Henry Jones, who became seriously ill after being homeless for 11 years, was admitted to Christ House in 1991, one of the first medical vacation programs in the country.
Ryan Levy / Tradeoffs
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Henry Jones, who became seriously ill after being homeless for 11 years, was admitted to Christ House in 1991, one of the first medical vacation programs in the country.
Ryan Levy / Tradeoffs
In the summer of 1991, Henry Jones felt he was at the end of the line.
“There was no way,” he thought. “I prayed and was tired, but I couldn’t see any way.”
Jones was homeless in Washington, D.C. for 11 years and took their toll for years. “I’m getting sicker and sicker,” he said. “I can feel my health failing.”
On a hot June morning, Jones was in a particularly rough shape – his legs ached, his stomach ached, and his arms trembled. A security guard had to give him a ride from the hospital parking lot to the ER because he could barely stand.
The hospital would not admit him, but a social worker referred him to a place called Christ House, a facility for homeless men who were too ill to be on the streets or in shelters, but not sick enough in need of hospital level care. .
Today, there are a growing number of programs such as Christ House that provide short-term medical care for the homeless, known as medical vacation or rehabilitation care. This growth is partly fueled by a push by state Medicaid programs to help patients prevent preventable healthcare use, such as emergency room visits.
“We’ve seen sick homeless people who were on the streets getting worse,” said Dr. Janelle Goechias, who started the 34-bed facility in 1985. For. “
By the time Henry Jones arrived in 1991, Christ House had admitted more than 300 people a year.
“I couldn’t believe what I was seeing,” Jones said, recalling his first day. “I was sleeping in a nice, clean bed. I was getting some good food to eat. The nurses and doctors, they were very worried. They just wanted me to get well, and I could see that.”
Medical leave is increasing
Christ House was one of the first medical rest centers, and is now one of 133 programs spread across 37 states and Washington DC, all offering a safe place for homeless people to recover from surgery or other serious illness, to manage a chronic condition. Help learn and find permanent housing.
But the programs are unregulated and unlicensed, and they often look incredibly different from each other, according to Julia Dobbins, director of the National Health Care Medical Vacation for the Homeless Council.
The most common setting is a homeless shelter – a few beds or a separate room where a nurse comes to check in once a day. Others, such as Christ House, have their own building and include a full-service kitchen, social space, examination room and round-the-clock medical services.
In the last seven years, driven by multiple factors, the number of medical retirement homes has more than doubled.
First, the number of homeless people increased every year from 2016 to 2020, reaching about 600,000. The homeless population is also getting old and sick. Research shows that homeless people in their 50s are in worse health than people in their 70s who have a place to live, and half of homeless adults are over 50 years old.
At the same time, doctors, healthcare executives, and state and federal policymakers are beginning to recognize that non-medical factors, such as housing, affect human well-being and that the healthcare industry should do something about it – such as medical vacations.
Private Medicaid plans to increase fuel consumption
Perhaps the most surprising driver of medical vacancy growth is the interest of managed care companies – a private insurance company that covers 7 out of 10 people on Medicaid.
Most medical vacation programs have multiple funding sources. Hospitals, philanthropists, and state and local governments are historically the most common, but about 1 in 3 programs now receives some funding from Medicaid plans.
Dobbins said it began when the Affordable Care Act allowed 38 states and Washington, D.C., to expand Medicaid to any childless low-income adult, bringing thousands of previously ineligible homeless people to Medicaid.
A resident watches cooking in the living room at Hope Has a Home Medical Resort in Washington, DC
Ryan Levy / Tradeoffs
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A resident watches cooking in the living room at Hope Has a Home Medical Resort in Washington, DC
Ryan Levy / Tradeoffs
Many state Medicaid programs are simultaneously pressuring caregivers to reduce costly avoidable care, forcing more insurers to consider medical leave.
An example is one of the three managed care plans in 2016 at AmeriHealth Caritas DC, Washington DC, Washington’s Medicaid program began to dock the pay of insurers if they failed to reduce hospital admissions and unnecessary emergency room visits.
AmeriHealth estimates that it has provided Medicaid facilities to about 3,500 homeless people, and some of them have used hospital and ER. The company ran the numbers and was convinced that medical leave could improve people’s health, help businesses avoid financial penalties and save up to $ 200,000 a year.
From there, they partner with other local agencies to launch Hope has a home, two new eight-bed medical vacation facilities that opened in 2019 and still serve 62 homeless people.
“I thank God for this place,” said Wayne Gaddis, 58, who came home to Hope Hedge after spinal surgery. “If I hadn’t been here, I’d have been on the streets, probably coming back with drugs, slowly killing myself, not taking my drugs, not caring because I think no one else cared. But this place, it gives me new hope. New life. “
More proof is needed
There are about 20 peer-reviewed articles on medical leave, recently reviewed by Dobbins and his team at National Health Care for the Homeless Council. This study strongly suggests that those who use medical leave spend less time in hospital, are less likely to be hospitalized, and are more likely to use primary care.
But much of the evidence that exists has been self-disclosed by medical vacation programs, and no one has conducted strictly randomized controlled trials in the United States.
“Unfortunately, there is not as much literature in this field as we would like,” Dobbins said.
And there is even less evidence that medical leave can save insurers money.
Paying someone hundreds of dollars a day for medical leave is definitely cheaper than paying thousands of dollars a night for their hospital stay. But it can extend one’s life and reveal chronic conditions that require years of management.
“We cannot underestimate how sick we are [homeless] People are, “Dobbins said.
In the case, AmeriHealth Caritas DC says the first 11 people they sent to Hope Has A Home were less likely to go to ER. But their initial care inspection is skyrocketing, helping to increase the total cost of care by 75%.
This is just a small sample, and AmeriHealth is committed to medical leave with plans to launch two facilities for homeless women next year.
“Everything we do may not be cost-effective,” said Dr. Karin Wills, chief medical officer of CareFirst, another Washington-based care company that began paying for medical leave in 2021. “It’s important, but it’s not our primary driver.”
Principle speed and constraint
Policymakers in the states of Washington, Minnesota, Colorado and New York are exploring how they can expand access to medical vacation through Medicaid. But a big hurdle remains.
Federal Centers for Medicare and Medicaid Services are prohibited from paying for “rooms and boards”, which prevents medical leave from being provided by Medicaid, like other services such as a doctor’s visit or a nursing home stay.
Managed care agencies must establish separate agreements with each medical leave provider, and the money they spend on leave is not included in their annual contract negotiations with state Medicaid programs to determine how much state and federal money they receive.
In 2022, California became the first state to receive a waiver from CMS that allowed medical leave to be a covered benefit. Utah is in the process of getting its own waiver, further proof that CMS is open to this test.
A bedroom at Christ House, a medical vacation facility in Washington, DC
Ryan Levy / Tradeoffs
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A bedroom at Christ House, a medical vacation facility in Washington, DC
Ryan Levy / Tradeoffs
Vacation providers, insurance companies, lawyers and policymakers have agreed that a major change in CMS policy could open the floodgates for more medical vacations. Even if that happened, it would still touch a fraction of the country’s nearly 600,000 homeless people.
“We are not going to end this crisis with medical leave alone,” said Julia Dobbins. “Medical vacation care is not accommodation.”
Forty percent of Christ House residents have been left in shelters or on the streets in the last three years. Hope Hedge has left without finding a stable place to have a share similar to Home.
Lack of affordable housing allows homes to choose between leaving someone homeless or putting someone else to bed.
“We always have to talk about access to affordable housing for people who are homeless,” Dobbins said. “Otherwise, we’re just going to talk about developing more and more leisure programs. And while I’m here to support them, that’s not my long-term goal.”
Produced this story TradeoffA podcast explores our confusing, expensive, and often anti-healthcare system.
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