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You’re homeless, but you

have to leave the hospital.
Where do you go?

# $ !

Originally published December 24, 2018 at 6:00 am Updated

December 24, 2018 at 12:17 pm


% &

1 of 6 Tasha Webb, 38, is back to living in a tent camp

but is determined to stay on methadone after her... (Ken
Lambert / The Seattle Times) More (

In Seattle, there's a place--and it costs

much less. Cities around the country are
looking to programs like Seattle's as a

By Scott Greenstone !

Seattle Times Project Homeless engagement editor

For decades, Edward Thomas was hard to

help. He slept on a mat in the Downtown
Emergency Services Center’s main
homeless shelter. He came in late and left
early, muttering to himself, his legs so
swollen he could wear only Velcro-
strapped cast boots, his doctor said.

Thomas’ elephantiasis got so bad it caused

open wounds on his legs, landing him in
the hospital for seven weeks. His doctors
couldn’t send him back to the shelter in
good conscience; his legs were leaking
fluid into his socks.

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So the doctors tried something new.


They moved him into a medical respite in

the Salvation Army shelter in the
International District — a few beds with
nurses on staff. They gave Thomas
headphones and music to listen to. He got
comfortable, and finally met with a mental-
health caseworker. He got antipsychotic
meds. He got into housing, and never went
back to the shelter.

As homelessness continues to rise in

Washington, patients like Thomas present
a worsening problem for public hospitals.
Hospitals are required by federal law to
treat patients regardless of their ability to
pay, but many chronically homeless people
have overlapping medical and mental
struggles that make them ethically difficult
to discharge.

The problem is serious enough that

Washington State Hospital Association
convened a work group from area
hospitals: They found that in Western
Washington during summer 2018, there
were 200 homeless patients who spent an
average of 82 days in the hospital after they
no longer needed acute inpatient care.

When homeless people do get released,

their issues combined with living on the
street will usually land them back in
emergency rooms, costing hospitals like
Harborview Medical Center — which
operates on a thin margin — time and

“Some patients come to the hospital ER a

hundred times a year, or more,” said Cassie
Sauer, president of the WSHA. “A volume
that you and I can’t fathom.”

One solution is the type of respite program

Thomas benefited from, providing short-
term care to homeless patients who are too
sick to be on the streets or in a shelter, but
not sick enough to continue to take up a
hospital bed. Thomas proved such a
success that, when the respite program
moved in 2011 across the street from
Harborview’s emergency room, the
planning committee named it the Edward
Thomas House. A photo of his face greets
patients as they enter today.

Hilary King, supervisor of Harborview’s medical respite

program stands near a portrait of Edward Thomas, whom
the program is named after. (Ken Lambert / The Seattle

In the Edward Thomas House, it costs $400

a day per person. Across the street at
Harborview, it’s around $2,000 a day. And
time spent in respite care reduces future
time in the hospital: A 2006 study of a
Chicago hospital found the average
homeless person who had respite care
spent 3.7 days in the hospital in one year;
the average homeless person who didn’t
spent 8.3 days.

National studies show medical respite

decreases future hospital stays for the
homeless people who come through,
cutting costs for hospitals and the
government. In Arizona, one study showed
a Phoenix respite saved Medicare and
Medicaid $1,320 per patient per month,
reducing costs by 58 percent and saving
more than $4.7 million in care for the 309
patients who participated in the study.


Medical respites can also hold hospitals

accountable for making sure they
discharge people to a safe place, according
to Julia Dobbins, who works as a liaison for
the National Health Care for the Homeless
Council to respite-care providers.
Discharging a vulnerable patient can turn
into a PR nightmare for a hospital: Last
winter, video of a homeless woman left
outside a Baltimore hospital in her socks
and a hospital gown went viral; other
instances of “homeless dumping” have
kicked up outrage across the country.

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“We’re making sure they don’t come back

to the hospital for the reason they came in
the first place,” Dobbins said.

Inside respite

Harborview’s respite program for homeless under medical

care is housed in the building at left, which is a stone’s
throw from the emergency room, at right. (Ken Lambert /
The Seattle Times)


Edward Thomas House doesn’t feel like a

house so much as a clinic; It’s a floor in
Jefferson Terrace, Seattle Housing
Authority’s largest apartment building,
across the street from the ambulance
entrance of Harborview.

There’s a lounge with an electric keyboard

and a bookshelf, exam rooms with views of
Smith Tower and First Hill, and three-
person rooms with privacy curtains and
containers. Some of the beds are unmade,
with clothes or food strewn around; others
are meticulously clean and well-kept.

There are, of course, limits to the program.

It’s not a nursing home, and there is no
bedside care. People must be able to walk
or operate a wheelchair. They can stay for a
maximum of three months (the average
stay is around three weeks, according to
staff), and sex offenders are not accepted.

Drug use is not allowed on the property,

but the program won’t refuse care to
someone they know is using drugs; social
workers at respite can connect people to
everything from drug treatment to eye care.

Programs like the Edward Thomas House,

or its shelter-based predecessor, started in
the 1980s but have grown in the last
decade to around 80 facilities nationwide.

Washington has four — besides Seattle

there’s one in Yakima, one in Spokane, and
one that opened in September in
Bremerton — which is more than any other
state except California, according to the
National Healthcare for the Homeless
Network’s directory. Seattle’s is one of the
larger ones in the country, with 34 beds
that stretch to 35 when demand is
especially high.

A lot of respite care’s utility is — for lack of

a better word — “capturing” a homeless
person, according to Dr. Leslie Enzian, the
medical director at the Edward Thomas
House and Edward Thomas’ doctor for

“I can’t tell you how often I ask someone

who their emergency contact would be and
they have not one person in the world,”
said Enzian. “Often their community is a
community of people who are drinking
alcohol or using drugs and that’s really the
only support network they have.”

Two hospital visits, two different


One night in 2014, Tasha Webb signed

herself out of Harborview with nowhere to
go, so she rolled her wheelchair down the
hill to a shelter downtown. She’d been in a
car accident, had a broken hip and ankle,
and Webb said she had only recently
become homeless after running from her

Tasha Webb, 38, says her most recent medical crisis “was
actually kind of a blessing because it got me help.” After a
hospitalization, Webb went to Edward Thomas House,
where she got more help and got on methadone. (Ken
Lambert / The Seattle Times)

She had no money for therapy; her hip and

ankle healed wrong. She became addicted
to heroin she used to deal with the pain.
Today she walks with a cane and lives in
an unsanctioned tent camp in
Georgetown. Two months ago, she landed
in the hospital again after she got an
abscess from a heroin needle. She was
admitted to Swedish.

This time, instead of rolling herself out of

the hospital, Webb went to Edward Thomas
House, where she had her own little corner
with a small window. She got a kidney
biopsy. She got on methadone. It’s the
fourth time Webb has been in treatment,
but she feels this hospitalization has
scared her straight.

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powered by Hearken

“It was actually kind of a blessing because

it got me help,” Webb said. “I had never
been so sick from a stupid mistake. I’m
trying to get off the stuff.”

This month, she was discharged and went

back to her camp in Georgetown. It’s cold,
rainy and wet, she says. But despite the 45-
minute bus ride to the treatment center
every day, so far “the fear of being sick is
enough motivation” to stay on methadone.

But on the streets, fears compete with each

other. Webb is scared, for instance, of
getting the results of her kidney biopsy
back — but worse is the fear of what will
happen if she stays in a tent outside.

“Maybe I’ll be fast-tracked to get housing if

there’s something wrong,” Webb said in an
email. “That’s awful to think but it’s true.”

Scott Greenstone: 206-464-8545 or

sgreenstone@seattletimes.com; on Twitter:
@evergreenstone. Scott is Project Homeless’
producer and engagement editor. Before
working at The Seattle Times, Scott was a
news assistant at National Public Radio’s
Weekend All Things Considered. He is a
graduate of the University of Oregon.

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