Standards for Medical Respite Companion
The Standards for Medical Respite Care Companion is a compilation of policies, procedures, and forms from existing medical respite programs to correspond with each standard.
These resources are meant to help your program document that your practice adheres to the national standards. They are free for you to use and adapt as needed in your organization. Click each standard to find its corresponding documents, or download the entire compilation as a PDF file below.
Additionally, the Council developed an organizational self-assessment for programs to use internally to track their progress towards meeting the standards.
If you have questions or would like additional resources, please contact Julia Dobbins
Medical respite program provides safe and quality accommodations
Medical respite program provides quality environmental services
Medical respite program manages timely and safe care transitions to medical respite from acute care, specialty care, and/or community settings
Medical respite program administers high quality post-acute clinical care
Medical respite program assists in health care coordination and provides wrap-around support services
Medical respite program facilitates safe and appropriate care transitions from medical respite to the community
Medical respite care is driven by quality improvement
For a printable version of all Standards forms, policy, and procedure examples, click here
Standard 1: Medical respite program provides safe and quality accommodations
Medical respite programs provide patients with space to rest and perform activities of daily living (ADLs) while receiving care for acute illness and injuries. As such, the physical space of medical respite programs should be habitable and promote physical functioning, adequate hygiene, and personal safety.
1. A bed is available to each patient for 24 hours a day while admitted to the program.
2. Onsite showering and laundering facilities are available to patients to promote proper hygiene.
Refer to 1.1 example
3. Clean linens are provided upon admission.
4. The medical respite facility is accessible to people who have mobility impairments and other physical disabilities.
5. The medical respite facility provides access to secured storage for personal belongings and medications (when the program is not authorized to store/dispense medication by applicable governing bodies).
6. Food services meet applicable public health department guidelines for food handling.
Note: If partnering with another organization to provide food services, the partnering organization agrees that they meet this criterion in a written formal agreement.
7. At least three meals per day are provided.
- Non-congregate settings (including private and semi-private rooms in apartments or motels) may provide unprepared food if a fully equipped kitchen is available to the patient. If a kitchen is made available, it is safe and hygienic and includes proper refrigeration and disposal of trash.
- Meals and unprepared food accommodate medical diets.
8. Medical respite programs located in congregate facilities maintain 24-hour staff presence. On-site staff (either clinical or non-clinical) is trained at minimum to provide first aid and basic life support services and communicate to outside emergency assistance.
9. Medical respite programs have 24-hour on-call medical support or a nurse call-line for non-emergency medical inquiries when clinical staff is not on site.
10. The organization has written policies and procedures for responding to life-threatening emergencies.
11. The medical respite program is compliant with local and/or state fire safety standards governing its facility.
12. The medical respite program has a written code of resident conduct or behavioral agreement that describes program policies including potential causes for early discharge.
13. The medical respite program has plans in place and staff trainings to address:
- the handling of alcohol, illegal drugs, and unauthorized prescription drugs found on site.
- the handling of weapons brought into the facility, including strategies to maximize client and staff safety, and appropriate staff response to violence.
Standard 2: Medical respite program provides quality environmental services
Like other clinical settings, medical respite programs must manage infectious disease and handle biomedical and pharmaceutical waste. Medical respite programs should follow applicable local or state guidelines and regulations related to hazardous waste handling and disposal, disease prevention, and safety. Written policies and procedures described below should reflect applicable local, state, or federal guidelines and regulations.
1. The medical respite program has a written policy and procedure for safe storage, disposal and handling of biomedical and pharmaceutical waste, including expired or unused medications and needles.
2. The medical respite program has a written protocol for managing exposure to bodily fluids and other biohazards.
3. When patient medications are stored and/or handled by staff, the medical respite program follows state regulations for the storage, handling, security, and disposal of patient medications.
4. The medical respite program has written protocols in place to promote infection control and the management of communicable diseases (e.g. scabies, Methicillin-resistant Staphylococcus aureus (MRSA)).
5. The medical respite program follows applicable reporting requirements for communicable diseases.
6. The medical respite premises and equipment are cleaned and disinfected according to policies and procedures or manufacturers’ instructions to prevent, minimize, and control infection or illness.
7. A pest control program is implemented and documented.
Standard 3: Medical respite program manages timely and safe care transitions to medical respite from acute care, specialty care, and/or community settings
Care transitions refer to the movement of patients between health care locations, providers, or different levels of care within the same location as their conditions and care needs change. Care transition initiatives aim to improve quality and continuity of care and reduce the chances of medical errors that can occur when patient care and information is transferred to another provider.
1. Medical respite program maintains clear policies and procedures for the screening and management of referrals into the medical respite program including:
- Written admissions criteria
- Review for clinical appropriateness
- The point of contact or phone number for referrals
- Clinical summary
- Referral decision time and communication back
- HIPAA compliant communication
2. The medical respite program maintains standards for admitting practices:
- Each patient admitted to medical respite program has a designated medical respite provider of record
- The medical respite program performs medication reconciliation
- The medical respite program screens for and honors existing advance directives
- The medical respite program notifies existing primary care providers about a patient’s transition into the program
Standard 4: Medical respite program administers high quality post-acute clinical care settings
In order to ensure adequate recuperation from illness and injury, medical respite programs must provide an adequate level of clinical care. Medical respite programs need qualified medical respite personnel to assess baseline patient health, make ongoing reassessments to determine whether clinical interventions are effective, and determine readiness for program discharge. High quality clinical care responds to the patient’s needs and goals and promotes interdisciplinary team work.
Clinical care may be provided by a partner organization as long as all of the criteria below are met. In the event that clinical care is delivered by another provider, that relationship should be documented in a written contract or agreement. The contract or agreement should address the criteria below.
1. A medical record is maintained for each patient and its content, maintenance, and confidentiality meet the requirements set forth in federal and state laws and regulations.
Note: Medical records may be maintained by an off-site health care organization that assumes responsibility for the clinical care of patients while in the medical respite program provided all privacy laws are followed in the sharing of patient information and access to such information.
2. Appropriate medical respite staff conducts a baseline assessment of each patient to determine factors that will influence care, treatment and services. For each patient, the baseline assessment includes:
- Current diagnoses, pertinent history, medication history (including allergies and sensitivities), current medications, and current treatments
- Physical and mental health status
- Behavioral health needs, including substance abuse
- Pain status, as needed
- Fall risk
- Immunization status (at minimum influenza, consider other age appropriate vaccinations)
3. With each patient, an individualized care plan is developed specifying treatments, desired outcomes or goals, and discharge indicators.
4. Clinical encounters are conducted based on individualized care plans or changes in patient conditions.
5. Patients receive at least one wellness check every 24 hours by medical respite staff (clinical or non-clinical). Changes in the patient’s condition or patient concerns are communicated to the designated medical provider.
6. When various professional disciplines are involved in the care plan, care, treatment, and services are provided to the patient in an interdisciplinary, collaborative manner.
Standard 5: Medical respite program assists in health care coordination and provides wrap-around support services*
Medical respite programs are uniquely positioned to coordinate care for a complex population of patients who may otherwise face barriers to adequately navigate and engage in support systems. Case managers can improve coordination of care by brokering linkages to community and social supports in order to help patients transition out of homelessness and achieve positive health outcomes.
1. The medical respite program designates staff to coordinate health care. Care coordination activities include:
- Supporting the patient in developing self-management goals. Self-management goal setting is a collaborative approach to help patients increase understanding of actions that affect their health and develop strategies to live as fully and productively as possible
- Helping patients navigate health systems and establish an ongoing relationship with primary care providers/patient-centered medical homes
- Coordinating or providing transportation to and from medical appointments and support services
- Facilitating patient follow up for medical appointments and accompanying the patient to medical appointments when necessary
- Ensuring communication occurs between medical respite staff and outside providers to follow up on any changes in patient care plans
- Providing access to local phone service during the medical respite stay
- Making referrals to substance use and/or mental health programs, as needed
2. The medical respite care team provides wrap around services including the following as appropriate (the services are either provided internally or contracted for).
- Facilitating access to housing, including supportive housing when appropriate
- Identifying community resources as indicated
- Submitting applications for SSI/SSDI, food stamps, Medicaid, and/or other federal/state benefit programs
- Providing access to social support groups (e.g., cancer support, addiction support).
- Facilitating family/caregiver interaction.
* The Federal Health Center Program uses the term enabling services to describe wrap-around support services. Per Section 330(b)(1)(A)(iv), enabling services are non-clinical services that do not include direct patient services that enable individuals to access health care and improve health outcomes. Enabling services include case management, referrals, translation/interpretation, transportation, eligibility assistance, health education, environmental health risk reduction, health literacy, and outreach.
Standard 6: Medical respite program facilitates safe and appropriate care transitions out of medical respite care
Medical respite programs have a unique opportunity to influence the long-term health and quality of life outcomes for individuals experiencing homelessness. A formal approach to the transition of care when patients are discharged from medical respite will optimize the chances for success.
1. Medical respite program maintains clear policies and procedures for discharging medical respite patients back into the community.
- The medical respite program has a written discharge policy. The policy specifies the personnel authorized to make discharge decisions.
- Patient is informed of the discharge policy and procedure.
- Patients are given a minimum of 24 hours’ notice prior to being discharged from the program (exceptions for administrative discharges in the event of inappropriate behavior).
2. The medical respite program maintains standards for discharging practices:
- Upon discharge, a discharge summary is made available to the patient. Discharge instructions can be made available within a reasonable period of time. The discharge instructions may include the following:
- Written medication list and medication refill information (i.e., pharmacy)
- Medical problem list, allergies, indications of a worsening condition, and how to respond
- Instructions for accessing relevant resources in the community
- List of follow-up appointments and contact information
- Special medical instructions (e.g., weight bearing limitations, dietary precautions, wound orders)
- Adequate protocols are in place for transferring patient information (or access to e-record) to appropriate community providers.
- A discharge summary generated by the medical respite clinical team is forwarded to the primary care provider. The summary may include:
- Admitting diagnosis, medical respite course, and disposition
- Discharge medication list
- Follow up instruction list
- Any specialty care and/or primary care follow up appointments scheduled
- Patient education/after care instructions
- List of pending procedures or labs that require follow up
- Communicable disease alerts
- Behavioral alerts
- Any pain management plan
- Any follow-up actions needed as a result of health insurance applications or other benefits initiated while at the medical respite program
- Contact information for treating providers
- Exit placement
- For patients returning to the hospital, a clinical summary is generated by the medical respite clinical team to describe the reason for return.
- The medical respite program has a policy and procedure that addresses non-routine discharge including but not limited to death and elopement.
- Patients are provided with options for placement after discharge from the medical respite program. Every effort is made to transition patients to a living situation that is acceptable to the patient. Patient should be given information about community resources and where to follow up with pending applications.
Standard 7: Medical respite is driven by quality improvement
Quality improvement consists of systematic and continuous actions that lead to measurable improvement in the services provided in the medical respite program. The integrity of a medical respite program rests on its ability to provide meaningful and quality services to a complex population. As such, medical respite programs have policies and procedures in place to ensure that their personnel are qualified and effective in improving the health of people experiencing homelessness.
1. The program established and annually updates a quality improvement plan. The quality improvement plan includes essential information on how the program will implement and monitor high quality clinical and enabling services.
2. Self-audits and/or peer reviews are conducted at least annually as part of the quality improvement plan. Self-audit and peer reviews are regular reviews of client files to ensure that appropriate standards are maintained in the provision of care.
3. The medical respite program has a written patient grievance policy and procedure.
4. The medical respite program has a written procedure for managing and reporting incidents, including patient falls.
5. Staff employed by the program have written job descriptions and meet the qualifications required by such job descriptions. The job description defines the competencies of employees involved in patient care, treatment or services.
6. The credentials of licensed and certified professionals (employed, contracted, and volunteer) are initially verified and subsequently reviewed at least every two years per program policy.
7. To the extent the program or organization utilizes volunteers in providing care, treatment, or services, there will be written procedures in place to screen volunteers to ensure patient safety. All clinical volunteers are credentialed per programs credentialing process for their relevant scope of practice.
8. The administering agency employs or appoints a Medical Director to oversee the medical aspects of the program. The Medical Director is a licensed provider who is an (NP, PA, MD, DO).
9. Performance reviews are conducted annually for all employees pursuant to written human resource policies. For clinical staff, the performance review includes an evaluation of the quality of clinical care provided.
10. The medical respite program establishes a training plan to equip employees, volunteers, contractors with necessary skills to maintain a safe and quality-oriented environment. Training topics may include:
- Health information privacy and HIPAA regulations
- Non-discrimination and cultural competency
- Sexual harassment
- Bloodborne pathogen exposure
- Incident Report
- Timely and complete documentation of clinical care
- The medical respite program conducts a patient experience of care survey.