Medical Respite Referrals

Referrals to H4’s medical respite service will most frequently come from hospitals, but referrals from other medical providers and organizations serving the homeless population of urban Honolulu will also be considered.  H4’s clinical team will evaluate the appropriateness of each prospective patient’s admission to the unit based on the information provided by the referring provider or agency, and an in-person examination and interview may be required before the final determination is made.  Prospective patients must meet the following five screening criteria:

Admission Criteria
1. Homeless in Hawaii.
3. Post-acute medical illness which requires short term (60 days) resolution and care
4. Environment needed in which to prepare for or recover from medical procedures such as surgery, endoscopy.
5. Independent in activities of daily living with the ability to dress, bathe, transfer and Ambulate independently with or without a device such as a wheelchair, walker crutches or cane
6. Psychiatrically stable enough to accept and receive care and not interrupt the care of others.
7. Acute enough to need more than an emergency shelter bed, but not sick enough to require hospital level of care or psychiatric in-patient admission
8. Established and managed complex drains such as colostomy, ileostomy, urostomy and bile drains
9. Methadone Treatment established with a methadone clinic
10. Continuous oxygen therapy > 4 liters per minute except for hospice patients (Approved by Subcommittee for admission
11. Wound Vac Therapy
12. IV antibiotic therapy
Exclusion From Medical Respite
1. Dementia patients with behavioral concerns such as wandering off unit
2. Patients with acute and recent (7 days) psychotic behaviors
3. Patients admitted to hospital with recent (30 days) suicidal and homicidal ideation
4. Patients requiring a one-to-one sitter for agitated and combative patients.
5. Patients with recent (7 days) combative and aggressive behaviors as noted in hospital H&P and Nurses notes.
6. Patients whose pain management has not been attained or stabilized in the inpatient acute setting.
7. Hospice patients with a life expectancy greater than 60 days.
8. TPN Management

To refer a patient for potential admission, please fill out H4’s Patient Referral Form and email it with attachments to .  Then call H4 at 808-784-3831 within 24 hours to discuss the patient’s status and any additional information that may be required.  Information describing the patient’s condition and treatment to date is required with the application, and in some cases, a minimum supply of medication or medical equipment must be furnished by the referring provider.  These requirements are detailed in the Patient Referral Form itself and accompanying Referral Checklist.

Please see ABOUT US for more information on H4’s medical respite service.