As I look into the eyes of the late-middle-aged man before me, I cannot help but imagine the pain, fear, and vulnerability he must be experiencing at this very moment. Why am I here on the fifth floor of Cottage Hospital, talking with this man who only four days before was at death’s door, experiencing a shortness of breath and the inability to walk just 20 feet without experiencing a dizziness that verged on unconsciousness and possibly death – a heart failure that is critical? Without the strength to find a safe place to rest his head, I learned that he spent the night in a ditch without a blanket to cover himself.
This man, one of many homeless men and women who suffer from physical and psychological conditions that warrant hospitalization, was referred to Willbridge of Santa Barbara by Cottage Hospital for medical respite. My job is to interview and determine if Richard (a pseudonym) meets the minimum requirements necessary to safely be cared for at Willbridge. I will describe and define those requirements shortly, but first, I wish to explain the role Willbridge plays in medical respite.
Medical respite for those who are homeless – and those who try to reach and help them – is a special gift. It is an opportunity to conduct what I like to call “in-reach.” What we have learned is that when somebody is weak and seriously, even critically, ill, they are open to a greater degree of trust and suggestion. Life on the streets – homelessness – closes down that trust. Only when our health is seriously jeopardized do we decide to let someone else help us get better. This is the gift that medical respite offers, and this is why the collaboration between Willbridge and Cottage Hospital is so important.
Willbridge picks up where the hospital needs to take a step back. When a patient is stabilized but still seriously ill, the possibility for change emerges, the possibility that, as one physically heals, the conditions that led to homelessness will also change with the help of the dedicated, trained, and caring staff at Willbridge. Willbridge offers far more than just safe and caring respite, though. It provides three meals a day, personal hygiene supplies, clothes and shoes, compassionate personal counseling from trained case managers, and help in securing employment, permanent housing, and all necessary medical and social benefits that a resident may have earned earlier in his or her life.
In addition, it has been found that long term medical respite leads to far less medical recidivism. When the homeless are discharged from respite, after maybe just two or three weeks, directly back to the street, they tend to repeat their trips to the hospital. When their respite lasts for three months or more, recidivism is reduced because of the social help they receive from their case managers. Many who have stayed for multiple months are now able to live on their own and hold a job. This equation is simple; they are given time to change.
Though I have only been with Willbridge for a short time, I have worked with the discharge planners at Cottage Hospital on several occasions. What I have experienced, is a caring, professional, and hardworking staff. Discharge planning is not easy, as there are ever-changing plans and doctors’ orders; some orders coming up to the last minutes prior to discharge. All are doing the best they can.
Aware that Willbridge, at this time, does not provide nursing care for the safety and wellbeing of a medical respite patient, Willbridge requires the following:
Patients must be ambulatory with the ability and strength to climb stairs and care for basic self needs;
Patients must be knowledgeable in administering their own medications, and medications must be with patient upon arrival at Willbridge;
Discharge summaries and discharge instructions for patients must be reviewed and approved by Willbridge staff prior to placement;
Patients must be interviewed by designated Willbridge staff before placement at Willbridge;
Willbridge must be notified at least 24 hours prior to placement of patients, whenever possible;
Initial transportation to and from future medical treatments must be arranged by Cottage Hospital until Willbridge can make other transportation arrangements;
In addition, prior to placement, Visiting Nurse Services must be arranged by Cottage Hospital. Arrangements must also be made for special diets and therapies when necessary.
Willbridge understands and welcomes the need for medical respite for the homeless, and looks forward to serving the homeless community for many years to come. Willbridge also looks forward to continuing its successful partnership with Cottage Hospital in seeing that our shared goal of assisting those less fortunate to receive the best medical respite possible, and make the necessary life changes that will reduce their need for multiple hospital stays. In addition, Willbridge welcomes the opportunity to expand the number of medical respite beds it can offer, and to bring on board-licensed nursing staff.