Finding the Missing Link: Transitional Housing, Shared Housing, and Medical Respite as Strategic Pressure Relief
Shelter systems across the country are strained like never before. As homelessness rises and affordable housing production lags, communities are facing the unthinkable:
Shelters are becoming long-term housing by default.
For people experiencing homelessness — especially seniors on fixed income, people with health vulnerabilities, and those exiting institutions — this is not just inefficient: it’s harmful.
But there is a structural solution — one that doesn’t wait for new housing units or multi-year developments to come online.
Transitional housing, shared housing, and medical respite are the missing link between emergency shelter and permanent housing.
If you haven’t read it yet, start with the Public Housing Authority blog on this topic:
That post makes the case for the “missing link” in a PHA context. In this post, we’re going deeper into why this matters for homeless system design, how these models work in practice, and what it looks like to implement them through a SPARC-oriented systems strategy.
Why the Missing Link Matters Now
Let’s be honest: homelessness response in most communities has been reactive rather than strategic.
Outcomes like reduced shelter stays, improved housing retention, and lower system cycling are talked about, but the interventions to deliver them are often missing.
Two major dynamics are driving the urgency:
☑ 1. Permanent Housing Takes Time
Affordable housing development often takes years — from financing to occupancy. In contrast, emergency systems need solutions now.
☑ 2. People Are Getting Stuck in Shelter
Especially seniors and people with health challenges — many remain in emergency shelter far longer than intended because:
Permanent housing isn’t available,
Support funding doesn’t follow them,
Their needs aren’t suited to emergency shelter.
This is no small problem: seniors are one of the fastest-growing segments of the homeless population, yet systems lack appropriate stabilization pathways for them.
The Structural Funding Gap for Seniors
One of the most glaring system failures is not clinical — it’s financial.
Shelters often provide stabilization work for seniors that is unfunded because the payer system doesn’t align with the services seniors need.
Here’s the core issue:
Medicaid can reimburse case management, peer support, and supportive services in many housing settings, including shelters.
Medicare — which covers most seniors — generally does not pay for these same services in shelter environments.
The result?
Shelters provide long-term, unfunded stabilization — which:
Depletes staff bandwidth
Reduces capacity for others in crisis
Prolongs shelter stays instead of creating flow
This isn’t a service gap; it’s a funding mismatch.
What Transitional Housing Actually Does
Sometimes transitional housing is dismissed as “just temporary shelter.” That’s a misunderstanding.
Transitional housing — when implemented strategically — functions as:
✔ Flow Management
It moves people out of emergency shelter into a stable setting where housing readiness can be built.
✔ Stability for People Who Don’t Need Intensive Support
Many households, including low-income seniors, are ready for housing but cannot move directly into permanent housing due to supply constraints.
✔ A Pathway to Permanent Housing
With a clear exit plan and supportive services, transitional housing improves housing outcomes and reduces returns to homelessness.
Examples include:
Time-Limited Transitional Housing
Ideal for households who need time—not intensive services—to secure housing.
Recovery-Oriented Transitional Housing
Works well for people exiting treatment or institutions.
Bridge Housing
For people with high needs who require stabilization before permanent placement can succeed.
Shared Housing — The Fastest Pathway to Capacity
Unlike new construction, shared housing repurposes existing housing stock — and it can be stood up quickly.
Shared housing includes:
🏠 Shared Homes
Unrelated adults share a single family home with light oversight. This is particularly effective for:
Seniors with fixed income
Individuals whose needs are low-to-moderate
🤝 Peer-Run Shared Housing
Peer managed homes with shared expectations and mutual accountability.
🧩 Master-Leased Shared Housing
An organization leases housing and subleases rooms with light support.
Why shared housing matters:
It’s cost-effective
It gets people out of shelter quickly
It creates housing flow without waiting for development
In communities with limited development capacity — especially rural areas — shared housing is one of the highest-impact tools available right now.
Medical Respite — Health Stabilization That Works
Medical respite is a short-term stabilization setting for medically vulnerable individuals who:
Are too ill to recover on the street
Don’t require hospitalization
Have no safe place to recuperate
For people experiencing chronic health conditions, untreated injuries, or post-surgical recovery, medical respite provides:
✔ A safe place to recover
✔ Support that reduces readmissions
✔ A bridge to housing placement
Medical respite not only improves health outcomes — it reduces system cycling and hospital costs.
Implementation: How Systems Make It Work
For transitional housing, shared housing, and medical respite to actually relieve pressure — they must be implemented as part of a coordinated system, not siloed programs.
That’s where a SPARC strategy becomes essential:
🔹 System-Level Targeting
Define who each intervention will serve (e.g., seniors on fixed incomes, people exiting hospital with no housing, people with chronic homelessness histories).
🔹 Pacing and Throughput
Determine how long people should be expected to stay, and what exit plans look like.
🔹 Access Pathways
Design entry from shelter, hospitals, corrections, and outreach.
🔹 Responsiveness to Need
Match the right setting to the right person at the right time.
🔹 Continuous Data & Improvement
Use HMIS and system performance data to refine pathways, reduce exits back to shelter, and track outcomes.
Without this level of system orchestration, these models become isolated and lose their pressure-relief impact.
What Success Looks Like
When implemented strategically:
✔ Shelter stays shorten
✔ Permanent housing placements increase
✔ System costs per household decline
✔ People experience more stable outcomes
And importantly:
People are housed in settings that meet their needs — not stuck in settings that do not.
Closing the Loop: From Shelter to Home
Transitional housing, shared housing, and medical respite are more than programs — they are system design elements.
They do something that emergency shelters cannot:
They create flow.
While affordable housing production remains essential, it’s unrealistic to expect shelters to function as long-term housing or stabilization settings.
As one community strategist recently put it:
“We can’t build our way out of today’s crisis with tomorrow’s housing.”
Instead, we need to use all the tools we already have.
That’s the missing link.
➡ Read the PHA perspective here:
The Missing Link: Transitional Housing, Shared Housing, and Medical Respite as Pressure Relief for Shelter Systems
By Matthew Vorderstrasse, M.A., PHM