Caring for Our Community: Safe Housing for Homeless Hospital Patients

Posted on Aug 18, 2015

As he talks about his current situation, Ed Stump quickly mentions he is thankful for the blessings he’s received. While he was recuperating from a heart attack at Alta Bates Summit Medical Center, social workers discovered that Stump, 57, didn’t have a safe place to go when he was discharged.

“I was new to the area and I didn’t have a place to live,” he recalls. “I was dealing with a number of health problems and I was afraid of being on the street.”

In the past, when a person in Ed’s situation was released from a hospital stay they would recuperate on the streets, out in the elements. Their health would have improved more quickly if they had rested in a bed in a safe place. Often their conditions worsened and they were soon re-admitted into the hospital.

New cover shot website

Thanks to a partnership between Alta Bates Summit Medical Center and LifeLong Medical Care, Ed Stump found a safe place to recuperate after his hospital stay.

Care, Dignity and Support

A collaboration between Sutter Health’s Alta Bates Summit Medical Center and LifeLong Medical Care provides safe housing for homeless hospital patients like Mr. Stump. Vulnerable members of our community get a chance to recuperate with dignity and to receive resources to help guide them out of homelessness.

All participants are screened and referred to the program by Alta Bates Summit social workers. The program assists homeless hospital patients with:

  • Finding a clean, safe place to heal for up to six weeks
  • Medical and mental health care
  • Transportation, housing and substance abuse services
Steve O'Brien

Steve O’Brien, M.D., Alta Bates Summit Medical Center’s chief medical executive

“Ensuring patients get routine medical care has helped improve their health outcomes and they are less likely to be readmitted to the hospital,” says Steve O’Brien, M.D., Alta Bates Summit Medical Center’s chief medical executive. “The program not only affords people the time to schedule follow-up appointments with a primary care provider, but a chance to address other factors that can contribute to their overall health.”

Medical home, community resources

Launched early in 2014, the Interim Care Program has expanded to a total of three sites in Oakland and Berkeley to support homeless members of the community. Recently discharged patients receive healthy meals and 24/7 access to a single or double room, so they can rest comfortably and regain their strength in a safe environment.

In 2014:

  • 55 homeless patients discharged from Alta Bates Summit entered the program
  • 33 days was the average length of stay in a shelter
  • Only three patients were readmitted to the hospital within 31 days
Brenda Goldstein website

Brenda Goldstein, MPH, Psychosocial Services Director at LifeLong Medical Care

“This program has produced impressive outcomes by connecting patients to a medical home and helping people enroll in eligible programs and support services,” says Brenda Goldstein, MPH, Psychosocial Services Director at LifeLong Medical Care. “It’s all of these positive interventions tied together that have helped improve the quality of life for these patients.”

Listening and Learning to Live Again

A drug and alcohol counselor for more than 20 years, Tonnette Guzman LifeLong’s case manager for the ICP, works to understand each client’s challenges.

“I really try to listen to our clients and figure out the best way to help them,” she says. “I know these people need a lot of support so I hold their hand and help guide them every step of the way. I check in with clients two to three times a week to make sure they’re taking their medications, visiting their doctor and developing short term goals they can reach.”


Tonnette Guzman (far right) with program participants Patricia Brown and Ed Stump

Guzman also helps by linking clients to:

  • Mental health services or substance abuse recovery
  • Transportation to doctors’ appointments and pharmacies

“Tonnette has been extremely helpful and she’s given me the confidence to start doing everything myself,” says Stump. “Because of this program, I have a roof over my head, I have food and every day my health keeps getting better and better.”

‘Every Day Gets a Little Better’

Patricia Brown moved into her own apartment in Oakland after completing the Interim Care Program. Because she requires dialysis treatment for kidney failure, Brown needed a home and help getting to appointments and taking her medications.


Patricia Brown now lives in her own apartment in Oakland.

“When I entered the program I had no energy and I had difficulty walking,” she says. “Having an advocate like Tonnette, who cared about my welfare and opened a lot of doors on my behalf, was very important. I’m stronger and back on my feet. It’s still a struggle but every day gets a little better. I want to dance again. That’s what I’m striving for.”

Patricia is enjoying life again thanks to the Interim Care Program.

Kim Pavlakos website

Kim Pavlakos, LCSW, social worker at Alta Bates Summit

“This program offers vulnerable people in our community a chance to address the most basic needs in their lives,” says Kim Pavlakos, LCSW, Social Worker at Alta Bates Summit. “I get so much gratification from patients who are so appreciative they have a safe place to go following their hospitalization.”

Priority Need: Ensuring Access to Primary Care

Through its not-for-profit mission, Alta Bates Summit is providing more than $1.2 million to LifeLong Medical Care in 2015 to fund the program and help other East Bay residents gain access to primary care and key social services.

Learn More Online

To learn more about Alta Bates Summit’s community benefit programs and see how our partnerships in the community help underserved and underinsured residents in the East Bay, visit


  1. I have a friend who needs more information about the Interim Care Program.
    An older man, well-educated, nearing 60 years of age, is in Alta Bates hospital presently and will have need for housing when he is released.
    Please let me how, and to whom to speak, about this matter. Thank you.

    Jon Crowder

    Home phone: 510-900-6135

    • Thank you for your inquiry. Someone with more information about the Interim Care Program will get in touch with you.

  2. It could be that someone is not talking to someone else. It seems that this friend of mine that I mention in the post is confused about why he is not being helped as promised. Could someone please let me know a phone number of someone with whom to speak to follow-up. Thank you.


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