4. BHCHP Basic Goals 1984
Establish a health services care delivery model to provide continuity of care from shelter and street to hospital;
Provide care through multidisciplinary outreach teams;
Establish the capacity to meet the needs of homeless individuals for home-type respite care

6. MGH Mission, 1810
“When in distress, every man becomes our neighbor…It is unnecessary to urge these truths on those who are already in the habit of cherishing them…The relief to be afforded to the poor, in a country so rich as ours, should perhaps be measured only by their necessities.”
From the “Circular Letter” of 1810 of John C. Warren and James Jackson leading to establishment of the Massachusetts General Hospital

11. Chronic Homelessness: 75% of Patients Are Homeless Longer than One Year

12. Respite Referral Source

13. Complexity of Illness: Dual and Triple Diagnosis in Respite Admissions

14. McInnis House Length of Stay

15. City of Boston Annual Census, 12/8/2003
Among 3,875 homeless individuals identified on a single night census:
863 (22%) in medical/mental health facilities
17 EDs
291 medical hospitals (88 in Shattuck Hospital)
87 medical respite beds (McInnis House)
176 detox
292 mental health hospitals/inpatient programs

17. BHCHP and ED High Utilizers Boston, 2005
Boston Medical Center /25
(Boston University Medical School)
New England Medical Center 14/25
(Tufts Medical School)
Massachusetts General Hospital 16/25
(Harvard Medical School)

18. BHCHP and Partners’ Healthcare 2004-2005
14,200 BHCHP patients
2,090 (15%) received services at MGH
1,148 (8%) received services at BWH
Only 259 of these 3,283 served at both MGH and BWH

19. BHCHP and Partners’ Healthcare 2004-2005
ED Utilization
MGH: 1,515 persons (73% of 2,090) had total of 5,539 ED visits
Average # ED visits: 3.7
865 (16%) of ED visits resulted in admission
BWH: persons (83% of 1,148) had total of 2,836 ED visits
Average # ED visits: 3.0
319 (11%) of ED visits resulted in admission

20. Barbara McInnis House

24. Barbara McInnis House FY 18 Admissions Level of Care
2335 admissions (1224 unique patients)
Avg LOS: 14.3 days
Level of Care
Acute and sub-acute care (pneumonia, cellulitis, diabetes, cirrhosis, HIV, cancer
IV antibiotics (e.g. endocarditis)
Pre- and post-operative care
Palliative and end of life care
Wound care
Detox (alcohol, opioid, sedative)
Psychiatric care

25. Medical Respite Care: Data
Respite Decreases Hospitalizations
225 Hospitalized homeless persons in Chicago
Referred to respite  fewer inpatient days at 12 months1
Respite Decreases Readmissions
743 Hospitalized homeless persons at BMC
Referred to respite  50% reduction in readmission at 90 days2
Respite Increases Service Utilization
181 respite admissions in Ottawa3
Improved medication adherence
24.3% obtained housing
1: Buchanan et al AJPH 96(7)
2: Kertesz et al 37(2)
3: Thompson et al CJPH 97(5):

27. HRSA Definition: Respite Care
“Short term medical care and case management provided to persons (generally homeless) recovering from an acute illness or injury, whose conditions would be exacerbated by living on the street, in a shelter or other unsuitable places. “

28. BHCHP Model of Care 12,000 men, women, and children served in 2017
bridge between shelters/streets and teaching hospitals/CHCs
medicine and public health
family and adult teams (MD/NP/PA/RN/CHW)
daily hospital clinics at BMC and MGH
over 40 shelter and outreach clinics in greater Boston
house calls to formerly homeless persons in housing
104 beds of medical respite care at McInnis House
24 beds of step-down respite care at Kirkpatrick House
EMR since 1996 (now on EPIC)
integrated, co-located medical/psychiatric/SUD care
20 MD, 3 DMD, 40 NP/PA, 60 RN
PHS Section 330(h), stand-alone HCH
annual budget $55M, 80% from Medicaid/care
12,000 men, women, and children served in 2017