Circle the City helps homeless people with serious injuries and illnesses
Circle the City provides medical care and respite to homeless people who might otherwise struggle with serious illnesses and injuries on the streets.
David Wallace, Arizona Republic
For homeless people, serious illness can leave them vulnerable and without choice when recovering from surgery or other illness.
That’s why Shasta Community Health Center’s Medical Respite program was launched in 2020 – to provide a safe environment for homeless people to recover from surgeries and other medical treatments.
Since the program opened in November 2020 through June 2024, a total of 339 patients have been admitted, and the program has the potential to expand, said Lesha Schaefer, executive director of Pathways to Housing, one of the groups that operates the recovery center.
“I think we have a really successful product and we’ve done really well,” said Amber Middleton, senior director of the HOPE program/Enhanced Patient Services at Shasta Community Health Center. “We’ve provided a really high-quality service to our community. I think that’s reflected in the work we do, and I think medical relief is possible here.”
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When it was first launched, the program housed recovering patients in area hotels. In 2022, the Hartman House at 1871 Kenyon Drive was added, located in the former Church of the Redeemed of Redding.
Patients are referred from hospitals, physicians, nursing homes, mobile health programs and street outreach teams that serve Shasta County’s homeless population.
This year, Hartman House has increased the number of beds from 15 to 20. The house’s capacity is now 15 beds – space for 10 men and 5 women. Five additional people can continue to receive respite services in hotels.
This model allows the medical respite program to remain a service with low barriers to entry, said Anira Khlok, system manager of community health and housing at CommonSpirit, which owns Mercy Medical Center and is one of the program’s original funders. “That means people are admitted with their partners, their pets and their belongings,” Khlok said. “And often that’s a limiting factor for homeless people being admitted to any program or homeless shelter.”
Only patients who are unable to perform daily living skills or are incontinent cannot participate in the program, Middleton said.
Partners of patients can live separately from the patient in the house or be accommodated together in hotels.
Patients with a criminal record would be housed in a separate hotel room, Middleton said.
On average, people stay 29 days, said Ashley Brand, system director of community health integration and housing at CommonSpirit. Additional Medi-Cal CalAIM funding in 2022 has created more flexibility by covering respite stays of up to 90 days.
“CalAIM is a learning process,” Brand said. “But it has allowed us to create different funding portfolios within the program to look at sustainability and long-term structures and see how we can respond while also looking at ways to be reimbursed through the Medicaid system, which hasn’t historically been an option from a financial perspective.”
The program was originally created as part of a concerted collaboration between facilities that “historically served the same population but didn’t necessarily have the most coordinated approach to identifying our homeless patients and enabling a truly safe discharge,” Brand said.
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The collaboration includes:
- The nonprofit Shasta Community Health Center provides medical services and case management and determines who should be placed at the center and how long the person can stay there.
- Pathways to Housing is a nonprofit organization founded in 2019 by Schaefer and physician Dr. Douglas McMullin of the Shasta Community Health Center after working with the health center’s HOPE mobile medical outreach program for the homeless. Pathways owns the Hartman House building and provides hospitality such as meals, laundry service, social activities and an on-site clinic.
- An initial three-year, $1.67 million contract with CommonSpirit Health, the parent company of Dignity Health, which owns Mercy Medical Center Redding, covered initial operating costs. The hospital will provide $100,000 annually for an additional three years through 2026, which will help supplement costs not covered by CalAIM.
- Additional funding from other sources, including grants from the County Medical Services Program (CMSP), funds from the Continuum of Care (CoC), the Community Foundation of the North State, and the city and county.
- With the addition of CalAIM, the program is now able to “offer case management and medical respite as a billable service,” Middleton said.
Mercy Medical Center had originally expected to save about $3 million a year from shorter hospital stays and fewer readmissions. “I would say we’ve seen significant benefits from the program,” Brand said. “We haven’t put that in dollar terms. Rather, we’re trying to make discharges more appropriate and safer. We’re actually seeing a reduction in patients’ hospital stays because they’re getting more appropriate accommodations.”
Provides holistic recovery
Khlok said the program provides more than just a place for physical recovery, but also focuses on spiritual renewal, including by hosting gatherings and honoring birthdays and other milestones.
“Their programs really focus on building community, creating a place of healing for the individual and connecting with people who would otherwise be isolated if they didn’t have housing,” she said.
Each patient housed at the recovery center receives fresh clothing, a hygiene kit with basic necessities, laundry service, medically coordinated meals and is encouraged to participate in a consumer advisory council, Schaefer said.
Hartman House also has a private counseling room for clients as well as a clinical area so providers can provide on-site medical care, including wound care or physical therapy. Through the HOPE program, patients have access to a drug and alcohol counselor and a psychiatric nurse.
“If we didn’t have all of this, all of these visits would have to be done off-site,” Schaefer said.
Since its founding, Hartman House has doubled its workforce from six to twelve.
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Medical care
The medical respite program has treated patients with a wide range of care needs, but wound care is one of the most common reasons. “That makes sense, because when you live outdoors, you get wounds that become infected and need to be treated,” Schaefer said.
The program also included individuals with heart failure, substance abuse withdrawal and treatment, cancer treatment, diabetes, medication-based mental health stabilization, recovery from surgery, recovery from broken bones requiring intravenous antibiotics and treatment for neurosyphilis, Middleton said. In this disease, the bacteria that causes syphilis attack the brain and/or spinal cord.
Providers are also serving more pregnant women and offering them prenatal and postnatal care, “which is not very common for homeless people to receive these specialized services,” Khlok said.
The center can also accommodate patients who need to prepare for a colonoscopy and helps ensure that cancer patients can safely receive chemotherapy, which leaves them vulnerable to secondary infections.
“There are all these different, nuanced stories about the special care that is given to individuals,” Khlok said. “But at the core, they really give people their dignity and provide them with a space to heal and thrive, which is great.”
Planning for the future
Mercy Medical remains committed to its commitment after “seeing that our initial investment was used so appropriately and benefited homeless community members that we remain committed to supporting the program,” Brand said.
The hospital and program continue to focus on sustainability, such as bringing other referring health systems into the conversation “so that it really becomes a community-wide solution and not just supported by a single organization,” Brand said.
The goal of the program is to expand to 30 beds next year, Middleton said. “The need is definitely there.”
Schaefer said the program would like to add another facility with more private rooms and possibly close the motel to house everyone at two locations.
She said: “So if anyone out there has a facility they would like to lease, we are always looking for opportunities.”
