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Harborview's Medical Respite Program (Edward Thomas House Medical Respite) is a unique harm reduction program that provides recuperative care to people experiencing homelessness who are too sick to return to the shelter or streets, but do not require a hospital level of care. Our team uses a harm reduction philosophy to work together with the patient to resolve medical problems; assess and treat patients for mental illness and/or substance use; and connect patients to primary care, public funding and housing. The Medical Respite care team is comprised of our medical director, psychiatric and medical nurse practitioners, registered nurses, medical assistants, mental health practitioners (respite case managers) and mental health specialists.

The Respite Program is a collaborative project between Health Care for the Homeless Network (HCHN) and Harborview Medical Center with the financial support of several local hospitals and managed care organizations. The program facility is located on the 7th floor of Jefferson Terrace, 800 Jefferson St, on First Hill in Seattle. Jefferson Terrace is a residential high rise owned by the Seattle Housing Authority.

Edward Thomas House at Jefferson Terrace

Respite provides admitted patients with 24/7 shelter, medical care, and support. Respite nurses are on site from 7am until 1130pm with nurse practitioners on site every day of the week. Mental health case managers are available Monday to Friday. Mental health specialists provide milieu management throughout the day and night to help provide a safe and quiet environment for clients around the clock.

The respite program screeners are available 7 days a week for referrals.

Eligibility criteria: (Client must meet all)

  • Homeless* (see definition below)
  • Acute medical problem requiring daily nursing care
  • Referred from a health care facility/provider/shelter in King County
  • Medically and behaviorally stable (not a risk to self or others, appropriate for group setting)
  • Independent in mobility, transfer, feeding, not known to be fall-risk at this time
  • Agreeable to admission and receiving care from Respite staff

 Acceptable conditions:

  • Wheelchair or walker use with independent mobility of at least 250 feet
  • Urinary incontinence with care management plan in place
  • Post-contagion/treatment - Hepatitis A, impetigo, TB or influenza
  • Alcohol/Drug: From hospital – CIWA < 10
    • From outpatient – No DT/seizure expectation
  • Methadone – administered at community site
  • Bowel prep, 24 hour urines, pre-surgical procedures
  • Chemotherapy – administered at community site
  • CPAP use
  • IV infusion - QD or BID orders or 24 hour infusions (PICC lines must be in place at admission with ID follow-up available until antibiotics are completed)
  • Insulin dependent diabetic (patient must arrive with a glucometer, chemstrips, lancets, and syringes for 30 days)
  • Wound care – up to  BID dressing change
  • Wound VAC, if small and attached (wound vac and wound vac supplies must be provided by the referring hospital
  • Portable oxygen use (must be arranged by referring hospital)

Ineligible conditions:

  • Fecal incontinence
  • Registered sex offenders (Respite will screen)
  • Contagious air-borne respiratory illness

Definition of homelessness:
Homeless patients referred to respite must have:

  • no stable living environment in which to recuperate, and
  • no other community placement options available or appropriate for the person.

Information about an individual's living specific living arrangements is central to the process of classifying someone as homeless. Homeless means that their regular living situation(s) includes sleeping in/on:

  • Outside / on the street
  • Shelters
  • Encampments
  • Transitional housing
  • Cars
  • Abandoned buildings
  • Doubled-up temporarily

Social workers, nurses, and health care providers may call to initiate a referral and check on bed availability. Individuals may not self-refer. To make a referral to Medical Respite, please call the Screener directly at 206-744-5277. Once determined that your referral meets eligibility criteria complete a Respite Referral Form and fax it to the screener at 206-744-5233.

If you are referring from an inpatient unit, use the Inpatient to Respite Referral Checklist to gather and fax information required for a complete referral. Please make sure your patient is aware that he/she will be sharing a room with one to two other people.

Respite clients are housed in studio rooms with two or three individual beds to each room. Each room has a private bathroom with shower and individual lockers for safe storage of personal items. A client may be isolated in a single room in response to specific care needs.

Clients share meals in the facility's community rooms and have access to laundry facilities and telephone. Respite also provides a regular series of therapeutic and/or recreational activities throughout the week focusing on life skills, housing readiness and recovery.

For questions regarding the referral guidelines and process, please contact 206-744-5277.

Edward Thomas House: What's in a Name?

Ed Thomas lived on Seattle streets and in shelters for two decades, cautiously avoiding contact with shelter staff members. Living with serious mental illness, Ed lived an isolated life, avoiding care and offers of help. Without a regular source of health care, Ed received his care in hospital emergency rooms. He came to Medical Respite to recover from leg wounds in 2004. Ed's s stay in Respite was a turning point in his life. Respite nurses gave Ed a space with privacy and brought music to share, Ed connected positively with Respite staff. The respite stay also offered Ed an opportunity to engage with his case manager. Upon discharge from respite, Ed obtained his first apartment and has remained stably housed since then. He has maintained a connection to his primary care physician and has not been hospitalized or visited the emergency room since his respite stay.

Medical Respite at Jefferson Terrace is named in Ed Thomas' honor. His life and experience stands an inspiration to others living homeless on our streets, Respite staff and others working to end homelessness in our community.