When complications from a blood clot forced amputation of Jimmy Howland’s leg, it might have led to a chance for him to get into housing. Instead, the hospital ushered him into a reluctant relative’s home to fully recover.
It wasn’t long before Howland became homeless again and hooked by fentanyl. He lived in a tent by a Fred Meyer store. Two years later, Howland has kicked addiction on his own and lives in one of Vancouver’s Safe Stay shelters. If transitional care had been available when Howland was recovering from his surgery, maybe things would have turned out differently for him.
Medical respite care helps those who are too sick to return to the streets but not ill enough to stay in the hospital. Howland wishes he had received that kind of care instead of embarking on the path that led him back to homelessness.
“It would have got me moving,” he said.
Respite beds do exist in Clark County, but there are only five of them for the county’s estimated 9,032 people experiencing homelessness. If they can’t get one of those spots, recovering patients either take up an expensive hospital bed or spend a few days at a motel before returning to homelessness. A potential solution lies just across the Columbia River.
Central City Concern’s Evergreen Crossing, which provides 90 respite beds in northeast Portland, combines a primary care clinic and a shelter full of workers who monitor people’s recovery and help them get housed.
Something similar is desperately needed in Clark County, advocates say.
Adam Kravitz, founder of the nonprofit Outsiders Inn that operates a shelter and two Safe Stays, said about a third of the shelters’ residents need medical care.
“My shelters are full of older, medically fragile, vulnerable adults,” he said. “We don’t want to put any kind of blame on the medical providers because we understand people are leaving the hospital medically stable. But they are absolutely showing up in our spaces needing wound care, memory care, stroke recovery.”
High demand for help
Even back in 2011, the need for respite beds in the community was clear. That’s why Share — a Vancouver-based nonprofit that operates several shelters in the county — partnered with PeaceHealth Southwest Medical Center to dedicate five of Share’s beds for people coming out of the hospital.
The beds are spread across three sites: one at Share House, two at Share Homestead and two at Share Orchards Inn. Share also offers medication support, case management, housing assistance and daily meals to people staying in its shelters.
But more than a decade later, with 10 times the estimated homeless population, those five beds aren’t enough.
“I mean, I just had four referrals that I had to turn down — because the hospital can’t hold people until a room opens up, of course — and we don’t have anybody that’s getting ready to exit,” said Nicky Ferguson, who runs two of Share’s shelters.
The beds, often located in a private room with a bath and a TV, are in high demand.
“Having someplace safe where they have running water and can shower, wash their clothes and have somebody around to assist them just a little bit will give them the opportunity to heal from whatever medical thing that’s going on with them,” Ferguson said.
However, Share can’t provide the same level of care as Evergreen Crossing because the Portland facility contains a primary care clinic. PeaceHealth occasionally sends a nurse or another staff member to Share’s shelters to offer wound care, for example, but it’s not standard practice.
Share staff members will check on people in respite beds, but they can’t do what nurses can. Usually only one employee staffs a given shelter, which can have more than 60 people staying there, Ferguson said.
“We don’t have the staff and then the staff are not certified in a way that allows us to help,” she said.
Brondalyn Coleman, Share’s deputy director, said sometimes clients’ needs exceed what Share can offer through its respite program.
“Our goal is to provide quality exceptional care, but we also know we’re not a hospital. I can’t ever expect my staff or my team members to really step into (that) role,” Coleman said.
When Share’s beds are full, PeaceHealth will sometimes pay for a few days at a motel for the patient. If that won’t work, patients stay in the hospital while hospital staff work to locate a place where they can go. That can take a month, according to Debra Carnes, a PeaceHealth spokesperson.
The lengthy stays impact other people’s access to the hospital and consume staffing resources, Carnes said in an email. Federal law requires that emergency services treat people, regardless of their ability to pay. Once these patients leave, they often return.
“There is a significant gap in the care available to our unhoused population. We have very limited options for medically complex patients who have ongoing care needs. These patients are some of the most vulnerable in our community and make up a high portion of our readmitted patients,” Carnes said.
Share and PeaceHealth have a tentative plan to expand the respite program, which Coleman said she hopes will happen in the near future.
Legacy Salmon Creek Medical Center does not contract with any respite bed facilities, according to Mathea Christopher, manager for care management at the hospital.
The state doesn’t track hospital stays by people experiencing homelessness or how often they are released to shelter or respite beds. Although PeaceHealth staff can indicate on discharge paperwork where patients go, Carnes said the hospital does not have data to share with The Columbian.
The need may be difficult to measure, but people working in shelters and camps see evidence of it every day.
Interrupting the cycle
Central City Concern works to meet that need in Portland at Evergreen Crossing, a former Comfort Inn with an attached primary clinic.
It’s where Tom Harvey has been recovering from congestive heart failure. Harvey’s illness could have killed him. Instead, it broke his seven-year cycle of homelessness. On a recent afternoon, he hung out in his room at Evergreen Crossing with his favorite music playing and his tabby cat, Christina, curled on the bed.
Before his illness, he was living in a tent in a wooded area of Portland. Soon, he’ll move into an apartment staff at Evergreen Crossing helped him secure.
“If I were still out on the streets and I didn’t receive any medical treatment, I would have had less than a year to live,” Harvey said. “Just having this facility as a place to land after the hospital has made the entire difference in the world.”
For up to 90 days, people staying at the facility recover in a stable environment, receive case management and undergo treatment in the building’s primary care clinic. People often find housing during their stay.
It’s only a 20-minute drive from downtown Vancouver, but most people in Clark County who would otherwise be eligible to stay at the Evergreen Crossing can’t because Washington Medicaid can’t pay for most Oregon services.
“I think that services like this are necessary because we have invested very little in things that vulnerable people need the most,” said Jordan Wilhelms, director of recuperative care at Central City Concern.
It’s no secret that living outside or being unable to afford to go to the doctor regularly can result in major health problems or worsen existing conditions. That’s why Central City Concern began its recuperative care program in 2005. At the time, it had just a few beds. But as health care providers witnessed the program’s success, the number of respite beds continued to grow with more funding, ultimately evolving into Evergreen Crossing, which opened in October.
“It includes the whole spectrum of what people need help with,” Wilhelms said.
Evergreen Crossing works to interrupt the cycle of homelessness, Wilhelms said. Care takes many forms — health care, mental health care, addiction treatment, as well as help finding jobs and housing.
“The thing that people need the most when they need a lot of different things is someone to help connect them all,” Wilhelms said.
Between 60 and 65 percent of people leaving Evergreen Crossing move into transitional or permanent housing, according to Wilhelms. Sixty-one percent of people achieved the goal they had for their recovery during their stay, such as healing a wound.
It can be a difficult feat to accomplish in only a few months, but Evergreen Crossing has been successful enough to keep a flow of public and private funding. It receives money through contracts with local hospitals and Medicaid providers, as well as from Portland and Multnomah County’s Joint Office of Homeless Services.
Central City Concern also received $4.8 million from American Rescue Plan Act in 2021 to expand recuperative care services in Portland. In 2022, Health Share of Oregon (a nonprofit that serves people around the Portland area enrolled in Oregon’s Medicaid program) granted $6.01 million for building acquisition and $990,000 for start-up costs.
Evergreen Crossing saves hospitals around $7,000 per patient over the 90 days, according to Wilhelms.
It also prevents people from returning to the hospital repeatedly for care.
“It’s an easy thing to say, ‘Housing is not health care. Housing is housing, and we as a health system have no business paying for a thing like that,’ ” Wilhelms said. “But then … you as a health system may have no business paying for that, but you are losing a major opportunity to do the right thing and to actually manage your costs.”
Quasi-caregivers
Jamie Spinelli, the city of Vancouver’s homeless response manager, said shelters are turning into quasi-caregivers, helping transport people to medical appointments and navigate medical systems. Often those living outside can’t get surgeries they need because doctors require that they have a stable place to recover.
This was the case for Lee Printz, 67, who fainted in a parking lot due to heart failure in August.
The doctors told him he needed a pacemaker but that he couldn’t get one until he moved out of his van and into housing, where he could recover in a stable environment.
One of the first things he did when he moved into his apartment this month was contact his doctor about a pacemaker. He’s still waiting to get one.
“Sometimes, I’m afraid to fall asleep at night,” he said.
He might have received it months ago if a respite bed had been available. Both Kravitz and Spinelli are working on ways to incorporate respite beds into shelters.
Although these likely won’t include a primary care clinic like at Evergreen Crossing, Wilhelms said something similar could be created by organizations collaborating in the same facility, with a mix of public and hospital funding.
Spinelli hopes to collaborate with hospitals in the future.
“We’re kind of seeing failures of the health care system being dumped on homeless services,” Spinelli said. “If we can just meet that need and then have those two systems work together, then we could much more rapidly get people indoors in safer conditions where they’re not aging into chronic homelessness.”
Columbian reporter Chrissy Booker contributed to this report.
