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SALT LAKE CITY — Folks who are experiencing homelessness often use expensive acute health services like emergency department visits at a high rate but often experience poor outcomes. They may end up back on the streets and then cycle back to care when medical conditions become acute again. Sometimes, because they have no place to go, their hospital stays are longer than they would otherwise be.
A Utah Valley University study that focused on care provided by The INN Between in Salt Lake City suggests that medical respite for those experiencing homelessness saves money, improves outcomes and takes some pressure off often-stressed health care systems.
Amanda Weller, who has a master of social work degree, and Angelea Panos, an assistant professor of social work, looked at outcomes for patients who were referred to The INN Between by the University of Utah Hospital and Huntsman Care Institute for medical respite and got in, compared to those for whom there was no room at the time. Their needs were roughly comparable, but the difference was whether they could enter the medical respite program.
The data was collected as part of an internship funded by the Community Foundation of Utah.
The researchers found that medical respite at The INN Between reduced individuals' hospital utilization 91%. Additionally, it was estimated that the program:
- Saved local hospitals $30.5 million since the facility opened in 2015.
- Saved $6.4 million in just the last fiscal year.
- Saved an estimated $47,110 in medical costs per patient each year.
Research suggests that individuals who are homeless use emergency services up to 19 times more than housed individuals, the report said. They also have more readmissions within a month and within a year of receiving care. Previous research has shown they often seek care for chronic obstructive pulmonary disease, high blood pressure, major depressive disorder and psychotic disorders, all of which could be treated "effectively at a lower acuity level with reliable access to housing, medications, nutrition and rest."
The numbers are especially salient as the Utah Legislature prepares to meet soon, since The INN Between is hoping for a one-time, half-million-dollar funding to help it expand from 63 beds to 80, as well as $100,000 in ongoing funding. The facility can't expand to that full capacity unless it can update some of the infrastructure, like the HVAC system. Each room needs individual heating and cooling units, like a hotel, and not all of them have that. They need the state's help to afford it.
About The INN Between
The facility, currently located in what was formerly a long-term care facility in Salt Lake City, is part haven for those who have no home and are dying and part safe place to heal for those who have medical conditions that require some care and downtime but who have no place of their own to rest and get well.
Jill Olmsted, executive director of The INN Between, told the Deseret News that the study showed medical respite at the facility led to a 24% decrease in Medicare costs, a 30% reduction in hospital readmissions and emergency room visits and a 92% increase in follow-up appointment attendance.
The research, which is in the process of being expanded for peer review, shows the value of the collaboration the facility has with various stakeholders, including nearby health care systems.
"That was kind of the impetus of doing this because we've been able to take general medical respite numbers throughout the United States and show that what we're doing aligns with that," said Olmsted. The numbers show specifically that people referred to The INN Between need fewer resources elsewhere, which are generally more expensive. And their outcomes are better because of the respite care.
The INN Between has also been able to help about a quarter of its residents transition to permanent supportive housing. They'd love to be able to help more, Olmsted said.
The facility would like to bill insurance, which it cannot now do, but which would help funding. Grants and donations are a primary financial resource.
In 2021, the Legislature passed a Medicaid medical respite waiver, but it's still pending on the federal level. The facility hopes to see that go through soon.
Eighty beds would be the facility's capacity and would help reduce the waiting list of people who need a place to heal. Though the need still might exceed that capacity, "my hope is that we'll never have to go over those 80 beds and that the community helps find a way to have more affordable housing, some more step-down care and things like that. Because especially if we can't bill insurance, there's just no way that we can continue to carry this burden when we don't get any of the homeless funding," Olmsted said.
The INN Between is medical support housing and there's no pot of money to fund that, she noted. The U.S. Department of Housing and Urban Development doesn't see that as housing. And homeless funds target substance use shelter and housing and other criteria the facility doesn't fit.
Olmsted said she'd also like to see the state adopt a broader vision of affordable housing and step-down care facilities, which would help stabilize the fragile population The INN Between serves.
