Tips for medical students driving change in homeless health care

Often the biggest challenge facing homeless people after hospitalization is having a place to rest and recuperate. There are some programs that address this problem by combining clean, safe spaces with essential support services, such as case management and nursing services. Unfortunately, these programs often face political, financial and social headwinds.

An education session recorded for the 2022 AMA Annual Meeting explores what is so significant about medical respite programs, as well as what medical students can do to foster their acceptance and effectiveness.

The session was sponsored by the AMA Medical Student Section, the Association’s representative body for medical student needs and issues.

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Stopping misinformation, restoring trust are steps on the same path

Medical respite programs are post-acute places for homeless people “who no longer need to be in the hospital but don’t have a place to rest and recover, like you and me,” said Barbara DiPietro, PhD, senior policy director of the National Council of Health Care for the Homeless. These programs “provide a residential component for short-term recovery after hospitalization for those who do not require a higher level of care, such as skilled nursing.”

Part of what informs respite care is that a lot of medical training doesn’t involve caring for the homeless, said David Munson, MD, medical director of the Street Team of the Respite Care Program for Boston’s homeless.

“People don’t realize, they don’t appreciate, the trauma that patients have experienced,” Dr. Munson said. ‚ÄúRespite programs are beautiful because the care is provided by people who are really passionate and interested in this work and who understand. You can create an environment where people who are not comfortable in hospitals, who have unplanned discharges from hospitals all the time, settle in and feel comfortable in a medical respite program.”

Still, there are numerous obstacles to widespread adoption of respite care, including stigma, DiPietro said. If you ask around, “you’ll be told at least 12 different reasons why this is not a population worth your time or our money or our resources or, or, or…”

As part of a broader policy to eradicate homelessness, AMA encourages studies on the financing, implementation, and standardized evaluation of respite care for the homeless. Learn more about AMA’s policy on ending homelessness.

Explore the AMA Center for Health Equity and AMA’s strategic plan to mainstream racial justice and advance health equity.

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3 ways medical students can help reverse mistrust of medicine

Medical students are in a special position to drive the adoption of medical respite programs through their idealism and also their passion for the medical profession.

“The No. 1 thing you can do is use your privilege and use your credibility,” DiPietro said, noting that medical professionals will listen to medical students in a way that others may not. “We need a value structure in medicine that really pushes the boundaries of where all these blind spots have been consciously created and also consciously removed.”

The second is to learn about evidence-based models to take advantage of, such as trauma-informed care, said David Woody III, PhD, LCSW-S, president and CEO of The Bridge Homeless Recovery Center, in Dallas. These include communication models.

“Things go much better when you see your patient actively involved in understanding what’s going on and understanding how they might be part of their healing experience,” Woody said.

The third is to get out of the classroom and find out who is providing care to the homeless in your community.

“Someone is doing it at some level,” said Dr. Munson. “Ask around and then go out and hang out with these people. Shadow them and see what it’s like to care for someone after they’re discharged from a hospital when they’re on 12 medications and come back to the shelter and still have a wound. It happens the time on the street”.

Read about the other highlights of the 2022 AMA Annual Meeting.

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