Bobbi Six first heard of medical respite care after learning that hospitals in Oklahoma were sometimes discharging people experiencing homelessness back to the streets or to shelters after they received services.

At the time, Six, who is also a registered nurse, was serving as a public health official with the Oklahoma State Department of Health. She began helping coordinate efforts to address the growing number of people who were discharged after seeking care at a hospital but had nowhere else to go to continue recovering.

Now, Six will lead a new medical respite facility in Oklahoma City intended to care for people who are discharged from the hospital but are still too sick for the city’s already strained shelters. 

“This is a population that I feel is just very marginalized and has so many vulnerabilities,” Six said. With her background, Six said she’s been able to see the challenges to addressing this issue. “Both the hospitals and the shelters end up with these just really tough situations where hospitals aren’t meant to hold these individuals until they recover, and shelters don’t have the ability to provide the care that they need.”

Six will act as the senior director of medical respite for City Care, one of Oklahoma City’s longtime service providers for individuals experiencing homelessness.

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City Care plans to open a 40-room medical respite facility in 2027 west of downtown Oklahoma City. The facility will be built near City Care’s existing night shelter. The director for City Care’s shelter previously told The Frontier that people frequently come to the shelter after receiving services from hospitals across the city. City Care staff said they expect the beds to fill up immediately. 

The facility hopes to partner with a health care provider that will provide medical care for higher-need patients, Six said. The facility plans to have certified nursing assistants on staff to do daily wellness checks, and other services like home health or occupational therapy can be done on-site, Six said. City Care has over 100 housing units and will help clients find permanent housing. Some clients may also need hospice care. 

Homeless service providers and hospitals have said that a medical-level respite facility would expand care options to people with higher needs. 

Federal law requires hospitals to screen and treat everyone with an emergency medical condition, regardless of ability to pay. But hospitals have faced a dilemma over where to send people experiencing homelessness once they have been treated and are ready for discharge. 

Because of Oklahoma’s limited resources for people experiencing homelessness after they’ve been discharged from a hospital, hospital social workers have had few options but to discharge people to the street, typically armed with a bus pass, or to send them to local shelters that aren’t equipped to handle people with medical needs. 

To help address this need, Cardinal Community House opened in Oklahoma City in March 2021 as a non-medical respite program. The facility can only serve people who are able to do basic tasks on their own, like going to the bathroom or bathing. City Care hopes to be able to serve people with higher needs at its new facility.

Even though Cardinal Community House does not provide medical services on site, its facility has remained full, with a record number of clients this year, said director Kelli Ude. Both respite programs said they will coordinate with one another to provide services.

“There is such a great need for respite out there,” Ude said. 

State data from 2020 to 2022 showed that the number of people discharged to homelessness from hospital emergency rooms grew across Oklahoma. When individuals are left to recover on the street or in shelters, they typically get worse, providers said. 

“It’s just an awful reality that there aren’t better solutions, and that’s why we are just working as fast and furiously as we can to get this thing up and running,” said City Care CEO Rachel Freeman.

Funding for these kinds of facilities can be challenging to secure, service providers have said.

While some states have waivers that allow Medicaid to reimburse for services at medical respite facilities, Oklahoma does not. City Care may be able to work with managed care organizations or contract with hospitals to help cover costs, Six said. If clinicians provide services on-site, they may be able to bill for those. Cardinal Community House relies on grants and contracts with hospitals. 

Multiple hospital systems in Oklahoma recently released a community needs assessment that identified respite care as an ongoing need in the Oklahoma City metro area. Freeman said SSM Health and Mercy hospitals have already pledged financial gifts to the City Care project. 

Mercy also sponsors respite rooms and provides a client navigator at Cardinal Community House, said Cindy Maggart, executive director of acute care services for Mercy Hospital Oklahoma City. Maggart says she expects a similar partnership with City Care. 

“The need continues to grow,” Maggart said, especially as the cost of medical care rises. “So expanding this capability, I think, is going to be crucial.”