“If you have a church that is by day providing services and nothing at night so [the homeless] are coming to you at night, then you should go over to the church and discuss if there is something we can assist with or if there are other resources available,” he says. “It may not be that the hospital has to come up with the solution, but we can be part of the thought process and overall solution for the community.”
It is also important to work closely with local police to ensure members of the transient population are treated properly.
“We often see the emergency petition or behavioral health complaint as a tool that law enforcement uses that really doesn’t meet the objection of getting the help these folks need,” says Sheets. “Trying to work with them and finding which community resources best fit the needs of these folks is where we can collaborate better and work with the government to get funding in those areas as opposed to utilizing the hospital emergency department as the primary resource for the homeless.”
Be Careful When Discharging Homeless Patients
Once a patient who is homeless has completed treatment, another challenge that hospitals often face is how to properly discharge them. That’s where security and other concerned hospital staff can be particularly helpful, perhaps placing patients in nursing homes until another residence can be found.
Glasson is proud of a situation that one of her former hospitals resolved:
“We had an individual who made too much to qualify [for assistance] but not enough to survive,” she says. “The patient was near the end of her life, and the security people actually went to the organization’s leadership and said, ‘If this person goes back out on the street, the next time they come in, they probably won’t walk out.’ Leadership pulled a team of social workers, care providers and security together. A local charitable organization was assigned guardianship, and that individual lived out the remaining six months of her life in a clean environment that took care of her and made sure she was safe and comfortable.”
In some cases, however, law enforcement must assist because the patients won’t leave despite hospital staff finding them a place to stay, issuing food vouchers and the like. When this occurs, many hospitals issue trespass notices, which usually results in the homeless patients leaving campus.
When it comes to discharge, Glasson recommends clinicians and security staff refer to CMS, as well as legal counsel, risk management and care planning so they avoid the potential for patient dumping.
Hospitals Can’t Solve Homelessness by Themselves
No matter how well hospital security personnel, administrators and clinical staff are trained and work to do the right thing by their local homeless population, they can only accomplish so much if the problem is not addressed by society as a whole, says Sheets.
“It’s not just an issue for healthcare,” he says. “It’s an issue for the communities involved and how we manage this whole issue of homelessness. The resources for mental and behavioral health have dried up at the federal and local levels. The primary source for acute care for these folks becomes the hospitals. It drives up the cost for everyone.”
This article was originally published in 2013.
