homeless pt's? - page 5

This is my first winter in the ER. The weather just turned really cold and yesterday I had 3 homeless pt's come in with vague complaints...one had just moved from a warmer climate to our bitter cold... Read More

  1. by   VeryPlainJane
    I see the number one problem as a lack of affordable housing. An avg. American that makes min. wage or even over can not afford decent housing. They did a study in my city, to show how much one must make to have avg. housing, It was 15.00 an hour. Sad. Remember two weeks ago the house passed it's new budget. They slashed college loans and grants plus food stamps, but then gave themselves a fat raise.
  2. by   teeituptom
    Quote from traumaRUs
    I see one commonality from all of us: our frustration with the current system.
    Yes the current dominantly Republican system, that where its not a family oriented problem then they dont want to deal with it. That is what is so frustrating. Its easier for them to ignore callously the plight of the homeless. The attitude of our Republican society of if they dont care for themselves then why should we care for them. Its not that easy or simple of a problem. What are we going to do, wait untill their bodies start piling up in the streets. We need to help these people now. We are so concerned with human rights in Afghanistan and Iraq, yet we show so little care, concern, and compassion for those within our own country. We are spending billions of dollars over there, but we cry and complain about helping our own. So many of our homeless are veterans of Viet Nam, and Desert storm. They have shed blood for our country yet we complain about assisting them. I see something very wrong in this picture!!!!!!
  3. by   kadokin
    Quote from babynurselsa
    We have numerous homeless shelters in our area. Yet, we still get in influx of the people in whenever it gets too hot, too cold, or too wet. Often it is because they are intoxicated and the shelters won't let them in until they sober up, or they have been barred for stealing and fighting.
    I do get extremely frustrated when I have a very sick person sitting in the waiting room because our beds are full and 1/3 of the beds are taken up with these cases. It frustrates me also that all of the shelters offer programs for detox, job training and placement, mental health services and housing assistance. The problem being you have to WANT to participate in thse things. You can't MAKE an alchoholic stop drinking, or a schizophrenic take meds compliantly, or a thief stop stealing. That is a step they have to make for themselves with the available support systems.
    I know that my sympathy/empathy for these members of society has dulled over the years. I don't think the ER has enough resources for the community as it is without being overwhelmed by persons who do not require ER tx, just a warm bed and a hot meal. Much less the workup for vague, bogus complaints that have to be done for fear of liability.
    What is the answer? I don't know.
    Yes, what is the answer. And to pawpaw John, would any other gov't in the world have better solutions? I think not. When poverty-stricken households still have access to cable tv and x-box, I kind of think our poor folks have it a lot better than poor folks in other countries. Just my .02 cents.
  4. by   kadokin
    Quote from VeryPlainJane
    I see the number one problem as a lack of affordable housing. An avg. American that makes min. wage or even over can not afford decent housing. They did a study in my city, to show how much one must make to have avg. housing, It was 15.00 an hour. Sad. Remember two weeks ago the house passed it's new budget. They slashed college loans and grants plus food stamps, but then gave themselves a fat raise.
    Yes! They ARE SHAMELESS OPPORTUNISTS and thieves of the worst kind! Vote these charlatans OUT OF OFFICE! The value of real estate/housing has grown to artificially ginamic proportions. One day, this bubble will burst, then what will we do? It is amazing the sea changes individual greed can reap.
  5. by   kadokin
    Quote from tam-traumaRN
    I have been an ER nurse for many years. Over time as I have paid higher and higher taxes for social programs I have found my political leanings falling further to the right. This is particularly a difficult subject for me because I have a brother 32 years old who is a homeless, drug addict. I have watched him throw away his life, his career (succesful artist), college education (parents sent him to a private university) and his family. He has been arrrested nearly 50 times, has been in and out of jail, detox and rehabs. I have witnessed to him, cried for him, prayed for him and written to him; all to no avail. He is now facing a prison term and my elderly parents have yet again bailed him out and hired another lawyer for him (his last fired him). This has gotten so bad that my parents have chosen to no longer speak to me because I have voiced my opinion regarding tough love. My heart breaks and I do not see a light for him. I wait for the call that says that he has finally ODd or been killed. The only way I can cope is to treat all homeless as if they are my brother with common decency, respect and compassion. I support our local homeless shelter because I cannot financially support my brother for obvious means. But none of this takes away the pain that I feel or the heartbreak of an addicted family member.
    I know this is a world of hell for you, but keep praying, God knows what he is doing. And keep us posted. We care.
  6. by   papawjohn
    Hey!!!

    Papaw John has learned the hard way (the only way I learn anything it seems) NOT to talk politics or religion at work. I am a liberal. I support only one charity and it is a homeless shelter that practices "tough love" approach to homeless in offering them the chance to re-make their lives. They HAVE to go to AA meetings, or be kicked out. They HAVE to work, or be kicked out. They HAVE to do 'chores' around the place, or be kicked out.

    I s'pose that makes their treatment plan "conservative". And I s'pose that only a minority of the homeless end up profiting from the plan. But it's the best that I can figure out.

    I agree that many homeless people simply CHOSE to live on the street. And we are fortunate in living in a country that offers so much freedom that someone can make that choice.

    I agree that a homeless person in the US is lucky compared to the lowest social group in the 'Third World', because of the overall richness of our society and the readiness of the American folks to offer individual and church based charity.

    I am impressed that there is such a big response to this topic in this forum. Proves that we are a group with a special 'caring' response to these folks, even if our response is frustrated anger that they WILL not get off the street.

    But the basic moral/ethical question remains (in my mind): If I lived in a million dollar condo and strolled out on my patio and looked down on a city park filled with dozens of homeless---would I feel like an ethical person who lived in a decent society?

    Obviously, I would not.

    So I am perplexed and frustrated like many here, but do not forget that it is essentially an ethical/moral problem for the larger (read: political) society, not isolated virtuous individuals.

    Thanx for mentioning me after all the other responses, Kadolin. I guess that means you read the whole thread from start to finish? I bet you'll agree that altho there's a lot of disagreement here--we'd all be willing to try to solve the problem if offered the chance.

    Papaw John
  7. by   VeryPlainJane
    Quote from papawjohn
    Hey!!!

    Papaw John has learned the hard way (the only way I learn anything it seems) NOT to talk politics or religion at work. I am a liberal. I support only one charity and it is a homeless shelter that practices "tough love" approach to homeless in offering them the chance to re-make their lives. They HAVE to go to AA meetings, or be kicked out. They HAVE to work, or be kicked out. They HAVE to do 'chores' around the place, or be kicked out.

    Papaw John
    They have to go to AA meetings? What if they are not alcoholics? I understand the job (even though finding a job and affording childcare can be very hard when you have nothing) and doing chores.
  8. by   papawjohn
    Hey VeryPlainJane!!!

    Uh, I s'pose that a homeless person without any substance problems wouldn't have to go to AA. But such a person would be in a remarkably small part of the homeless population. I don't wanna seem like a know-it-all!!! I know what I do from the people who run this homeless aid place--but the lady who explained their program (believe it or not-claimed to have a PhD in English but to have become homeless because of a severe alcohol addiction) had BEEN IN this program. She made the absoluteness of the rule (AA or NA or both--depending on the nature of the addiction) seem like one of the BEST features of their program.

    It also seems to me that the few people who end up homeless through loss of income but who have a job record and are willing to work (and do not WISH to be homeless) would find some sort of assistance and work themselves out of homelessness in a short time. Probably not move into my neighborhood or yours, but somehow would maneuver themselves into a group-home, then a trailer park, etc.

    One thing about America--there is work here and one can live pretty cheap if you just gotta!! When the conservative side of this debate makes that point, they're completely correct. And altho I'm on the Left--I acknowledge that they are correct. (If it were not true--there would be no influx of illegals over the Mexican border. And many of them work at menial low-paid jobs and STILL send money home to their family. THAT fact cannot be forgotten in this discussion.)

    Still, my question is: What should a large society do politically in the presence of this moral/ethical problem?

    Papaw John
  9. by   babynurselsa
    I think there are a couple of different groups as you have also alluded pawpawjohn. There are the TEMPORARILY homeless, due to loss of job or huge financial setback, etch. There are those who have made a lifestyle choice to be homeless.
    The temporary homeless get up and out and do what they need to do to change their situation. They get a job or even two, they accept assistance and get back on their feet.
    Then there are those that drink literine, lysol, huff carbuerator cleaner, or $2 vodka. They check into the ER and CLAIM to have had a sz, or chest pain, or difficulty breathing or detox. Or maybe they laid down beside the road and any number of helpful citizens called 911. They arrive to a nice warm room in the ER and begin demanding dinner and extra blanket and that you stand there and change the channel on the tv until you find them a show they want to watch. Then you do the obligitory workup for thier complaint while they smirk at you. They curse the social worker and/or the psych nurse for waking them and demand they leave the room. Then they sober up throw all of the community resource referrals on the floor as they leave to start this vicious cycle all over again. All of this while I have chest pains, lols with pnuemonia and difficulty breathing, CHFers etc sitting in teh waiting room waiting for an available bed.
    My frustration lies in teh fact that you can have all of the resources in the world and they are useless to someone WHO DOES NOT ACTUALLY WANT HELP OR TO CHANGE THEIR CIRCUMSTANCES. I understand the heartbreak for these families of these people. But unfortunately one of the freedoms of this country is the right to abuse the system, break your mother's/father's/sister's/brother's/childrens hearts and destroy yourself slowly if that is what you want to do.
    I still don't have the answers to fix this problem. Sometimes I wish there was a way that the hospitals could just say NO, this is your 107th FREE visit to our ER this year and we are not going to deny sick people tx any longer so that you can sleep it off here in one of our beds instead of jail.
    I know this sounds harsh and it may be. I have no problem stretching already thin resources for someone who has no resources and is sick and needs medical care. I am just tired of stretching the same few resources for those who don't want help.
  10. by   Warpster
    Babynurselsa wrote "My frustration lies in teh fact that you can have all of the resources in the world and they are useless to someone WHO DOES NOT ACTUALLY WANT HELP OR TO CHANGE THEIR CIRCUMSTANCES. I understand the heartbreak for these families of these people. But unfortunately one of the freedoms of this country is the right to abuse the system, break your mother's/father's/sister's/brother's/childrens hearts and destroy yourself slowly if that is what you want to do."

    I'll tell you what, when we become omniscient we can tell which patients to help and which ones to simply send to hell, bypassing the streets entirely.

    As for me, I try to help anyone who asks for it. That homeless guy who reeks of Everclear (and worse) who got in by claiming about nonexistant chest pain is still asking me for help, and it's up to me to figure out what he really needs and to point him in the right direction to get it, if there's any to be had.

    Again, living on the streets is a horrible way to exist. Most of those folks didn't wake up some day and decide "Gee, I want to be a homeless skid row drunk! That's the ticket!" Face it, we live in a country that is hostile to anyone who isn't young, healthy and well educated. Nobody actually wants to be homeless, nobody wants to be addicted, nobody wants to be mentally ill, and nobody wants to go without simple human dignity.

    "All the resources in the world" generally exist elsewhere, not here. Our country has become stingy.
  11. by   babynurselsa
    I do not see our country as all that stingy at all. Our communities, our churches and any number of agencies exist all around us. It all depends on what an individual CHOOSES to accept in the way of aid. I cannot MAKE a drunk stop drinking, a schizophrenic take his meds, or a huffer put down the aerosol can. I CAN link them with agencies that will help them if they choose to get help with these problems.
    The ER is not there to give out sandwiches to drunks. It is there to care for those who are emergently ill or hurt.
  12. by   GIGGLZZ

    This question really strikes a deep cord in me. I feel anyone in the emergency room is in need of my assistance, homeless or not. As a nurse I care for all injuries, self inflicted or not. These individuals have a host of medical problems. Poor nutrition, communicable diseases, addiction, mental illness, are just a few of the ailments they present with. I know that they may not adhere to my teaching, but it is my duty to try. I know that they may not accept the referrels for social assistance. To me it does not matter. This patient is in my care for what ever reason and I will do my best to care for him. I can not solve his social issues but I can't solve any of my patients social issues. I can feed his current hunger. I can administer the IV's and medication that has been ordered. I can give him a warm blanket and speak to him kindly. I remind myself that this patient is the reason I want to be a nurse. He may be the most person in "need" that I have met all day. I will give every patient, regardless of my percieved judgement of his situation, my best, compassionate, professional care.
    I feel sad when I see nurses perform less than their best when a "repeat" customer enters the emergency room. I understand the frustration of the extra workload and the absence of beds. However, rather than place my frustration on the patient I would rather use my energy to advocate for alternatives. In some communities there are facilities where these people's needs can be met without using the emergency room to "dry out".
    Maybe that is an answer, until then I will continue to offer what ever is in my abilitly to assist any of my patients.
    What do you think? I am curious to know if I am just being nieve.
  13. by   papawjohn
    Hey Y'all

    Doggone it!!! I really didn't mean to get pulled into this thread. As far as the ER Nurse's description of the impact of "trolls" on the delivery of emergency medical care--you are of course correct.

    The issue is that some solution to this problem needs to be found OTHER that an Acute Care Hospital Emergency Room.

    Obviously, we nurses in ERs and MedSurg units are not going to solve the problem of chronically homeless/dependent and demanding people. Thats why I say a solution--assuming one can be found--will happen in larger political and social actions.

    Once upon a time there was a CRIME: Vagrancy. I s'pose that was putting the problem of the homeless onto the PoliceDep't which has other things to do with their time. When it became 'de-criminalized' to be homeless--it ended up in the ER's lap. Where it also doesn't belong. We need to stop passing the buck and figure out what we're going to do to-or-for-or-with these people but figure it out as a whole society.

    Last thing I wanna do is seem to be putting ER staff down because of their totally justifiable frustration.

    Papaw John

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