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JOHNSON CITY, Tenn. (WJHL) — Audra McCurry has lived it firsthand — released from the hospital and homeless, without the tools to get fully better.
McCurry, who’s been without a permanent home for more than a year, found her options limited when she left a local emergency room after a recent COVID diagnosis.
“I just had to go to the hospital,” McCurry said as she walked back to the wooded area she’s been staying in Johnson City. “Positive for COVID, positive for like sinus infection. I’ve been spitting up blood – not to be too nasty. But to put me out here saying I’ve got to quarantine myself, how do I do that?”
“I’m sitting here going, ‘so I’ve got COVID and pneumonia, you know that combination’s like a killer’ – and you’re out here in the middle of winter, bad for the lungs.”
If a new Johnson City non-profit has its way, homeless and underhoused people who face great risk when they leave the hospital won’t have to face the risk and uncertainty McCurry just did.
Unity Housing is a coalition of service providers and other stakeholders with an academic-sounding but really pragmatic mission: to address homelessness in East Tennessee through innovative and collaborative solutions based on proven methodologies.”
What that means right now, board members Opal Frye-Clark and Amanda Moorhouse told News Channel 11, is a focused effort to create what’s called a “medical respite facility” in the Johnson City area. Instead of returning to the streets after a hospital stay, people could experience a post-discharge journey that gives them a much better shot at not being right back in the hospital.
“What happens in a medical respite facility, at least the model that we’re looking at, is it’s a place for someone to have a transitional housing piece when they are discharged from a hospital facility,” said Frye-Clark, a former nurse who’s completing a doctorate in public health.
She said good examples might be release after a cardiac or diabetes-related hospitalization. Often, that sends a person with a home and good support system to a short stint in a rehab facility or, at the least, high-level skilled home health visits for things like IV antibiotics or wound care.
“You have to have an acute medical condition that needs a level of continuity of care,” Frye-Clark said. “So we would be able to provide through contracts, home health care, whether that person qualifies for physical therapy, occupational therapy, speech therapy.”
Moorhouse, who oversees East Tennessee State University’s health clinic and day center in downtown Johnson City, sees homeless people with those types of needs frequently — and knows plenty more are simply out trying to heal with essentially no support system.
“We had a patient who was discharged from the hospital, and that patient needed continued I.V. antibiotics,” Moorhouse said of a recent experience. “They had no health insurance, they weren’t eligible to go to rehab and it was time for them to be discharged from the hospital. So because they were unhoused, they had no home for home health to go to for them to get skilled nursing.”
In that particular instance, the ETSU clinic arranged with a home health company, and the patient was able to receive their IV antibiotics at the downtown clinic. Moorhouse, though, said that the half-solution didn’t serve the person as well as Unity Housing’s current goal.
“Medical respite would be a perfect place for that continuation of care,” she said.
Who’s paying the cost? Hospital systems, taxpayers and homeless people themselves
Moorhouse believes her organization is barely able to scratch the surface of need. And even if the clinic can provide a place for medication administration, the people benefiting still spend most of their days in situations that aren’t conducive to healing from a major health event.
“It probably results in rehospitalization more frequently than we are aware of,” Moorhouse said. “Think about something as simple as wound care and being able to shower and keep a wound clean. Until that wound is able to heal completely you have to be able to keep it clean, and if you’re out on the street or you’re unhoused, that becomes more difficult.”
Frye-Clark has done the research, and it’s not pretty. She said the number one hospital health event people experiencing homelessness are admitted for involves cardiac trouble. Leaving a hospital stay for heart trouble without shelter, with no place to keep track of medications and without home health vastly increases the odds of rehospitalization, Frye-Clark said.
If that occurs within 30 days, the hospital system takes a big hit financially, as hospitals get financially penalized for 30-day readmission rates.
Ballad Health, she said, is “very well aware of the costs on their end of things.”
Those healthcare costs are likely a major driver in the very high cost of chronic homelessness — something the United States Interagency Coalition for Homelessness, comprised of 19 federal agencies whose work has some relation to serving homeless people, has quantified.
“They conducted a study in 2017 and they determined that chronic homelessness, so experiencing homelessness for more than a year or multiple times within a year, cost the system between $30,000 and $50,000 per person, per year,” Frye-Clark said.
She said that’s a reason Ballad is at the table as the respite facility idea gets fleshed out. So are service providers like the Salvation Army, along with local governments like the City of Johnson City and Washington County.
“We’re saying, so we can truly be impactful with our community let’s talk about all these relationships and how can we make this come to fruition.”
The biggest cost is borne by people like McCurry, who said she’d love to have had a chance for some type of respite care when she walked out of the hospital.
A warm room, a bed and a chance to heal: “Steam, and getting that out (clearing her lungs), that would have been great,” McCurry said.
Moorhouse said it isn’t just clinical services that can make a huge difference.
“Think about just being able to rest somewhere and you’re not out on the street,” she said. “You have a pillow. You have a blanket. Being able to just have general hygiene, wash your hands, take a shower, brush your teeth.
“Those are simple tasks that we take for granted every day that someone recovering from an illness could benefit from in a medical respite facility.”
The Villages at Glencliff model
Though the advantages may seem obvious even from a financial perspective, medical respite facilities remain a fairly new phenomenon. Unity Housing hopes to model its efforts on one of just a few such facilities in Tennessee, The Village at Glencliff.
A community of a dozen tiny houses, it opened in mid-2021 on the property of Glencliff United Methodist Church after several years of organizational preparation. It doesn’t just provide respite until someone is “back to normal” health-wise. The program also supports people with services to help them find success in permanent housing, with the goal of a seamless transition to a home.
Rev. Ingrid McIntyre is the founder, has family in Johnson City and has been working closely with Unity. She told News Channel 11 she believes the Johnson City area has the realistic potential to start up and sustain a medical respite facility.
“This is one of those steps to help some of the most vulnerable people not die on the street, and be able to come back and live into who God has created them to be,” McIntyre said. “It is impossible to thrive when you are living on the street, particularly when you are sick.”
Frye-Clark said the Glencliff model of helping someone prepare to transition seamlessly into permanent housing is what Unity Housing is striving for.
“The other piece is providing specialized social services, so planning for discharge on day one and starting with the housing applications once that person is admitted.”
“They’ll go through different phases that are referred to as critical time intervention to make sure that they have all of the tools that they need to be successful once they’re discharged from the facility into permanent housing,” she said.
Unity Housing members are in the early stages of trying to gain financial support and find a suitable location. Frye-Clark estimates an ongoing operating budget might be in the neighborhood of $300,000 a year — probably the equivalent of a handful of lost hospital reimbursements and the cost of return trips to the hospital.
“Not only do we know that the cost savings benefit is going to inherently benefit the entire community as a whole, but it’s the right thing to do,” she said. “So yeah, I’m hopeful.”
Moorhouse said it’s a chance for the community to step up.
“We’re called to care for the least of these. And that’s what we need to be doing in our community.”
Not far from downtown on the side of a rarely used rail line, McCurry said she’s all for a medical respite facility. In her case a month ago, though, it was other people in Johnson City’s unhoused community who stepped up when she was on her own with COVID.
“Everybody needs people. I would not have survived out here had it not been for being able to be with people and be around people. If they hadn’t been able to help me I wouldn’t have survived.”
More information about Unity Housing is at the group’s website, unityhousingtn.org.
