A Safe Landing Place

Medical respite provides a supportive and stable place for unhoused people as they recover from medical issues or injuries.

Think back to small-kid time. When you got sick, maybe Mom and Dad, or Grandma, or a beloved neighbor, took loving care of you. They touched your forehead with a cool hand when you were feverish, brought you soup and noodles, fluffed up an extra pillow for you, and made sure you had some good TV shows to watch. You knew you were supported, and you could feel that care, literally speeding you on the road to recovery. That combination of safety, support, and healing – it’s the bedrock of the concept of medical respite.

“We want people to not just get the medical care they need, but also the feeling that somebody cares about them,” says Connie Mitchell, executive director of the Institute for Human Services a Honolulu-based nonprofit dedicated to homeless people and the issues they face. Among its services, the organization has medical respite homes for medically frail homeless people.

An Emerging Trend

Hawaii has been an early adopter of the medical respite model, an emerging health care strategy that seeks to support homeless people after hospital stays. And it is leading to positive outcomes, especially in the fight against chronic health issues common among the homeless population, including COPD, heart disease, and kidney failure.

Kaiser Permanente has supported medical respite efforts with grants, and contract beds with local medical respite homes. IHS’ Tutu Bert Medical Respite Homes offer a cozy atmosphere, with meals, medical monitoring, and other support. Tutu Bert’s comprises three medical respite homes, in Makiki, Kalihi, and Pearl City. With a total of 36 beds, they offer stability and access to health care, both of which can drastically improve outcomes for participants.

The facilities are the namesake of Roberta “Tutu” DuTeil, the widow of IHS founder Claude DuTeil. “She was very involved in helping homeless individuals go to and from the hospital when her husband was running IHS,” explains Mitchell.

Medical respite, Mitchell explains, is an approach that has evolved out of need. Before, unhoused people were hospitalized and then released back onto the streets. With no support, they’d often be unwell again and headed back into the hospital. It was like a revolving door.

“They’re living on the street where there’s no refrigeration for medications like insulin,” Mitchell says of the challenges facing unhoused persons. “No hygiene, you’re bound to get infections, and then you’re subject to a lack of sleep and physical or even sexual assault.”

Medical respite helps stop the cycle. Clients at Tutu Bert’s usually recuperate for six to eight weeks, says Mitchell. Professionals such as nurses or physical therapists provide the needed health care, and nurses are available after hours, too, in case a client needs help with things like pain management. Meanwhile, the IHS staff works to find transitional or permanent housing for the clients.

Mitchell can think of plenty of success stories. For example, one of Tutu Bert’s first guests, five or six years ago, had been injured in an auto accident. He couldn’t go back to work, and eventually he became not only homeless, but displaced from his home island as well, says Mitchell. Via the supportive setting at Tutu Bert’s, the man was able to recover fully and return to his home island.

Medical respite helps people get back on track in numerous ways, such as reconnecting with family, coordinated mental health care services, and access to permanent housing.

In addition to funding medical beds that serve homeless individuals in need of home care when they are discharged from the hospital, Mitchell says, “Kaiser Permanente is enabling us to share our learnings from five years of experience with other organizations beginning medical respite services to broaden the state’s capacity to serve medically vulnerable homeless individuals.”

New Projects on the Big Island

Hope Services Hawai‘i is a nonprofit homeless services provider on Hawaii Island. A participant in the National Institute for Medical Respite Care cohort, it has been implementing new respite beds on Hawaii Island, including at the medical respite home Wilder House, which opened in July 2024.

In its spare but tranquil homelike setting, eight residents will have constant nursing assistance, while also enjoying common areas like a kitchen, living room, and backyard space.

Clients typically stay with Hope Services medical respite for about 60 days, says Brandee Menino, chief executive officer of Hope Services Hawai‘i. “It really is just a transition. We get people connected and get them into housing, and that’s when they can get better, when they have their own space, when they have their own dignity, when it’s private.”

According to Hope Services, medical respite is more cost-effective for insurers than frequent emergency room visits or hospital stays for people experiencing homelessness. By addressing health issues in a more holistic and preventive manner, insurers can save the costs associated with avoidable medical interventions, Menino notes.

“By piloting and developing partnerships with Kaiser Permanente, with the hospital, it’s a community, it’s a team,” says Menino. “We’re excited about that, because we see that this helps get people to stay indoors, to move toward their pathway to housing, and not wanting to go back to the street. They’re getting care in the medical respite and they want to continue that care in housing.”

Menino also notes that the medical respite homes can even help unhoused individuals mend relationships with their ‘ohana. “We’re helping them rebuild community,” she says. “It’s exciting, helping them reconnect, and we do see better outcomes. We know that housing improves health. All of this is connected.”