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Medical Respite/Recuperative Care Directory Form, 2023
Program Information & Profile: *will be listed in the Directory as public information.
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Email
*
Your email
Name of Medical Respite Program:
Your answer
Year that the Program was Established:
Your answer
Name of Operating Agency:
Your answer
Street Address:
Your answer
City:
Your answer
State
Choose
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississppi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Your answer
Program Contact:
Your answer
Email:
Your answer
Website:
Your answer
Mission & Vision:
Your answer
Operating Agency Type:
HCH
FQHC
Non-profit
Hospital
Other:
Facility Type:
Shelter or Shelter-based
Standalone Facility
Assisted Living Facility/Skilled-Nursing Facility
Apartments
Motel/Hotel Rooms
Transitional Housing
Other:
Clear selection
Total Number of Recuperative Care Beds:
Your answer
Average Length of Stay:
1-14 days
15-30 days
31-45 days
46-60 days
61-90 days
91+ days
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Funding Sources for Medical Respite Program:
Hospital
Medicaid or Managed Care Organization (MCO)
HRSA
Local/State Government
Private Donations
Foundations
Religious Organization
United Way
Other:
Populations Served:
Men
Women
Families
Veterans
Older Adults (55+)
Unaccompanied Youth or Minors
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