It’s only about a year old, but the Pittsburgh region’s only medical respite center is already showing signs of success. The program is run by Allegheny Health Network and it’s meant to provide care to a uniquely vulnerable population: the homeless and unstably housed. This month, the program had too many patients for the 10 beds that AHN rents between two local Downtown human-services centers, Bethlehem Haven and Wood Street Commons.
The respite center is meant for patients who have healed enough to no longer require immediate hospitalization, but still require long-term care to ensure their health problems don’t return. For stably housed patients, this care would normally be provided by frequent nurse or caretaker home visits. But for homeless patients, such regular attention is difficult to provide.
Dr. Patrick Perri is the medical director of AHN’s respite program. He says before the program existed, problems with treating homeless and unstably housed patients persisted. “We recognized the number of homeless people being discharged, and it made it hard for them to recuperate,” says Perri. “Because they were so vulnerable, they ended up coming back to emergency rooms at very high rates.”
Perri says the program is hoping to expand. He says more than 50 percent of the respite center’s patients have health issues relating to opioid use, and he believes respite can offer the type of care needed to confront the growing opioid epidemic. AHN nurses and respite patients agree, but they all worry the program could have the rug pulled from under it if the Affordable Care Act is repealed and the health-insurance landscape is dramatically altered.
The latest score from the Congressional Budget Office on the U.S. Senate’s proposed ACA repeal says 22 million Americans will eventually be without health insurance. Perri says without support from Medicaid and other insurance, the respite program could be in danger, increasing the vulnerability of an already vulnerable homeless population.
“For the long-term sustainability of a respite program, one of the best ways to secure that is through the [health-insurance] payers,” says Perri.
One current respite patient, who asked to remain anonymous, says her six weeks in the center has provided the closest thing to becoming fully healed since she became addicted to opioids decades ago. “This is the only place that I have ever gotten the kind of care that I needed,” she told Pittsburgh City Paper from her room in Bethlehem Haven.
Her room is noticeably different from the sterile halls typical of hospitals. There is a colorful quilt and paintings on her walls. A handwritten sign with the patient’s name greets visitors. She says she suffered a back injury when she was a teenager and was prescribed OxyContin, an opioid pain medication. She says a few years after the injury, she went to visit her doctor, but the doctor was not in. This led her to seek out heroin as a replacement for her prescribed opioids; she has been dealing with addiction ever since.
However, she says respite care has given her some renewed hope. She says nurses and staff helped her sign up for health insurance, which she had never had before, and all the individual attention has helped with her addiction issues.
“This program has got to stay alive,” she says. “It’s the only way to help people like me fight.”
Her nurse, Danielle Dipre, says respite centers provide a type of care that hospitals can’t provide. For example, Dipre recently took a patient to get glasses, and used the patient’s insurance to pay for them, something the patient was unaware was possible. “If they are addicted, getting glasses is the last thing patients think of.”
Dipre also says respite centers actually save hospitals money, since many of AHN’s respite patients suffer from infections related to drug injections, and need weeks of antibiotics. Instead of keeping those patients in costly hospital beds, patients can receive their antibiotics at respite centers. There, they can also be put in contact with other social services to help them get their life on track, and even sometimes find permanent housing.
And Perri says this success has played out with one of their first patients. Perri says the man was addicted to heroin, but after going through the respite program “he is back to work, he is re-engaged with his family and he’s off heroin.”
But Perri says this positive momentum could be in trouble if the ACA were repealed, because the repeal could drastically alter Medicaid, which provides health insurance to low-income individuals. Perri says the vast majority of respite patients are on Medicaid.
“Any kind of shirking of those funds would be devastating,” says Perri. “If they were to lose that health-care coverage, it would be devastating not just to respite [care], but to all the ancillary and preventative care attached to respite. This would place more strain on vulnerable patients, and probably create more need for respite care. A dangerous snowball effect could play out.”