Facing serious illness can be hard for anyone. What happens when someone experiencing homelessness needs help recovering from a serious injury or while undergoing chemotherapy for cancer?
The Endeavors Respite program is a short-term service for people experiencing homelessness who don’t have a safe place to recover their health but aren’t sick enough to remain in the hospital.
Endeavors Respite program is part of a larger program providing care to people experiencing homelessness, said Morgan Smith, manager of the county’s Health Care for the Homeless program.
In addition to clinics located within shelters, the Health Care for the Homeless team visits encampments and connects people to care.
“Our goal is to be low barrier, to be equitable and to create access to quality health care,” Smith said.
Endeavors Respite program grew out of a previous shelter-based program that had just a handful of beds in two locations, following years of planning and collaboration between the county, Catholic Charities and other entities.
“We know that throughout the country, having medical respite programs leads to shorter hospital stays, fewer readmissions, fewer emergency department visits and higher patient satisfaction,” Smith said.
Patients receive referrals to Endeavors Respite program from providers. To be eligible, patients must be able to take care of themselves independently, such as walking to the cafeteria or going to the bathroom.
During their first 24 hours at Endeavors, new patients meet with a team member to talk through their care need and goals. In addition to providing the needed care, team members meet with patients weekly to talk through progress and make plans to meet the patient’s needs.
Length of stay can vary from five days — for someone who needs to have a diagnostic colonoscopy — to more than 100 days for people who are sicker or have more complex conditions. The average length of stay is around 70 days. Since Endeavors Respite program started in 2022, Health Care for the Homeless staff have cared for an average of 100 people a year, said Stephanie Corrente, clinical social worker.
In addition to Corrente, the team includes medical respite nurse Charis Folkert, family nurse practitioner Michelle McCoy, peer recovery specialist Joel Pabst, and nurse Jason Jones.
“We work collaboratively,” Folkert said. “The main thing we focus on is what the patient is admitted for. That grounds us. Beyond that, we’re able to offer a lot of other services… We really let the patients drive that. We’re following their lead but giving them options and opportunities.”
Other services can include support for people experiencing substance use disorder, helping patients get signed up for health care or housing assistance, and even helping them obtain identification cards.
"We meet people where they’re at and build from there,” Corrente said. When someone’s basic needs are met, it allows them to focus on other priorities, including health issues.
As a nurse practitioner, McCoy provides and coordinates care for patients. If patients already have a primary care provider, she works with them. But if someone doesn’t have a provider and wants one, she can help make the connection and the team works to get the patient signed up for medical coverage. McCoy also helps patients connect with specialists, who can provide care for chronic conditions, such as diabetes and heart disease.
“We give everyone a medical information sheet when they are nearing discharge, which outlines who their support team is and which pharmacy their meds will be at,” McCoy said.
While at Endeavors Respite program, some patients experiencing substance use disorder find themselves ready to seek help. As a peer recovery specialist with lived experience, Pabst is there to help.
“What I’m able to do as a peer recovery specialist is to slowly build rapport with people and gradually introduce [concepts of recovery] into conversations,” Pabst said. “I think it’s beneficial for them to be around people who are in recovery to see, ‘oh, that’s an option.’ I’m never pushy with it and I don’t really measure the success of what I’m doing based on how many conversations I’m having about recovery or addiction because that’s not [what it’s about]. I’m just being available and nearby.”
When someone’s been ready to make big changes, “it’s been pretty amazing to be a part of it,” Pabst said.
In addition to providing needed medical care, the team is helping George connect to new housing. To him, the one-bedroom apartment would mean everything.
“People are very respectful and welcoming here. They’re a great help,” he said.
Tim was awaiting surgery when he lost his house in spring 2024.
“This place saved me in the nick of time” by providing him a safe place to recover, he said
The team members say the moments they experience where patients make progress toward their self-identified goals are highly meaningful for them, too.
“For every single person, we can name a win, and there were victories that were celebrated in every single situation,” Folkert said. “I think the thing I love about our team and our program is we are able to count even the smallest things as wins, no matter what it is, because if it’s what the patient wanted, then it’s a win.”
The team sees patients as the experts in their own lives and recognizes that they know what they need, Corrente said.
“We really see the person for being a complex human being and a whole person,” Corrente said.
For each of the team members, Endeavors Respite care program holds deep meaning.
Jones said he’d always wanted to work with people experiencing homelessness. For him, the model of letting patients drive decision making has been a huge shift.
“I think for me it was recognizing the gaps in the health care system that people often experience, like those social aspects, those emotional aspects that are just not able to be addressed usually in a traditional health care setting,” Folkert said.
McCoy agreed.
“I think I experienced the barriers in our health care system that also were giving me burnout as a provider in certain settings,” McCoy said. “I’ve been here for about a year now. I’ve found that there’s still barriers in the health care system. However, working with a team and a clinic that is really focused on letting the patient drive the health care decision making is refreshing.”
Seeing their team at work is rewarding for Smith and King.
“It has been really nice watching the team. Everyone has their specialty, but they are all able to jump in and help when it’s needed,” King said. Each one has grown, too, as they’ve responded to patients’ needs. For many, permanent housing is a goal, but things like outstanding warrants can be barriers. The team — and particularly Corrente — have built relationships with public defenders and others to sort out legal matters. “For the most part, we’re a normal clinic providing care in a non-traditional setting.”
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