Do you just turn the homeless back out onto the streets?

[HopeItWorksDNP]

I'm in a small, rural area so I don't have to deal with nearly as many homeless as those of you in large urban areas. My question is: What do you do with them at discharge? Do you just discharge them back onto the streets?

For example, I recently took care of a "local character" who had been evicted from the roach motel he had been staying in. He had no money for an additional night. Nowhere to go this particular night. He came to the ER hoping to be admitted so he would have somewhere to lay his head. MD refused to admit him in order to prove a point (even though BS and BP were both high enough to justify admission).

I spent quite a while trying to secure housing for him. It was a Sunday so of course, no agency offices were open. There are no homeless shelters in my town. My coworkers were absolutely nasty to me when I finally, with no other option, paid for 2 nights in the local roach motel (no, I didn't give him a dime of cash). The cops drove him to the motel and checked him in to ensure the money was used properly. It was not a large amount of money and I felt better knowing he had somewhere to lay his head.

I gave him the numbers of local agencies he could contact the next day. I adamantly told him I would never help him again if he didn't do something to help himself (i.e., using the resources I gave him to secure housing). But my coworkers are worried he will return to the ER time and time again hoping I'll take care of him. And thus causing them to have to deal with him as well. The point they missed is that it wasn't about him...it was about me not being able to tell him, "sorry, you have nowhere to sleep tonight, but get out of my ER." I'm not that type of person.

So, blast away if you must for me being naive and stupid and trying to help someone that doesn't help himself....I heard it all in person on Sunday. But while you're blasting, could you tell me what you do at your hospital? Thanks.

[alkaleidi]

Not naive or stupid at all.

We discharge homeless people quite often to the streets (their "home") -- I generally print out a list of shelters and provide them with it. I deal with these people both at the ER and at the detox facility I work PRN at.

I have enough debt, I can't afford to spare money for hotels, but it's admirable you did that for this patient, and I am sure on some level they are very appreciative. One night we had a guy come in to detox and wanted a bed -- he flat out told us he was told he had to be drunk to get admitted, and went on to give us the "I'm serious about stopping drinking -- I want to quit" speech. However, he also told us that he doesn't go through withdrawals, denied any sx of w/d's or DTs, said he drinks 3-4 days a week... also uses opiates. We only had 1 opiate bed left, and due to it being busy for detox, I couldn't see myself admitting someone who was drunk wanting a place to lay his head who wasn't going to be detoxing from ANYTHING when that 1 opiate bed could and was filled later by someone who actually needed it.

I did, however, apologize that the government doesn't take care of its veterans, and thanked him for serving our country. I gave him referrals to shelters, only to find out that he had a bed at one of them currently! Also found out he had burned his bridges with another one after showing up repeatedly totally intoxicated and being belligerent toward the staff. Kind of like you said -- people have to help themselves as well (and follow the rules when someone is helping you out).... we ended up calling the emergency psych team that dropped him off and they came back to pick him up and take him to the shelter he was living at.

I guess part of me wondered how he could afford to be an alcoholic, another wondered why the government STILL hasn't come up with a way to take care of our veterans who have served and fought in wars, and then another part was irritated that this person was given a warm bed and free meals, and couldn't have the decency to at least abide by the few rules the establishment had set for those who chose to reside there.

Kudos to you... discharging the homeless has to be done -- otherwise the ER becomes yet another homeless shelter. Referrals are best, both to shelters and social services that can somehow link these people with resources to help them get out of the situation they are in. Their job is to follow through and take some initiative themselves -- you can't help someone that doesn't want help and doesn't want it enough to do some of the work themselves!

[jayne109, RN]

We never used to have to discharge people from the ER to the streets but our city closed one men's shelter, you have to have $15 to get into one and the other you have to go into their hand up program for 18 months and they screen them 0800-1630 only. We have women's shelters but no men's shelters anymore. And it is understandable because a lot of our men have burned a lot of bridges. But on the other hand, they are our problem now because they continually check in multiple times per day for meals and stuff. We have one guy that has been in 6 times in 2 days. That is expensive for our hospital but there is not another place for him. I commend the OP for her actions.

[HopeItWorksDNP]

I'm the OP and I want to thank all of you that replied to my post. And thank you for reassuring me that I'm not a naive idiot as my co-workers had made me feel last Sunday.

I had two nurses, a lab tech, and our ER doc tell me what a dumb thing I was doing because that meant every time this pt had a problem, he would show back up at our ER. The thing is, he has always showed up at our ER. That's why we know him so well. The criticizing went on for 3 hours that day until I broke down in tears. I guess they felt bad for making me cry, because they finally backed off.

Just a little more info on the pt: he isn't habitually on the streets. I don't know that he has ever had to spend a night on the street. He normally resides with a family member or manages to put himself up in a motel. This time he had been evicted from the motel because he had no money to pay. The family member he was with earlier in the month had stolen his disability check to buy drugs (he's had more than one extremity amputated). So he really had no choice if we turned him out. There was nowhere for him to go and we have NO, I mean NO, resources available in my town. He would have been sleeping on a rock.

After his two nights in the motel were up, he went to see his PCP. Turns out, he wasn't just homeless. He was also very sick. And in my ER doc's hurry to "prove a point" he completely missed the fact that this pt was sick. He was admitted to our hospital for his illness and will be going to a NH when he's stabilized. His PCP told me he thinks he has less than a year left.

And last night when I checked on "my" pt after my shift, he thanked me with tears in his eyes for helping him. He's thrilled to death to be going to the nursing home so he doesn't have to worry about where he'll get his next meal or where he'll lay his head. Can you imagine your life being so bad that being placed in a nursing home was a huge improvement? I just hope his last few months are easier for him than the last few days.

So thank you again to all of you that offered me words of encouragement and support. Just knowing there are others out there that haven't lost their sense of compassion and empathy helps to restore my faith in this profession. Thank you so much!!!

[sharona97, BSN, RN]

Give yorself a big hug!!!!!! You are the nurse of angels:balloons:

[Levin]

I'm glad it worked out so well. :) Well done. Levin

[traumaRUs, MSN, APRN]

Your compassion will carry you far. There is never anything wrong with sincerely trying to help others. I am so sorry you were the subject of ridicule for your actions.

[teeituptom, BSN, RN]

Can we please keep politics out of this too?

out with politics, ok

out with religion, ok

leave Golf in

[teeituptom, BSN, RN]

Yes I just turn them back out into the streets after a good meal.

thats a problem that will take a lot more than me to solve

[CRNA2007]

No need to blast away it is your money and you should do with it as you see fit. If you want to pay for the guy a night to stay then I can't understand how anyone could complain. I can understand where the co-workers believe in the "stray cat" theory but that doesn't always happen.

I'm in a small, rural area so I don't have to deal with nearly as many homeless as those of you in large urban areas. My question is: What do you do with them at discharge? Do you just discharge them back onto the streets?

For example, I recently took care of a "local character" who had been evicted from the roach motel he had been staying in. He had no money for an additional night. Nowhere to go this particular night. He came to the ER hoping to be admitted so he would have somewhere to lay his head. MD refused to admit him in order to prove a point (even though BS and BP were both high enough to justify admission).

I spent quite a while trying to secure housing for him. It was a Sunday so of course, no agency offices were open. There are no homeless shelters in my town. My coworkers were absolutely nasty to me when I finally, with no other option, paid for 2 nights in the local roach motel (no, I didn't give him a dime of cash). The cops drove him to the motel and checked him in to ensure the money was used properly. It was not a large amount of money and I felt better knowing he had somewhere to lay his head.

I gave him the numbers of local agencies he could contact the next day. I adamantly told him I would never help him again if he didn't do something to help himself (i.e., using the resources I gave him to secure housing). But my coworkers are worried he will return to the ER time and time again hoping I'll take care of him. And thus causing them to have to deal with him as well. The point they missed is that it wasn't about him...it was about me not being able to tell him, "sorry, you have nowhere to sleep tonight, but get out of my ER." I'm not that type of person.

So, blast away if you must for me being naive and stupid and trying to help someone that doesn't help himself....I heard it all in person on Sunday. But while you're blasting, could you tell me what you do at your hospital? Thanks.

[canoehead, BSN, RN]

After replying to your post and advising against helping I found myself in a situation where I gave a repeat patient $20 to buy gas. He didn't take advantage afterwards, and they really needed the boost. So I guess it's all a judgement call.

[tyrailia]

And last night when I checked on "my" pt after my shift, he thanked me with tears in his eyes for helping him. He's thrilled to death to be going to the nursing home so he doesn't have to worry about where he'll get his next meal or where he'll lay his head. Can you imagine your life being so bad that being placed in a nursing home was a huge improvement? I just hope his last few months are easier for him than the last few days.

So thank you again to all of you that offered me words of encouragement and support. Just knowing there are others out there that haven't lost their sense of compassion and empathy helps to restore my faith in this profession. Thank you so much!!!

Bless him and BLESS YOU you sweet woman!