Homeless Survey Template: Respite Care

The Respite Care survey template helps organizations assess the quality of temporary rest and recovery services provided to individuals experiencing homelessness who are recovering from medical conditions, illness, or injury.

When someone who is homeless leaves a hospital or medical facility, they face an immediate crisis: they have nowhere safe to rest and recover. Standard discharge planning assumes a patient has a home to return to. Without respite care, people who are medically fragile return to streets or shelters, where healing is nearly impossible and readmission rates skyrocket. Respite care fills this critical gap in the continuum of care.

This survey template collects feedback on the comfort, safety, and adequacy of the respite environment, the quality of medical and personal care received, and whether participants felt their recovery needs were met. It also measures whether the transition from respite care back to other services was well-supported.

Use this template to demonstrate the clinical and housing outcomes enabled by your respite program, identify areas for service improvement, and build the evidence base needed to sustain or expand funding. Quality respite care reduces hospital readmissions, saves healthcare system costs, andmost importantlygives individuals the dignity of recovering in a safe environment.