Long-Term Care for the Homeless Population

Jillian Olmsted

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

Jillian Olmsted: I’m Jillian Olmsted, executive director of The INN Between, Utah’s only residential end-of-life and medical respite facility for adults experiencing homelessness. At The INN Between I lead a team of dedicated staff and volunteers committed to improving the lives of homeless individuals in Salt Lake City. My passion lies in serving this vulnerable population, ensuring they receive dignified and compassionate care in their final days or through their recovery.

What specific barriers do terminally ill and homeless patients face when trying to access housing, and why is it particularly challenging for this population?

Jillian Olmsted: A common barrier for the medically frail and terminally ill populations is the inability to work due to their illness. Not being able to pay their rent and various bills can lead to an eviction, starting the cycle of homelessness. Getting back into housing after an eviction can be nearly impossible without community support and resources. Add poor health or a chronic illness, and it becomes even more difficult for these individuals to prioritize finding long-term housing. Many are just trying to survive, constantly in search of their next meal, pain relief, and temporary shelter. Homeless individuals also often lose vital documents and identification which makes it impossible for them to secure housing in the future.

Can you elaborate on the key services that medical respite programs provide, and how these services address the unique needs of terminally ill and homeless patients?

Jillian Olmsted: Homeless individuals often live with chronic health conditions, behavioral health conditions, and substance use disorders. Many are not receiving any health care, but those that do often utilize the emergency department for an acute care need—like wound care or an infection. But the emergency department is not an environment well suited to providing long-term health care or managing chronic conditions. If a homeless patient is hospitalized, they may stay in the hospital for longer because there is no safe place to discharge them. Additionally, because of the lack of an address and caregiver, these individuals cannot quality for life saving surgeries, cancer treatment, or hospice services. This is where medical respite programs can help.

Without medical respite programs, homeless patients are stuck in a cycle of homelessness to hospital and back. The key service medical respite provides is simply the place—the home—that allows individuals to access and qualify for health care services. It also offers patients a safe place to recover from their condition and connects patients with other social services to get them the individualized support they need. On top of a place to stay, we are providing whole person care, focusing on behavioral, environmental, and social factors as well as their medical needs.

In your experience, what are the main obstacles in ensuring terminally ill homeless patients receive continuous and adequate health care, and how does medical respite programs overcome these obstacles?

Jillian Olmsted: What we see at The INN Between is that many homeless individuals get lost within the system. Navigating our health care system is already challenging, but for a homeless patient with limited resources it’s even more complicated. Because of lack of transportation, they can’t make it chemotherapy appointments, or they miss a critical appointment that prevents them from receiving a lifesaving surgery. The lack of a steady food source means they are malnourished and hungry. Controlling diabetes and other health conditions while in the shelter system is nearly impossible.

In a medical respite facility like ours, we’re ensuring they understand their medical condition and treatment plan while also teaching them how to navigate the system. We provide transportation to and from their appointments, help them get access to medications, and provide meals and a place to refrigerate medications like insulin. We also try to end the cycle of homelessness for our residents by connecting them with community social service resources to find long-term housing options.

How do medical respite programs contribute to the overall health and well-being of homeless patients, and can you share any specific examples or success stories that illustrate their impact?

Jillian Olmsted: Without medical respite programs more homeless patients would be left suffering and dying on the streets. Beyond reducing the costs on hospitals and decreasing emergency department utilization, patient outcomes and quality of life is so much better.

One story I can share is about our former resident, Patti. Before she came to us, she was very sick and had been living on the streets off-and-on for 22 years. It was hard for her to ask for help because with her history she was shown that “it wasn’t really there when you asked for it.” When she came to live at The INN Between, she had just been diagnosed with stage four cancer, and her doctors only gave her six months to live.

She was going blind from cataracts, she was dealing with cancer, had a colostomy bag, and a good deal of bitter resentment against society. Within a couple of months, she decided this was going to be her home and she was going to get better. She received eye and ear surgeries, cancer treatment and chemotherapy, which on the streets was something she didn’t have safe access to.

If it were not for the compassionate care Patti received at The INN Between, she would not be where she is today, past her two-year mark, in remission. Because she gained access to safe medical housing, access to basic care needs, and life-saving treatments, Patti has since moved into long-term housing. And while she misses her family at The INN Between, she is thriving.

What is one key takeaway you hope the audience gains from this interview?

Jillian Olmsted: Housing is health care. Homeless populations aren’t thinking about how to manage their chronic illness or go get a diagnosis for their cancer; they’re thinking about where they are going to sleep tonight. You cannot get well if you are worrying about short-term survival. If we can take the lack of housing out of the equation, and the accompanying fear, stress, and anxiety, people can overcome illnesses and disease that might otherwise take their life on the streets.