Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia.
This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage.
Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support.
The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality.
MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions.
There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.
The authors would like to thank Rebecca Howard, Andrew Hannaford and Una McKeever from St Vincent's Hospital Melbourne for their assistance in the extraction of hospital data and logistical assistance in coordinating interviews. The authors would also like to thank The Cottage staff, staff of St Vincent's Hospital Melbourne and externals stakeholders and Cottage clients who participated in staff, stakeholder and client interviews. Finally the authors would like to acknowledge the authors’ co-researchers, Kaylene Zaretzky, Leanne Lester and Paul Flatau, who were involved in the original evaluation this paper was drawn from.
Gazey, A., Vallesi, S., Martin, K., Cumming, C. and Wood, L. (2019), "The Cottage: providing medical respite care in a home-like environment for people experiencing homelessness", Housing, Care and Support, Vol. 22 No. 1, pp. 54-64. https://doi.org/10.1108/HCS-08-2018-0020Download as .RIS
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