By Julia Gaines

Recuperative care (RC) programs, in one form or another, have been around for decades, providing compassionate care and a safe “home-like” environment for people experiencing homelessness who are recovering from illness, injury, or surgery. Also referred to as “Medical Respite Care,” these vital programs offer key components including 24/7 access to a bed, three meals a day, and empathetic staff to help coordinate medical appointments, pick up prescriptions and monitor the patient’s health—much like a friend or family member would do for a loved one in the family home.  Additionally, according to the Models of Medical Respite Care (2025) by the National Institute for Medical Respite Care (NIMRC), recuperative care programs offer access to a phone for communications related to medical needs, a safe space to store personal items, and a wellness check at least once every 24 hours. Regardless of how services are delivered, the message of recuperative care has been simple: everyone deserves a safe place to heal.

Then, along came CalAIM.

Medicaid reimbursements for recuperative care services have been the end-game goal for long-term program financial sustainability. In some pockets of the country, health plans soft-launched their support through Alternative Payment Models (APMs)—also known as “performance payments” for recuperative care based on program outcomes. But the dream of statewide support for recuperative care remained unrealized, that is, until California Advancing and Innovating Medi-Cal (CalAIM) hit the scene in 2022.

Now dubbed “Medi-Cal Transformation,” the California Department of Health Care Services (DHCS) program was designed to streamline healthcare access and services, promote equitable practices, and address the health and social needs of all Medi-Cal members. While this revolutionary program has propelled recuperative care into the spotlight, created more beds for unhoused patients discharging from the hospital, and generated millions of dollars in program funding, recuperative care services as we know them have not been the same. Six-bed dorms in homeless shelters have been overshadowed by 60+ bed mega facilities. Non-clinical care coordinator staff have been replaced with full-scale teams of nurses and physicians. Additional services, such as onsite behavioral health, support groups, and substance use disorder treatment, are now essential services. And the once little-known field of recuperative care has become the most lucrative Community Support offered on the CalAIM menu.

The field of Recuperative Care is experiencing a significant period of growth and transformation—and the message is “bigger is better.”

Growth in ‘Person-Centered’ Care

According to NIMRC, recuperative care programs have more than doubled in California since 2023—with more coming online at a rapid pace thanks to the availability of state capacity-building funds like PATH CITED and an average Medi-Cal reimbursement rate of $201 per diem per patient. Managed Care Plans (MCPs)—the entities that dispense the dollars—are setting the bar high, demonstrating a preference to contract with recuperative care providers who offer onsite clinical care and a bundle of services for a one-stop shop experience that, ideally, yields better health outcomes and leads recuperative care clients down a successful pathway to permanent housing.

Emerging from the frenzy of recuperative care’s high-speed evolution is the notion that a “one-size-fits-all” approach to service delivery doesn’t adequately address patient needs. As recuperative care continues to fill a crucial gap in the health care system for the unhoused, another gap has appeared: a lack of programming and physical space that accommodates the unique needs of growing homeless populations. To meet these needs, California is seeing a growth in specialized recuperative care. Here are four recuperative care providers in California who developed specialized programs for individuals with certain diagnoses and/or for specific populations of focus—and seeing the enhanced client experience because of this customized, person-centered care.

A Healing Community for Older Adults

National Health Foundation (NHF) in Los Angeles, CA, isn’t new to providing recuperative care, but they blazed the trail to serve older adults experiencing homelessness when they opened the Arleta Senior Interim Recuperative Care Center in 2024. This two-story former assisted living facility contains an incredible 79 recuperative care beds—all of which are for seniors age 55+.

Doing a complete remodel of the building enabled NHF to focus on the accessibility needs of seniors. The facility has multiple elevators, and each floor has spacious accessible rooms designed to meet the standards of the Americans with Disabilities Act (ADA), including roll-in showers for wheelchair users. There are also nursing pod stations located throughout the facility, improving access to 24/7 nursing services. Beyond physical accessibility, Arleta’s hallways are intentionally painted in different bright colors to help clients with vision impairment or confusion/memory issues navigate the facility safely.

Arleta recognizes that their older clientele may need additional support to ensure their safety and ability to function independently. Durable medical equipment (DME), such as wheelchairs and walkers, and their accessories, is available to clients who may need it. Clients with mild symptoms of dementia may have more frequent wellness checks on the schedule. And Arleta staff will personally drive and accompany clients to medical appointments, not only to ensure they arrive safely, but also to advocate for their care with their health providers when they are unable to communicate their needs. “Really, it’s just a really beautiful culture here,” says Angie Negrete, Arleta’s Director. “We create spaces where clients are acknowledged and honored; where their word is heard and it doesn’t fall on deaf ears.”

Typical transportation options—a public bus, Lyft, or taxi—may be challenging for older clients to coordinate, and potentially dangerous if they have mobility or cognitive limitations. Arleta responded to this issue by bringing community services to the clients: Tarzana Behavioral Health offers counseling services onsite, County Human Services sets up a table for CalFresh benefit applications, the Department of Mental Health brings resources for clients, and Arleta hosts numerous scheduled groups to provide behavioral health supports and boost life skills, from anger management to self-de-escalation training.

Most notably, Arleta is piloting an ‘Intergenerational Program’ where Transitional Aged Youth (TAY) in the community, ages 18 to 25, are paired with senior clients to assist them with technologies, like how to use their cell phone, be a gardening partner, or help with finding resources. Best of all, this program facilitates supportive companionships that bridge the generational divide and bring joy to both the youth and the older adult. “It’s about creating different spaces for them to interact with folks outside of the program, to kind of build up their social skills and help them feel alive again,” says Negrete. “I think that a lot of them come through the doors and feel very defeated by their experiences out there. We show them that it doesn’t have to be that way, and how to best manage the outside world once they discharge from us.”

What Negrete really enjoys, however, are the social activities. “We’ve done bingo and karaoke. We hosted a Spring Egg Hunt, and a Spring Fling Dance with food and a backdrop so people could take photos,” she says, recalling the event fondly. “Staff stayed late to chaperone, of course. The clients were really getting down! It’s great to see them come back to life, once they realize this is a safe place, and regain some of the dignity they lost on the streets or feel like they are losing with old age.”

A Safe Space for Her

A woman’s experience of homelessness can be wrought with unimaginable suffering. Partner abuse and sexual assault that can occur on the street leave women feeling incredibly vulnerable, fearful, and hypervigilant, so it’s understandable that women would need a particularly welcoming and safe space in which to recover, mentally and physically.

San Julian Oasis Recuperative Care, a 40-bed facility located in the heart of the lively Skid Row neighborhood in Downtown Los Angeles, provides just that: a secure, women-only refuge from the chaos and dangers happening outside of its gates. Its pastel pink and green-colored walls, adorned with artwork and words of motivation, create a sense of calm and inspiration. The Community Room is spacious and peaceful with lots of fun activities to do, and the Oasis’ courtyard, filled with tropical plants and sunshine, allows clients to relax and shut out the world—a space that truly lives up to its namesake.

Operated by JWCH Institute, a recuperative care provider contracted with L.A. County for multiple sites, San Julian Oasis offers individualized case management, counseling, onsite medical providers, and community-building activities to break down communication barriers and build meaningful relationships between the women clientele. “It’s very complex, I would say, because there is so much trauma involved. So, there are some moments where clients might not get along with each other, and that is where the therapists and the case managers come in,” says Jacqueline Azucena, LCSW, Program Director of San Julian Oasis. “We offer very nurturing, empathetic care, because the women we serve are vulnerable and maybe they don’t know how to behave differently. Maybe they can learn how to better communicate and to create healthier friendships because they might not be used to having healthy friendships.”

Lisa Cherqaoui, RN, the Clinical Director of Recuperative Care Programs for all JWCH’s facilities, says San Julian Oasis is different from other RC programs. “The clients do form bonds with each other; they do have a better understanding of each other. Because they’re all female and they all share some of the same problems.” Cherqaoui recalls the first time she came to San Julian Oasis: “There was a client outside on the Oasis patio area who was crying. And then there were two other clients, one on her left side, one on her right side, kind of rubbing her shoulders and telling her it’s going to be okay and to ’just breathe.’”  “I really appreciate that she had that, that sense of community, and that they were supporting each other and helping each other.”

And unlike other recuperative care programs that confiscate weapons, clients at San Julian Oasis are offered amnesty lockers outside of the main door to store items not allowed in the facility, such as drug paraphernalia, pepper spray, and knives. “When the clients leave our facility, they feel safer having these items on them for protection,” says Azucena, who notes that clients are checked and reminded to place these items in their amnesty locker prior to reentering the facility. Amnesty lockers are not monitored by staff, and clients hold the key for direct access.

The average length of stay at San Julian Oasis is about six months, but some clients may stay up to a year to achieve housing. Clients may also enter and exit the program numerous times before they accept services. With one out of three San Julian Oasis clients discharged to permanent housing, this hidden oasis truly transforms the lives of women ready to leave life on Skid Row behind.

The courtyard at JWCH’s San Julian Oasis Recuperative Care. Photo courtesy of JWCH.

A Recovery Home for Families

At an undisclosed location in Santa Ana, CA, sits a house that gives an amazing gift: the ability for unhoused families to remain together while their child recovers from illness.

The first large-scale recuperative care facility in the country designed for children and their families, Illumination Foundation, opened the Children & Families Recuperative Care program in 2024. “We always saw the need for having medical care services available to these children,” says Pooja Bhalla, the CEO of Illumination Foundation, which has eight recuperative care facilities across Southern California. “But they are a part of families, and these families are literally living in their cars or living in shelters. Just like our adults in recuperative care, those are not places to recover from medical conditions.”

The house, which is, of course, “child-proofed” for safety, can accommodate up to six families, with one child client and up to two family members in a fully furnished private room. While food is provided, parents are given full access to the house kitchen so that they can prepare meals for their families. Having kitchen access is different than the staff meal preparation or meal deliveries of a typical recuperative care program, but it gives parents more autonomy over what their family eats, teaches parents how to care for their families, and allows for their sick child’s special diets to be accommodated.

The Children & Families Recuperative Care program welcomes children of all ages, with the youngest so far being six months old. Diagnoses can range anywhere from bone fractures to cancer, but just like standard recuperative care, the child does need to be medically stable to be served safely in the program.

Recuperative care staff are onsite 24/7 to offer parents support. “A large part of our work is educating the parents on how to manage their child’s medical condition,” says Bhalla, who notes that staff make sure the parent understands how to administer their child’s medication and get them to their follow-up appointments. “The child is their responsibility, and we’re providing medical oversight and coordinating the child’s medical care.”

Bhalla notes that parents are typically very receptive to staff guidance, feeling empowered with the parenting tools to manage their child’s medical treatment plan. “They’re like ‘Oh, okay, I’ll check their temperature every two hours,’” Bhalla says as an example of a parent’s response. “They just never had the training or the opportunity to learn how to best care for their child.”

A Focus on Behavioral Health

Behavioral health (BH), such as mental health concerns and substance use disorders, often accompany the homelessness experience. BH services have made their way into recuperative care programs, which, thanks to a push from DHCS, now widely accept referrals from psychiatric hospitals and rehabilitation treatment centers for recovery from BH conditions (previously, qualifying diagnoses for recuperative care were only related to physical health or acute medical conditions).

One program in Riverside, CA has built its program around providing outpatient day habilitation and therapy services to its recuperative care clients. Helping Hearts California. started out with eight social rehabilitation facilities and opened their first recuperative care program in 2021, accepting client referrals from the San Bernardino County Sheriff’s Department to divert unhoused people with repeat offenses and BH concerns from incarceration.

“We were all seeing the same individuals move through this cycle of crisis, hospitalization, incarceration, and homelessness, just at different points on their journey,” says Dr. Ashley DeVito, DSW, Director of Forensic Program Development. “We realized that we were all working in silos on our own specialty piece, so we asked ourselves, ‘How can we come together and form a stronger network to break this cycle? Why are we just shuffling them from one institutionalization to another?’ Because nothing is changing.”

Christal Hampton, President of Helping Hearts California, recalls one client referred by the Sheriff’s Department who was arrested 47 times in one year for “survival crimes”— nonviolent offenses like trespassing or stealing what they needed to survive and mitigate their circumstances. “What they really need is mental health treatment or stable housing paired with mental health support,” she says. “Jails are not mental health providers. That’s not their specialty. But they have the largest population of people with behavioral health issues in the County.”

Helping Hearts California will even accept inmates still under electronic surveillance. “They are wearing ankle monitors and are technically still in custody, but they’re able to receive (mental health) treatment in a less restrictive setting,” says Hampton. “The Sheriff’s Department has a saying:  you can’t get well in a cell.”

Vulnerable Populations Served

While periods of considerable growth in any industry can create feelings of instability, it’s hard to doubt that California’s support for recuperative care has provided opportunities to individuals experiencing homelessness to receive post-acute care and other treatments that they otherwise would have been denied. Whether it’s children or seniors, women or inmates, the expansion of recuperative care in California has allowed a wider net to be cast to catch special populations—a significant improvement in increasing accessibility to vital post-acute care and an opportunity to work towards real solutions to end homelessness.

Note: This article is supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.