A Place to Heal

Sunday, December 1, 2013

By Jane Erikson

For 10 years, Stephen was homeless. In May, he found shelter and three meals a day – when he was hospitalized for several weeks with a severe cellulitis that required surgery on his left leg. He was discharged in a wheelchair, still in need of wound care and rehab, which he had no way to get on his own.

Four months later, his leg was healed. And for the first time in years, he had a good job and an apartment of his own.

“It’s been wonderful,” Stephen says, of the radical change in his life.

It came about thanks to Circle the City, a 50-bed medical respite center for homeless people who have been hospitalized and need additional care and support when they are not sick enough to stay in the hospital, but too sick to go back to the streets.

Circle the City, which opened in October 2012 in downtown Phoenix, was the vision of Sister Adele O’Sullivan, MD, a member of the Sisters of St. Joseph. She’s a 1984 graduate of the UA College of Medicine and a 1987 graduate of the UA family medicine residency program. In 2006, the American Academy of Family Physicians named her national Family Physician of the Year.  

O’Sullivan has focused her entire medical career on caring for the underserved. She worked at St. Elizabeth’s clinic in Tucson, a clinic in Benson, the Arizona State Hospital for the mentally ill, and a clinic in El Mirage, until 1996 when she became medical director of Maricopa County’s Health Care for the Homeless clinic in downtown Phoenix.

“In the course of doing that work, I learned that there was no place for the sick homeless to go,” O’Sullivan says.

In 2008 she resigned from the county program to devote her full energy to opening the medical respite center.

She started by talking to others.

“It was an easy story to tell, because people get it,” she says. “They know that if they have to go to the hospital, they may come home not feeling well, barely able to walk from the bed to the bathroom. But they know they have their family there, and they have a refrigerator full of food.

“But what happens if you are homeless? You go back to the streets, with no one to change your dressing, where you have to stand in line for food. So that’s why we started this.”

St. Joseph’s Hospital and Medical Center, the non-profit Hospice of the Valley, faith organizations, the Phoenix business community, the Diamondbacks, the Cardinals, and other philanthropic organizations contributed to the capital effort. It took about $1.5 million to turn an office building on Indian School Road near Central Avenue into what is now an attractive, two-story, 50-bed medical respite center.

Hospice of the Valley owns the building and leases it back to Circle the City.

It is one of about 60 respite centers for the homeless nationwide, O’Sullivan says. The first centers opened in Washington, DC, Chicago and Boston in the early 1980s.  Until Circle the City opened in October 2012, Phoenix was one of the largest cities in the country without a respite center for the homeless, O’Sullivan says.

Patients cannot self-refer to Circle the City; they must be referred by a hospital or social service agency. Hospitals that refer patients cover 60 percent of the center’s operating costs and donations help with the other 40 percent.

“Many of these are patients who otherwise could not be discharged from the hospital and would be in a much higher cost acute-care bed,” O’Sullivan says. “So the amount it costs to refer to us is a fraction of what it would cost to keep these patients in the hospital.”

They may be women recovering from domestic violence; people with cancer or heart disease or other long-term illnesses; those getting over severe infections; those who are seriously mentally ill and suffered a setback that put them in the hospital; and those who are dying and need a safe and supportive environment to live out their days.

The presence of Circle the City in the community is expected to reduce the number of discharged patients who bounce back into the hospital’s emergency rooms, often to be readmitted. When that happens, Medicare can financially penalize the hospital.

In October, when Circle the City had been open for almost a year, its daily census was approximately 30 patients, including several hospice patients. The occupancy is expected to be up to around 40 patients by the end of this year.

“Our goal is to not discharge people back to homelessness,” O’Sullivan says. “We are up around 70 percent or more who leave here and go to permanent housing. For the first time in years, they have a place of their own.”

“And they are more likely to keep their housing, and jobs, if they have them, because they have been stabilized here. We have had time to get to know them, to get the services they need, whether it’s physical therapy or mental health therapy or substance abuse treatment.

“And it’s not just one person’s effort. It’s thanks to the community that we have the time and the resources to do this for them.”