Medical respite provides vital care to people experiencing homelessness

Imagine being ready to leave the hospital after a heart attack or a major surgery, but having no home to go to finish recovering. That's a reality that Kate Bradley often saw firsthand when she lived and volunteered at the Loaves and Fishes Catholic worker community in Duluth, which provides shelter to people without a home. 

"Folks would get a cab voucher from one of the hospitals and show up with drainage tubes hanging off of them,” Bradley said, “saying ‘the hospital said you'd have a place for me.’"

Bradley now lives in a new home in Duluth called the Bob Tavani House for Medical Respite, which provides a place for people experiencing homelessness who are too ill or frail to recover from an illness or injury on the street or in a shelter, but who no longer require care at a hospital.

It’s part of a growing network of medical respite centers that now numbers more than 130 around the country — including four in Minnesota. More than half have opened in just the past 10 years, with a goal of disrupting what is often a sad cycle. 

"Where, because homelessness is often driving the disease state in the first place, people get better in the hospital, they're discharged back into homelessness, right back into the conditions that lead to worsened health,” said Dr. Jamie Conniff, “And a few days or weeks or months later, they are ill again, and need hospitalization."

Conniff is a family physician in Duluth and a faculty member at the Family Medicine Residency program, where two former residents first came up with the idea for the Bob Tavani House.

No ordinary house

“C'mon in!” Bradley said, welcoming visitors to the Bob Tavani House in Duluth’s Lincoln Park neighborhood earlier this week. “Don't worry about shoes.”

She's opened this door a lot since the home opened in the summer of 2018, a donation from the First Covenant Church next door, where the bright yellow house, built in the late 1800s, once served as the church parsonage.

"We're just a house,” Bradley said modestly, giving a quick tour. “Dining room, living room, kitchen around the corner, some guest rooms upstairs, one guest room here,” a couple bathrooms and laundry in the basement. 

But what Bradley describes as "just a regular house," has played a critical, some say lifesaving role for 55 people who have stayed here so far, to help recuperate after being discharged from the hospital. 

Bradley is one of two volunteers who lives in the home, along with up to three guests at a time.

The average stay here is about 45 days. Some guests leave after only a couple of nights; others have stayed as long as four months. 

The home doesn't provide medical care, but it creates a space where physical therapists or nurses can come to provide it to guests. It also offers a warm bed, family style meals, and, perhaps most importantly, community. 

"We are people, for people who need people," said Bradley. She described herself and fellow volunteer Kelly Wallin as essentially live-in case managers and navigators, to help people connect with housing, employment and other resources when they're ready to leave. 

"Instead of having an hour with their case manager, once every two weeks or once a month, they've got us all darn day. And when I'm doing dishes is usually when I'm giving out some interesting housing advice" said Bradley.

So far, more than half the residents have moved into permanent housing. 

The house is named after a Catholic worker and mental health counselor in Duluth, Robert Tavani, who himself suffered from bipolar disorder and cycled in and out of homelessness, Bradley said.

“He really could have used this house,” she said.

Tavani died in 2012.

Bradley said while the house now has a three-year track record of success, it doesn’t come close to meeting the demand. With only three beds, Bradley said she’s often in a situation where a hospital social worker calls with a patient they’d like to refer, but she doesn’t have a room to offer them. 

An even bigger problem is that the house isn’t equipped to care for people who are struggling with addiction, substance use or uncontrolled mental health problems. 

“And so we have to turn away a lot of people who are really interested in the respite house who would benefit from a respite model,” said Conniff. “But because they are still actively engaged in substance use, we can’t provide them a safe space to stay.” 

Save lives, save money

Medical respite centers like the Bob Tavani House were started to help people in the community. But in this case, what’s good for people has also proven to be good for the bottom line. 

"We know that people experiencing homelessness often stay in the hospital up to 4.1 days longer than they really need to be in the hospital,” said Julia Dobbins, director of medical respite at the National Health Care for the Homeless Council.

At roughly $2,000 a day for a hospital bed, “that's very expensive for the system," she said.

That's why many health care systems around the country are starting to invest in medical respite centers. 

California, where about a third of the nation’s medical respite facilities are located, recently became the first state to reimburse for medical respite care through Medicaid. 

But in Duluth, the Bob Tavani House is powered by volunteers, some grants and lots of donations of meals, coffee and toilet paper.

“We're a bunch of do-gooders that came together to do good,” Bradley said. 

The house’s annual budget is only $13,500. 

“When we recommend respite programs to look to in terms of their philosophy of care, I think the Bob Tavani House really rises to the top,” said Dobbins. “And I would also say I have concerns about the staffing challenges that they have.”

The nonprofit is now engaging in a series of community conversations to help put it on more solid footing. 

"You know, life happens,” said Board Chair Tony Olson. “And you never want just one thing going wrong to make a valuable service like this for people in the community to go away. So we're really focused on making sure that we can be sustainable."

Bradley said her vision is to offer more beds, a space for guests with mobility issues, and services to offer to people struggling with substance abuse. 

In the meantime, she’s looking forward to Easter, when past residents of the Bob Tavani House return with a dish they've prepared for a big, shared meal. 

"Once a guest comes through our house, they're kind of like family to us,” she explained. “And they're welcome to come back home.”

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