Kaiser Permanente Exec Discusses New Medical Respite Program Certification

Medical respite programs provide care for people experiencing homelessness after a hospital discharge. Supported by Kaiser Permanente, the National Institute for Medical Respite Care’s new certification program is creating standards and consistency across respite care providers. Pam Schwartz, the executive director of Community Health Programs & Charitable Contributions for Kaiser Permanente, recently spoke with Healthcare Innovation about the certification program. 

Healthcare Innovation: Pam, could you talk about Kaiser Permanente’s involvement in medical respite care? 

Schwartz: At Kaiser Permanente, we’ve had a role for over a decade in transforming how the industry supports the needs of people experiencing homelessness. I think medical respite is a really good example of that. It serves unhoused people who are too ill or frail to return to the street after a hospital discharge, but they don't necessarily need to remain in the hospital, so they're discharged into the community for the rest of their care. It fills a really important gap in the healthcare service continuum, because it helps the most vulnerable patients avoid additional emergency department care and hospital readmission. Medical respite also addresses people's social needs — do they have enough food? Do they have transportation? Child care? 

There is a significant shortfall across the nation in medical respite beds compared to the demand, and at the moment, there's no dedicated federal funding source.

HCI: Are many of these people on Medicaid? And if so, is there a way the reduced hospital stays and improved outcomes could lead Medicaid managed care plans to help fund the organizations that are doing this work?

Schwartz: Many are on Medicaid, and some of the 1115 waivers do include medical respite or recuperative care. That is helping to demonstrate the value of it and also build the workflows, and, to your point, is helping to contribute to the evidence around the benefits to the bottom line, basically. Some of the research shows a reduction in hospital admissions by 37%. We also have research that shows lower total cost of care, including hospital and specialty outpatient. We’re seeing higher rates of uninsured people getting connected to Medicaid and patients getting connected to social services.

As a field, we're trying to build the business case, if you will. When an unhoused person leaves a hospital or acute care setting, they often need somewhere safe to continue to recover and also to access the additional medical care that they need to get back on their feet. Without the care that these medical respites provide, the patients risk serious health complications and also readmission to the hospital.

HCI: Can you talk about Kaiser Permanente’s work with the National Institute for Medical Respite Care (NIMRC)?

Schwartz: There is a national organization called the National Health Care for the Homeless Council, and they established NIMRC in 2020. We've been supporting NIMRC since 2022. The work that they're doing is really reshaping the field of medical respite at both the local level and the national level. They are building the evidence, and also ideas about the scalability and sustainability of these programs and identifying best practices.

HCI: Could you talk about the certification program and the need for standardization in respite care?

Schwartz: We started working on this not too long ago, but certification is a tool that accelerates innovation and the ability for medical respite providers to more quickly adopt impactful and effective programs. This field is pretty new and also growing pretty fast. Together with NIMRC, we saw an increasing need to really define the quality standard and better understand how to help elevate programs across the nation.  

In our experience what we’ve seen is that medical respite programs across the nation vary pretty widely by things like facility type, staffing levels, services, and funding. But because there was no national medical respite certifying body or standard, the quality of service offered by the various programs was really variable. The certification is trying to raise the quality and the standards and therefore the scalability of impact, if you will, and hopefully cost savings over time. It’s a six-month certification process, and they get quite a bit of technical assistance and support.

HCI: I read that Kaiser Permanente has supported providers in three states going through the pilot program….

Schwartz: We began testing the program in 2023 and there were 15 organizations that were part of the pilot stage. We supported five of those. The certification program officially launched in April 2025, and there was so much interest. Over 50 programs applied to be in the first cohort and 22 programs were selected. What we're seeing is the demand for certification is incredibly high.

HCI: Do these medical respite programs often partner with an FQHC?

Schwartz: They could, yes, and they could even be an FQHC. The quality of medical respites varies. Some of them sit in different types of organizations, but an FQ could certainly be a medical respite provider or program. They're often in the community setting and the idea is to provide the right care in the right way for the most vulnerable, medically frail and also the most costly patients. 

HCI: I read that California is leading the way on medical respite care — that it has the highest number of facilities and its Medicaid transformation program is addressing it. 

Schwartz: Los Angeles has played a significant role in the development of medical respite care, and they really set the standard for what a high-quality provider can be. So Los Angeles is where this started for California. Also, we have invested in medical respite programs across the country, and we have quite a few in California. I don't have line of sight into where all of the medical respites are across the nation, but I know we've invested a lot in California, and I also know that L.A. is really ground zero for medical respite expansion, innovation, and quality standards. The state's Medicaid transformation program is continuing to drive innovation in the field of medical respite.

HCI: Do you think that one of the benefits of the certification program will be that it could help the organizations attract more Medicaid funding, grant funding or more partnerships?

Schwartz: I think some medical respites will continue to be supported through grant funding, and then some in a future state could partner with healthcare as we continue to build the evidence and the best practices. Because one thing that we know is that medical respites can reduce the length of hospital stays, emergency department use, and also readmissions. 

HCI: Anything else you would like to add? 

Schwartz: Just that I find this work incredibly promising. One of the questions you asked earlier was about lowering the cost of care for some of our most vulnerable patients, and I think that medical respites are an affordable and effective intervention for addressing the patient’s immediate medical and social needs, and they have positive short-term and long-term outcomes, both for the individual, but also for the health system. 

Patients who are experiencing homelessness tend to have highly complex care needs, and they also have greater frailty than housed patients. So medical respite really takes care of them well, and it can also reduce the length of hospital stays, ED visits and readmissions. It's exciting to think about how we can reduce the gaps in services and also increase the connections to these services. Many of the medical respite programs provide wrap-around services, like connecting patients to primary care or enrolling them in entitlement programs, like SNAP if they're eligible. All of this creates better health outcomes, leading to lower cost of care, while also addressing the social needs of our most vulnerable patients, and doing it not in the hospital but in the community setting, where they can really recover.