Todd Ward arrived at his room at Bonvouloir House in August 2022. There wasn’t much to it — basically just a bed — but it was a clean, safe and relatively comfortable place to live while he recovered from a bladder infection that hospitalized him for two weeks. Without it, Ward would have been living on the streets; he’d lost his housing a few weeks before getting hospitalized.
“I had a tube going up in me and bladder issues,” Ward said in a recent interview. “I had to have a stable environment.”
Ward, 51, is one of more than 200 patients who’ve lived at Bonvouloir House through the medical respite program since it started accepting patients in 2018. The respite program was run by the Community Health Centers (CHC) and funded by the University of Vermont Medical Center. It was intended to give unhoused people a place to recover from medical procedures or ailments that didn’t require hospital-level care. It was likely the only program like it in Vermont or New Hampshire.
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According to a representative from the UVM Medical Center, the program saved the hospital system an estimated $9 million over its tenure.
After more than five years in operation though, in July, the medical respite program at Bonvouloir House was quietly shut down. UVM Medical Center and CHC declined several interview requests. In written statements, the organizations said in recent years the care needs of the individuals in the program exceeded its capacity.
“The medical respite program was designed as a short-term, non-clinical bridge from the hospital to eventual community-based housing,” a representative for CHC said in a written statement. “As the physical and mental needs of potential residents continued to rise, it became increasingly difficult to accept patients into a program with no constant onsite nursing or medical care.”
Its closure comes as the state’s unhoused population has grown. Since the program opened, Vermont’s homeless population has nearly tripled — driven in part by the state’s extremely tight housing market and the winding down of pandemic-era protections, like rental assistance and Vermont’s emergency motel housing program. The state now has one of the highest rates of homelessness in the country, and this fall, more than 200 people were sleeping outside in Burlington, up from 80 last year, according to the city.
An abrupt ending
Residents and staffers at the medical respite program say they were caught off guard when the program ended, and in one case, a resident only had two days to find a new place to stay.
Ward, who lived at Bonvouloir House for nearly a year, was one of the final people in the program. He’d known for a while that he needed to have a heart valve replaced. After the bladder infection cleared up and he had some teeth pulled, it was time. He had the heart surgery on April 12, 2023, and was set to spend the four to six months recovering at the medical respite program. During that time, he wasn’t supposed to lift more than 10 pounds, and he needed lots of rest.
Ward said he was assured that he’d be able to stay until August or September — the duration of his recovery period. (Vermont Public also reviewed a text message where Ward was told this.)
But in July, only three months after his heart surgery, Ward was told he needed to leave. At first, he was able to argue for an extension, but eventually he was given 10 days to find a new place.
“There's a part of your brain that just has to be comfortable,” Ward said. “And that got taken away — carpet being pulled out from under me.”
Staff also didn't realize how abruptly the program was ending. They didn't hear the news until someone requested a meeting with CHC management, after the final residents had left.
“I said, ‘Wait a minute, I’ve already worked my last day,’” said Jeffrey Jarrad, a former staffer. “I had no idea that was going to happen.”
Another resident had even less time than Ward to find a place. Louise, who asked only to be identified by her middle name, spent just over seven months at Bonvouloir House recovering from a fractured toe and broken ankle. She’d lined up permanent housing for the beginning of August, but on July 10, Louise said she was told she had to be out in two days.
Her only option, besides sleeping outside, was to pay for a hotel room out-of-pocket until her permanent housing was ready. Louise, 30, said she’s struggled with substance use and addiction for the past decade, and while she was at the hotel, she relapsed.
“I did not maintain my sobriety,” she said. “The two weeks I was at the hotel, I just, I think the stress really got to me, and I just felt kind of betrayed or hopeless.”
CHC declined to comment on the experiences of residents or staff, citing “HIPAA and personnel protections.” In a statement, a spokesperson for CHC said the program shut down after the last resident transitioned to new housing at the end of July, and that all the residents were medically cleared to leave and “offered ongoing medical support as appropriate.”
“We’ve never received a complaint or grievance related to the medical respite program’s transition,” a spokesperson for CHC said in an email.
Filling a hole in the health care system
The medical respite program at Bonvouloir House was first announced when UVM Medical Center gave a nonprofit housing developer, Champlain Housing Trust, $3 million to buy and renovate a motel in Burlington. The housing trust converted the motel into eight apartments: Three units — with a total of seven beds — were set aside for the respite program. Five remaining apartments were turned into permanent housing for chronically homeless people with medical vulnerabilities, according to VTDigger.
“This is exactly the kind of investment we need to make if we’re going to achieve the goal of improving the health of our communities while controlling the costs,” Dr. Stephen Leffler, now president of the UVM Medical Center, said in a 2016 press release.
The program was not unique. There are more than 140 other medical respite programs like it across the country, also called recuperative care. They’re lauded as helping hospitals save money by freeing up beds and reducing how often patients have to be readmitted.
In Vermont, hospital capacity has been a huge issue.
“Every single day, we have 50 to 70 beds taken by people who don't need hospital care, but can't leave the hospital,” Leffler told Vermont Public last year.
Those beds cost $2,800 per day on average at UVM Medical Center, according to a spokesperson, and go for similar rates at another major hospital in the region.
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Besides potential cost savings, medical respite programs are designed to keep people healthy.
“It’s better care coordination, and continuity of care,” said Julia Dobbins, who leads the National Institute for Medical Respite Care, a group that supports programs throughout the country and shares best practices. “It’s an opportunity to rest, to recover, to heal, to build community, and really to work on housing goals.”
Like at Bonvouloir House, many of these programs have struggled to keep pace with the higher medical needs of their populations in recent years.
“We know that our population is getting older and more fragile, and we have seen the clinical needs go up,” Dobbins said. “It costs more to provide that level of care.”
“Trust me when I say that because there were many, many times that I thought of suicide, that place saved my life, in my opinion."Randy Wallace, former resident of the medical respite program
But rather than closing, more of these programs have opened in the U.S. than ever before, as the need, and funding opportunities, have grown.
These programs all work a little differently, but the one at Bonvouloir House operated a lot like many others: It was run by a nonprofit with most of its funding — in this case, $400,000 a year — coming from a hospital. It didn’t have clinical staff on site, which is fairly common at medical respite programs, according to Dobbins. Instead, residents received their medical care nearby, often from a clinic called Safe Harbor, also run by CHC.
Many residents were in rough shape when they arrived at Bonvouloir House, and former staff say most struggled with substance misuse.
"You’d see somebody — I would think, 'They’re going to be dead the next week,' because of the way they looked. And they survived and were resilient," said Tom Fowler, a staffer who worked at the facility for more than four years. “It really was a needed program.”
Most patients stayed a few days to a few months. The program required people to be sober, so sometimes people were kicked out for repeatedly using drugs or alcohol, CHC said in a statement.
Former patients like Randy Wallace say the medical respite provided a lifeline. He stayed there for several months in 2020 and 2021, while recovering from surgery and undergoing radiation and chemotherapy.
“Trust me when I say that because there were many, many times that I thought of suicide,” Wallace said in a text message to Vermont Public. He lives in Florida now, and is still in treatment for lung, throat and mouth cancer.
“That place saved my life, in my opinion,” he wrote.
Other residents of the program, like Todd Ward, say they had a good experience as well. Ward said there was a shared kitchen where he’d sometimes make meals, like quiche, for himself and others.
On Thanksgiving, he cooked everyone a turkey breast. The staff at the respite program were “dynamite,” Ward said.
“I felt like I was cared about,” he said. “I didn’t feel alone.”
Long-standing issues
But Bonvoulior House could be a tough place to work. According to five former staffers interviewed by Vermont Public, there were persistent communication issues with management and lack of support, especially in the final months of the program.
Long-standing concerns about mold at the facility exemplified some of the problems between staff and management, former staffers said.
Rachael Townsend first saw black mold in the closet of a resident’s room in the summer of 2019, when she had just started working at the respite program full-time.
She told her supervisor and other coworkers. Then, she started getting sick: She had trouble breathing, nausea, headaches, brain fog, swollen lymph nodes. Her symptoms got worse as the weather turned colder, and she spent more time inside, with the windows shut.
“I just remember feeling sick when I was there,” Townsend said in a phone interview. “And if I had a few days off, I would feel better. And then I would return and immediately feel sick again.”
Townsend lives in Lincoln now, and stopped working at the medical respite program in 2020.
In December 2019, Champlain Housing Trust, the property manager, hired a contractor to conduct an air quality investigation. It concluded the section of the basement beneath residents was “compromised relative to mold” and it was “possible that compromised indoor air is migrating into occupied areas of the building.” The report also noted that airborne spore levels in the facility were “non-existent or benign.”
A spokesperson for Champlain Housing Trust said in an email they did the recommended remediation work, including removing basement materials, and installing a dehumidifier and pump to remove water.
More recently, in 2022 and 2023, staff members again raised concerns about potential mold problems to CHC after finding standing water in the basement and waiting months to get replacement filters for air purifiers.
Several staffers who spoke to Vermont Public said they felt their concerns were dismissed, and that CHC would not share the 2019 air quality assessment with them, as required under federal regulations. At a staff meeting at the beginning of the year, a manager at CHC said the report was “no one’s business” in a recording reviewed by Vermont Public.
Townsend said she was only able to see the report after she got in touch with Vermont’s Occupational Safety and Health Administration in 2020.
In an email to staffers shared with Vermont Public, a manager at the medical respite program wrote, “All tests done at Med Respite were shown to be at acceptable levels. The sole incident of staff sickness were due to their own personal body makeup. CHC takes its staff’s health very seriously.”
CHC declined to answer questions about their response or the staff’s concerns about the mold. Champlain Housing Trust, the property’s manager, said there were no reports in their files about requests for replacement filters, and that during an inspection in May they didn’t find any water in the basement.
"I just remember feeling sick when I was there. And if I had a few days off, I would feel better. And then I would return and immediately feel sick again."Rachael Townsend, former staffer
Another challenge staff flagged was around medication for residents. Under state regulations, only licensed providers, or people working under them, can handle medications at this type of facility.
In practice, staff said the program’s policies were inconsistent, and they were put in the position of handling controlled medications, like ones used to treat opioid use disorder.
“We were told, 'This is how you dispense the meds,' we did narcotic counts,” said Tom Fowler, the longtime staffer. “Then we were told we shouldn't touch the meds.”
In the final months of the program, several staffers said they pushed for clearer procedures around medication management and for training about how to assist patients with self-administration.
CHC referenced this as one of their justifications for closing the program in an email to Vermont Public.
“We realized our staff were being put in untenable positions by wanting to provide a certain level of care, yet not being contracted to do so, such as medication management,” a representative wrote.
No plans for reopening
In the final years of the program, referrals from UVM Medical Center dropped as the state’s expanded emergency motel housing program offered additional discharge options for people experiencing homelessness, according to CHC.
This summer though, federal funding for the expanded motel program ran out, and the state imposed stricter eligibility rules that limited how long people could stay in motels.
It’s unclear if there will be a replacement for the medical respite program that was housed at Bonvouloir House. The three apartments set aside for the program are now being rented out as permanent housing units by Champlain Housing Trust, which still owns and manages the property.
In written statements, UVM Medical Center and CHC said it was a mutual decision to close the respite program, and they’re working to figure out what’s next.
“This group of partners came to the realization that the funds allocated to support very few people through this program could be better used to serve many more people if the program were [reimagined],” said a spokesperson for CHC by email.
In a statement, Champlain Housing Trust said they’d offer to work with UVM Medical Center to “host this program at another property either in our portfolio or to identify a new building if they find the need for medical respite is there.”
Todd Ward and Louise — the final residents at the program — are both currently in stable housing. Louise lives in South Burlington in an apartment. UVM Medical Center helped Ward move to another Champlain Housing Trust property in Shelburne in July.
Ward said the recovery from his heart surgery has gone well, and that he’s able to work six days a week at his job at a fast food restaurant in South Burlington. But he said the way his time at Bonvouloir House ended was frustrating and stressful, and he wishes that it was still around.
“All I know is that program was ideal,” Ward said. “It sucks it went away, because there’s more people like me, behind me, that need it.”
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