It was a normal fall day for Barbie Farino, a Yakima resident of more than 30 years. She came downstairs to give a tour of her living space - the back porch, the lights that do and don't work, her room at the end of the hall, and the kitchen. She opened the fridge and pointed out a meal she cooked for her housemates.
She was completely comfortable and familiar with these surroundings. But it wasn't her house. In fact, Farino was technically homeless.
She was living at one of Yakima Neighborhood Health Services' medical respite facilities, where people who don't have a home can find shelter and stability while YNHS staff treat medical problems their patients are facing.
Medicaid funding has increased for medical respite programs, which operate at the intersection of homelessness and health issues. Yakima's program is well-used with 200 patients entering it in 2023.
Farino was one of those patients this year. She moved into the downtown facility -- it's more a house than a facility -- due to sepsis, a life-threatening, extreme bodily response to an infection.
After six weeks, she was recovering and planning her next move: a transition to permanent housing. In the meantime, though, she found something that's not always available at other homeless shelters: trust and support.
"I have a family again," Farino said. "That is important. It lets us know that we're loved."
On the other side of downtown, Kevin sat on his bed in the Neighborhood Apartments. He made the transition from living in his RV to permanent housing.
Kevin used to work as a caregiver and concrete cutter before an aneurysm and spinal injuries left him out of work. He moved into his RV and struggled to cope with the pain, he said, before sobering up.
He has a host of mobility problems and has had surgeries on his back and knees. His arms were numb, he said, and YNHS staff were helping him prepare for another surgery.
He was happy to see the staff that come around once a day to check in on him. He was proud of his small apartment and every piece of furniture he's been able to fill it with.
"This is probably the best I could hope for," he said. "You're looking at a very grateful man."
Farino wanted to share her last name. Other patients' last names were not included in this story because of medical privacy issues.
What is medical respite?
YNHS' program isn't new, nor is the idea of medical respite programs. They have been around for almost 40 years after Boston's Healthcare for the Homeless Program started the first one in 1985 to give people a place to recover from medical procedures.
Dr. Jim O'Connell, who helped found the program in Boston, spoke in Yakima in November and said that nurses and doctors in Boston noticed people were discharged from hospitals before they were fully healed.
People with a home had somewhere to go for further recovery, but people without a home were left to keep up with medications or health issues on the street.
Medical respite programs help bridge that gap. YNHS founded its program in 2005 and it was the first such program in Eastern Washington, according to Dr. Rhonda Hauff, the organization's CEO.
The program developed out of two desires YNHS heard from patients and doctors, Hauff said: to give people somewhere to be when they're sick and to improve people's health outcomes by moving them into permanent supportive housing.
Patients can enter medical respite for a variety of reasons - an infection, addiction treatment, acute medical conditions or stabilizing chronic conditions. The program provides people a place to recover with more stability and security than they would have on the street.
YNHS developed its program using standards set out by the National Health Care for the Homeless Council. Washington has adopted those standards.
In 2021, the Legislature approved Medicaid funding for medical respite. That opened the door for more such programs across Washington, Hauff said, and YNHS' two decades of experience are being used as a template by others.
How does it work?
YNHS staff provide on-site services, said Annette Rodriguez, YNHS' chief housing and homelessness officer. A team of behavioral health specialists, nurses, housing specialists and case managers visit daily to help patients with everything from treatment to transportation.
The staff members help get patients rides to community health centers and stay in touch. At those centers, other health care providers and housing coordinators can provide further help.
Dr. Mary Davies is a doctor at YNHS, but also referred patients to medical respite when she worked outside the organization at the Yakima Valley Farm Workers Clinic.
She sends patients to the program for a variety of reasons. Injuries like burns or open wounds can get infected and need more stable treatment. Medical respite can also be a good place for addiction treatment, like suboxone medication.
People living on the street face a high level of stress and often don't have secure places to stay clean or keep taking medication, Davies said.
"It's probably the only point at which those people are able to completely heal," Davies noted.
Davies said medical respite has been relatively easy for her to access, even when she wasn't working with YNHS. There's a one-page form physicians fill out, and if patients qualify and a bed is available, they can move in.
"Without respite, people are dealing with pain they shouldn't have to deal with," she said.
YNHS also makes the point that medical respite programs save money because they are cheaper than sending people with nowhere else to go to the emergency room, which often happens.
"It's been proven to be a cost-effective way to recover from illness or to leave from the hospital," Hauff said.
According to YNHS, 85% of its medical respite patients were referred to the program instead of a hospital in 2023. Hospital care costs an average of $3,800 per day, Hauff said, and respite care costs between $104 and $430 per day, depending on the level of primary care provided.
Half of patients stay for a week or less. A third stay between one and two weeks. The remaining patients will be in medical respite for two or more weeks. Patients spent an average of 19 days in medical respite in 2023, but their stay ultimately depends on their medical condition and the availability of housing elsewhere.
"The minute you're in respite, we start having those conversations about your exit," Rodriguez said.
One of YNHS' key health care goals is expanding access to housing. YNHS helps people navigate the rental assistance process and even has its own stock of affordable apartment housing.
As soon as patients enter medical respite, Rodriguez said, YNHS works to get them on waitlists for low-income housing vouchers.
Room for growth
The goal is to transition people who use medical respite to permanent housing. That's not always easy, Rodriguez said.
There are a variety of barriers to acquiring permanent housing. Wait times for housing support can be long. According to data from the University of Washington's Center for Real Estate Research released in the fall, rents grew by almost 3% and average rents were $916 a month in Yakima. Vacancy rates were just 2.5%.
Rodriguez said that for people with no income, poor credit and painful or serious medical conditions, finding an apartment or a job can be difficult.
Still, staying in contact with folks and building trust by offering the medical respite program is important. It creates connections that YNHS can use to coordinate housing in the future.
Hauff noted that funding and resources are always limited. To grow or add more facilities takes money that isn't regularly available. In 2023, for example, YNHS received $2.7 million from the state to convert a Yakima hotel into permanent supportive housing.
Davies pointed out that more beds would be helpful. YNHS staff try to plan ahead of time to make room available, but last year just over 20 patients were unable to use the program because there wasn't enough space.
There also isn't a medical respite facility in the Lower Yakima Valley.
"If someone is discharged from Toppenish or Sunnyside, there's nothing down there," Davies said.
Those who use the program
Esteban spent two weeks in the medical respite program after a severe case of trench foot.
He pointed out the benefits of his time there -- he was applying for permanent housing and had access to medical resources. Esteban also lamented the fact that it was hard to find those resources out on the street.
People experiencing homelessness don't have easy access to internet or medical knowledge, he said. Focus shifts to survival on the street, and it takes time to change daily routines, Esteban said.
"You have to give in to some type of trust in order to trust the process," he said. "That's an extreme fight."
Others don't seem to mind the change as much. Joseph, a former wildland firefighter and laborer, settled in Yakima to be close to his daughter and his brother, but couldn't afford to live anywhere besides a tent near the river.
One day, he said, he woke up and medical issues prevented him from leaving his tent. He has since lived in the medical respite program and now has permanent housing, where he's proud to pay rent and live on a lease.
"I'm loving it, anywhere indoors where the walls don't move when the wind blows," he said.
Serious injuries can make life hard and can be more common on the street. If untreated, those conditions can become chronic and send people to the emergency room again and again. Medical respite is a chance to pause that cycle and let people heal.
Farino said her health improved and she stopped using drugs while in YNHS' medical respite program. It's tough, Farino said, but she is taking it one day at a time.
"We get dealt, in life sometimes, some really hard blows," Farino said. "You can whine about it, moan about it or, excuse my French, bitch about it. Or you can wake up and thank God for the next day."