Central City Concern created the Recuperative Care Program (RCP) in 2005 to let patients go home to CCC housing with staff to care for them. 

Hospitals and major medical providers are caring for patients who are ready for discharge, but must stay unnecessarily in the hospital or return to the emergency room because of social barriers, lack of primary care/insurance and homelessness. By providing immediate housing, intensive case management and a primary care home with immediate post-hospital follow up, CCC's Recuperative Care Program removes these barriers for hospitals, HMO's and health agencies. Patients are picked up from the hospital (not dropped off on a shelter doorstep), given their own room and are immediately established with a primary care provider and a multi-disciplinary case management team, transforming the patient's experience of their health care, the cost for the population and most importantly, improving clinical outcomes.

RCP case managers check on patients daily, take them to follow-up appointments and ensure that they eat regularly and safely take their medications.  If patients exhibit the need for additional medical care – from basic needs to addiction and/or mental health concerns -  RCP connects them to Old Town Clinic’s array of services.  RCP patients also learn how best to use the healthcare system. The staff teaches them to use their primary care home, rather than the local emergency department.

Once patients stabilize, they can focus on rebuilding their lives with CCC specialists there to help them get supportive housing, food stamps, skills training, work and other resources to become self-sufficient. 

RCP staff works closely with Portland area hospitals and CareOregon to identify patients in need of respite care. The Recuperative Care Program not only improves the health of at-risk patients by reducing unnecessary recidivism and discharging people onto the street, but it also improves the efficiency of hospitals.  Quality recuperative care reduces the frequency of return visits to an emergency room, significantly lowering hospitals’ costs and saving critical resources.

Impact:

• More than 600 people served since its founding in 2005
• Successful discharge rate (full recovery and completion of care):  74%
• Percentage discharged to stable housing: 61%
• CareOregon recently assessed costs for one complex patient and found that the patient’s referral to RCP saved the health plan $79,000 in the following year.

Partners:

• CareOregon
• Kaiser Permanente Northwest
• Legacy Health Systems
• Oregon Health and  Sciences University
• Portland Adventist Medical Center
• Providence Health Systems
• Portland Housing Bureau