Oklahoma City respite facility ensures care for unhoused patients after discharge

January 2024

A colorful community room at Cardinal Community House has tables, vending machines and a television.


Catholic hospitals in Oklahoma City are partnering with a nonmedical respite care facility to help unhoused adult patients recover safely as they build a more stable life.

Cardinal Community House in the city's downtown area has 40 private rooms in four dormitories where patients can recuperate from illness or injury after discharge. Mercy Hospital Oklahoma City, part of Chesterfield, Missouri-based Mercy, and SSM Health St. Anthony Hospital — Oklahoma City are among the five local hospitals that rely on the respite center. The two Catholic institutions refer 65% of all its patients.


The nonprofit Homeless Alliance estimates that there are more than 1,400 people without housing in Oklahoma City. This population experiences the full spectrum of health issues. But Kelli Ude, Cardinal Community House's executive director, says many of those living on the streets are hospitalized after being hit by vehicles or for conditions caused or exacerbated by exposure to harsh weather.

"We see quite a few individuals who have an underlying condition such as a diabetic neuropathy issue," Ude says. "Before respite care was available, they might leave the hospital and then have nowhere to go and be out in the elements — and that would maybe lead to something more severe like amputation."

Ude says Cardinal Community House's respite services prevent such drastic outcomes by giving people who leave the hospital with no home to return to a safe, comfortable space in which to heal.

Caring for them as they convalesce is a privilege, Ude says. "I know this sounds cliché," she says. "But it's 1,000 percent the truth that it is just so rewarding."

Wraparound services
The average stay at Cardinal Community House is 30 days. Patients benefit from case management, social workers, home health visits and medication services. They're provided with three meals a day, clothing and hygiene supplies. They also receive education and therapy for substance abuse along with help with permanent housing, official identification, family reunification and transportation.

The Cardinal Community House in Oklahoma City provides respite care for people experiencing homelessness after they leave local hospitals.

Recently, a patient arrived with a new diagnosis of kidney disease, and instructions to undergo dialysis. During his stay, Cardinal Community House not only made sure he kept his dialysis appointments but also took him to apply for Social Security benefits.

"Now he has an income to support himself in his chronic medical condition," Ude says.

Cardinal Community House has a long history of serving the unhoused. It first opened as a shelter in 1966. Later, it became the Oklahoma City Halfway House for inmates completing prison sentences, transitioning back to its original mission during the height of the COVID-19 pandemic. In 2021, the center began offering respite care to a small number of clients through the Oklahoma City-County Health Department.

SSM Health participated in a Cardinal Community House pilot program hoping to find a better option for its patients experiencing homelessness.


"For a lot of people, we discharge them and say, 'Rest up for a few days,'" says Andrew Ochs, SSM Health regional vice president of mission integration. "But when unhoused patients were ready, we didn't have a safe place to discharge them to, and we would keep them in the hospital for longer than we would have liked — or they would have liked."

Two models
From his previous work with Ascension Saint Thomas in Nashville, Tennessee, Ochs was familiar with a homeless shelter in that city whose residents include patients recovering from illness and injury. Like Cardinal Community House, Nashville's Room in the Inn partners with local medical systems.

Hospital beds and recliners donated last fall by Mercy are among the furnishings in a room at Cardinal Community House in Oklahoma City.


"I had this desire to get something like that up and running in Oklahoma City," Ochs says. "Around the same time, our partners down the street at Catholic Charities came to us with the same idea."

Patrick Raglow, executive director of Catholic Charities of the Archdiocese of Oklahoma City, had recently learned about the transitional respite program at House of Charity in Spokane, Washington. The 10-year-old facility operates in conjunction with Catholic hospitals and the Diocese of Spokane.

To Raglow, the idea of respite care made sense not only as a Catholic mission but also for the financial health of local hospitals. He says spending money to keep patients without medical reason isn't cost-efficient.

"But you can send them to a place like Cardinal Community House for pennies on the dollar," Raglow says.

SSM Health St. Anthony Hospital granted the respite center $40,000 in November 2021 to help with initial costs. After a trial period, the hospital entered into a formal agreement in February 2022 to pay a per-patient, per-day fee. Later that year, Mercy Hospital Oklahoma City began partnering with Cardinal Community House under a similar accord, paying $130 a day for each room.


Cindy Maggart, Mercy's executive director of post-acute care services, stresses the arrangement is truly a partnership that includes weekly interdisciplinary care-plan meetings at Cardinal Community House.

"How are our Mercy patients? How are they progressing? We want to know," Maggart says. "Our goal is to make sure that we get them well and that they don't end up back in the hospital."

Both Catholic hospitals are still gathering hard data about readmission rates.

Part of a bigger picture
This past September, while cleaning out a storage area, Maggart discovered 50 beds Mercy purchased during the pandemic but unneeded afterward. The hospital donated them along with 30 unused reclining chairs to Cardinal Community House.

"While we can't solve all of the problems with homelessness and access and social determinants of health, respite care is a step in the right direction," Maggart says.

Raglow hopes other cities will begin looking to Cardinal Community House as a model for caring for their unhoused populations.

As for the Oklahoma City partnership, he says the collaboration speaks distinctly to the Catholic mission "to value the dignity of each person and to work with all others of goodwill to serve the common good."


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