The most challenging respite patients: Opportunities for improvement

The Phillip Dorn Respite in Contra Costa County California first opened in 2010 as a temporary home for recovery, service connection and medical coordination for the county's sickest and most vulnerable homeless patients. Each year approximately 150 individuals are housed at our site and then transitioned into an adjacent, larger general shelter with long-term care and housing plans. While all of these patients have some complex medical issue many also have co-occurring mental health diseases and substance abuse disorders. As a result, these clients have a much higher risk of morbidity and mortality. Our respite shelter has certain policies by which clients must abide in order to remain in the shelter. Each year a number of our respite clients either choose to leave on their own or can no longer reside in the shelter due to repeat policy offences. Most often, these infractions directly relate to mental health and substance abuse. As providers and staff, we may find ourselves challenged and frustrated by those patients who have difficulty following the policies of the shelter. There is often no alternative living situation for these vulnerable individuals. Their only option becomes the Emergency Room and, inevitably, admission to the hospital- or worse, they are discharged to the street. These patients are at times referred to as having "failed" shelter living. But, really, we have failed to meet their needs. In order to re-frame the discussion on what makes these patients challenging for us as providers and how we could better serve them, we surveyed our clients who have repeatedly been required or chosen to leave the respite shelter in order to understand how we can better serve them. This workshop will focus on our findings and discuss the approaches our team took to address the needs of our patients and improve the quality of care they receive. We will also encourage others to share their challenges and innovative approaches to care in the respite or shelter setting.