Often the biggest challenge homeless people face after hospitalization is simply having a place to rest and recuperate. There are several programs that address this problem by pairing clean and safe spaces with essential support services, such as case management and nursing services. Unfortunately, these programs often face political, financial and social headwinds.
A taped education session for the 2022 AMA Annual Meeting explores what is so meaningful about sick leave programs, and what medical students can do to encourage their acceptance and effectiveness.
The session was sponsored by AMA Medical Student Sectionthe representative body of the Association for the needs and issues of medical students.
Respite programs are post-acute places for homeless people “who no longer need to be in the hospital, but don’t have a place to rest and recover, like you and me,” said Barbara DiPietro, PhD, director of senior policy at the National Homeless Health Care Council. Such programs “provide a residential component for short-term recovery after a hospital admission for those who do not require a higher level of care, such as skilled nursing.”
Part of what informs emergency medical care is that much medical training does not include care for people without housing, said David Munson, MD, medical director of the street team at the Boston Health Care Program for the Homeless.
“People don’t understand — they don’t appreciate — the trauma that patients have experienced,” said Dr. Munson. “Respite programs are beautiful in that the care is provided by people who are truly passionate and interested and understand this work. You can create an environment in which people who are uncomfortable in hospitals, who have unscheduled discharges from hospitals all the time, really settle in and feel comfortable in a sick leave program.”
However, there are numerous barriers to the widespread adoption of respite care, including stigma, DiPietro said. If you ask around, “you’ll be told at least 12 different reasons why this is not a population worth our time, our money, our resources or, or, or …”
As part of the wider policy for eradication of homelessness, the AMA encourages studies on the financing, implementation, and standardized evaluation of respite care for the homeless. Learn more about the AMA’s policy on ending homelessness.
Medical students are in a unique position to drive adoption of sick leave programs through their idealism and also their passion for the medical profession.
“The No. 1 thing you can do is use your privilege and use your credibility,” DiPietro said, noting that medical professionals will listen to medical students in a way that they don’t listen to others. . “We need a value structure in medicine that really pushes the boundaries of creating all these blind spots consciously, and those blind spots need to be consciously pulled as well.”
The second is familiarity with evidence-based models to use, such as trauma-informed care, said David Woody III, PhD, LCSW-S, president and CEO of Bridge Homeless Recovery Center, in Dallas. These include communication patterns.
“Things go a lot better when you see your patient actively involved in understanding what’s going on and understanding how they can own some of their healing experience,” Woody said.
The third is to get out of the classroom and learn who is caring for the homeless in your community.
“Someone is doing it at some level,” said Dr. Munson. “Ask around and then go out and spend some time with those people. Go to them and see what it’s like to care for someone after they leave the hospital, when they take 12 medications and come back to the shelter and still have a wound. Stay on the road.”
Read about the other one highlights from the 2022 AMA Annual Meeting.