With COVID-19 cases in decline, Washington County has repurposed 10 private rooms in an Econo Lodge in Hillsboro, Oregon, that had been used to quarantine people during the pandemic.
The rooms will now be a clean and safe place for people who are homeless to recover from an injury or illness with help from a visiting nurse. It’s a model known as recuperative care.
The Virginia Garcia Memorial Health Center, a safety-net provider, will coordinate medical care for participants.
The two-year demonstration pilot is small by design. Alongside Virginia Garcia, Washington County’s Department of Housing Services and shelter provider Greater Good Northwest have partnered on the project.
They are hoping to show that the combination of transitional housing and some medical care will end up being cheaper for hospitals in the area — and the coordinated care organizations that oversee Oregon’s Medicaid program — than the status quo, where people who are homeless often use the emergency department to access primary care.
‘Emergency medicine is not designed to treat long-term illnesses’
Emergency departments are the only part of the health care system in the United States that cannot, by law, turn people away before evaluating and stabilizing them.
Statewide, emergency departments are struggling with overcrowding, with beds often occupied by people who no longer need hospital-level care.
While emergency rooms are the easiest place for many people who are homeless to walk into and get care right away, they might leave with just a few days of medication, or a wound that needs ongoing attention, leading them to potentially return just days later.
“Emergency medicine is not designed to treat long-term illnesses,” said Angie Hurley, the director of operations for Virginia Garcia. “It’s the most expensive and the least effective.”
The pilot program is taking referrals from three area hospitals: Oregon Health & Science University’s Hillsboro Medical Center, Providence St. Vincent Medical Center and Kaiser Permanente’s Westside Medical Center. Participants do not need to have insurance to qualify.
The program is limited because it doesn’t have nursing assistants on site or a large medical staff, so it cannot take patients with acute needs or people who need help to dress, eat, and do other daily tasks.
But it can provide support for people with less intense needs. The program’s nurse can check on wounds, assist with insulin injections, and make sure people understand how to take their medications.
The program started accepting referrals in October and has accepted three patients so far. The slow start is partially intentional, as each patient is complex and needs services beyond just medical care. Hiring nurses to staff the program has also been challenging, in an employment market where nurses are in short supply and high demand.
Part of ongoing growth in homeless services
One of the first participants, a male, was admitted for help with relatively minor medical needs.
Staff quickly saw how a lack of housing was limiting the man’s access to health care. He needed back and hip surgery, but his primary care provider wouldn’t consider performing it until he had a stable address.
“He would not be able to even schedule these surgeries because he would be discharged onto the street and I don’t think that doctors in good faith would start that type of procedure without them having somewhere to recover,” said Caitlin Simpson, the recuperative care coordinator for Greater Good Northwest.
Shelter staff have worked to get the man on a path to more permanent housing that will allow him to get the surgery.
The pilot is not the state’s first experience with recuperative care. Central City Concern’s Blackburn Center in Portland has 51 beds for recuperative care, and in Eugene, ShelterCare has 18.
In Washington County, it’s part of an ongoing growth in homeless services. The county has 300 year-round shelter beds, up from none just a few years ago.
Washington County is funding the recuperative care pilot with a grant from Kaiser Permanente, as well as with income and business tax dollars through the housing supportive services tax collected by Metro, the Portland area’s regional government.
The partners said the two-year pilot period will allow them time to develop a long-term funding plan.