Between the Hospital and the Street: Addressing a Crucial Gap in Care

“They are the primary beneficiaries of this program aside from the patient,” she notes, and hospitals “are extremely motivated to discharge to someplace other than a shelter.”

She says the organization serves a variety of needs, including hospice and medical respite care. It also acts as a temporary home for patients with complex care issues, such as transplants, recent surgeries and those undergoing cancer treatment, patients with chronic care issues like uncontrolled diabetes, all of which might need a safe home environment in order to qualify for medical care.

“So we help clear up all those barriers for them, maybe help get them on Social Security, get their ID, Social Security card, all the things that prevent them from getting into some sort of housing,” she says.

Addressing a societal concern

Without a resource like The INN Between, it’s likely a lot of these patients would fall through the cracks. They’d return to the streets or another unsafe living situation, ignore follow-up appointments and prescriptions, and eventually show up in the ED with a more serious health concern, repeating the ED-to-ED cycle.

According to Greendoors, which develops community partnership programs to help the homeless, each visit to an ED costs $3,700; at an average of five ED visits a year, that’s at least $18,500, with much higher costs for frequent users. In addition, homeless patients often spend at least three days in the hospital, at a cost of more than $9,000.

Continuing that thread, roughly 80% of ED visits by the homeless are for medical issues that could have been prevented through preventative care, and the homeless are at a far higher risk of developing chronic health concerns. Little data is available on the cost to the healthcare industry for missed care appointments or unfilled prescriptions. Finally, these costs are usually not recouped by health systems and hospitals.

Providing a place to Stay

Olmsted says The INN Between is staffed by some nurses and CNAs, care coordinators and case managers, a wide assortment of volunteers, including chaplains, representatives from Mental Health America, and occasionally social workers or people on internships or some other arranged program. Hospice care is coordinated through the hospice care provider of the patient’s choice. And through the national No One Dies Alone (NODA) program, volunteers are on hand to sit at a patient’s bedside during their final days.

“It’s just an extra set of eyes and ears for maybe when someone’s no longer able to push the call button,” Olmsted says, adding that each patient who passes away is remembered in a house meeting later on.

She says there are plenty of stories about the people who stay there.

“People come in with rough exteriors, not willing to accept help,” she says. “They’ve lost trust in healthcare. They’ve lost trust in homeless services, but here they have their own room and a TV. And they get to choose when they eat, and they have a dresser, and I think it just helps people change and think, ‘Maybe there’s something different for me. Maybe I don’t need to just stay in the cycle of homelessness and, you know, in and out of the shelter.’”

The INN Between can’t currently bill payers for its services. Olmsted is working with a lobbyist to push passage of state legislation that would enable them to qualify for a Medicaid waiver that would allow health plans to pay for medical respite care and housing support for homeless beneficiaries as medical expenses.

The push for permanent source of funding is crucial, as is the quest for support from the healthcare industry, including hospitals and health systems. Olmsted says The INN Between serves an important role in the healthcare ecosystem that is often overlooked or addressed by small groups, charities, and the likes of the Ronald McDonald House.

“My hope would just be that if we can have a sustainable funding stream that we would just be a really good model for different states to follow,” she says.