer hospital readmissions, and will be less likely to visit emergency rooms.
- With fewer, shorter hospital visits, the cost of treating patients who participate will be significantly lower than the cost of treating those who do not.
Research Study Design
This medical respite program is being evaluated through a quasi-experimental study. Because there are more patients eligible to participate in the program than there are available beds, a waitlist is used to determine which patients receive access to the program.
To construct the waitlist, healthcare providers identify all patients who are eligible for the program and about to be discharged. If a patient consents to participate, their name is added to the waitlist.
When a bed becomes available in the respite center, the patient at the top of the waitlist receives it. They become members of the treatment group. Some patients, however, will be discharged from the hospital before a bed becomes available. These patients become members of the control group. The unpredictability of bed availability, then, randomly sorts patients into treatment and control groups.
At the conclusion of the study, LEO researchers will compare the number of hospital stays and the number of hospital readmissions across both groups.