When the average person is discharged from the hospital, they go home with a friend, family member, or in-home care nurse to support recovery. But what happens when someone experiencing homelessness is discharged from the hospital?
That is the role of Housing Matters’ Recuperative Care Center (RCC).
For more than a decade, the RCC has provided short-term medical respite to people experiencing homelessness who are recovering from illness or injury. The program grew from a partnership between Housing Matters, the County of Santa Cruz Homeless Persons’ Health Project, and local hospitals and healthcare providers. Today, the RCC remains an important part of our community’s health and homelessness response system.
What is recuperative care?
It can be tempting to view recuperative care as a specialized program serving relatively few people. In fact, Housing Matters has served 643 community members at the Recuperative Care Center since 2014, amounting to over 65,000 bednights – that’s one person experiencing homelessness in one bed, for one night. The impact extends far beyond the people who use these services. Recuperative care, also called medical respite, fills a gap that hospitals and traditional shelters were never designed to address.
Imagine someone hospitalized for a serious infection, surgery, or another medical condition. They are medically stable enough to leave the hospital, but recovering in a tent, a vehicle, or on the street would make healing difficult or even dangerous. Recuperative care provides a safe, temporary residential setting where that person can continue to recover while accessing healthcare and supportive services.
RCC participants receive medical support, meals, case management, transportation assistance, and housing-focused services. The goal is not simply to help someone get through an illness or injury. It is to create the stability needed for recovery and, whenever possible, to help someone move from homelessness to permanent housing.
The connection between health and housing is fundamental. Housing Matters has seen firsthand how difficult it is for people to maintain their health without a safe, supportive place to recover. The RCC gives healthcare providers a place to discharge patients who no longer need inpatient care but still need support.
What is changing?
Starting on January 1, California is changing how it funds recuperative care, moving it into regular Medi-Cal managed care plans rather than a special federal waiver program. At the same time, the separate program known as Short-Term Post-Hospitalization Housing will end. This program has served as a medical and residential bridge for unhoused individuals who are well enough to leave the hospital but too medically frail to recover on the street.
These changes will have significant implications for the RCC and for other medical respite programs throughout California. The new model introduces substantial operational and staffing requirements. These changes require more resources and expertise to operate the program. At the same time, the new reimbursement structure creates a significant gap between the funding available and the actual cost of providing care.
The most consequential change for Housing Matters is the exclusion of room and board from reimbursement. Under the new model, Medi-Cal reimbursement will not cover essential facility-related expenses, including maintenance, custodial services, utilities, kitchen operations, and food. These expenses are estimated to exceed $600,000 per year.
For this reason, effective Jan. 1, Housing Matters will pause RCC operations while we work to identify a financially sustainable path forward for the program. This is a big loss for Santa Cruz County.
We believe this moment calls for a collaborative, community-wide response. A safe and supportive place to heal like RCC is not incidental to recovery; it is integral to it. We should consider its future as part of our broader system of care.
As we pause operations, we intend to work with partners to explore two central questions:
- How can we reimagine the RCC program to make it economically viable? We need to identify a viable financial model that covers the full cost of delivering medical respite services, including clinical care, staffing, and the residential environment necessary for recovery.Â
- Is Housing Matters the right organization to operate the RCC? We must honestly assess whether operating a medical respite program under the new enhanced medical model is the best use of Housing Matters’ expertise, resources, and organizational capacity. This includes considering whether another healthcare or community partner may be better positioned to lead or share responsibility for the program.
These questions are connected. A sustainable future requires both an adequate funding model and an operating structure that assigns responsibility to the organization or partnership best equipped to deliver it. Even the best clinical models, staff, and partnerships will fail if reimbursement rates fall short of actual residential operating costs.
Why this matters
Recuperative care sits at the intersection of healthcare and housing, and the two are inseparable.
When people have a safe place to recover, they are more likely to complete treatment, attend follow-up appointments, and access the services they need. They can begin addressing the barriers that led to their homelessness in the first place.
California Department of Health Care Services (DHCS) compared the cost of each service with the savings from avoiding Medi-Cal-covered benefits, including hospital, emergency, and long-term care. DHCS found that Recuperative Care was associated with an 8.8% net cost reduction, and Short-Term Post Hospitalization Housing with a 20.6% net cost reduction. These reductions translate into millions of dollars in avoided costs for traditional healthcare settings, such as hospitals.
At Housing Matters, we advocate for a system of care that recognizes what it truly takes to help someone recover: a safe place to heal, access to healthcare, compassionate support, and a pathway home. A hospital discharge should not mean recovery happens on the street.
As public funding for recuperative care shifts, it is up to us to decide what kind of community we want to be.
Learn more about the RCC program pause here.
Learn more about Housing Matters here.
