homeless pt's?

  1. 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 dry climate and was pretty sick with an asthma exac. 2 of the homeless pt's I had were found a shelter for the night and one was admitted for etoh detox. But trying to find a place for them took me a long time. Not only did it take me a long time, but it seemed that everyone was just too burned out to really help.

    My question...How do you deal with your feelings on this. My heart just about broke. A few of the long-timers said things like "these people have made choices in their lives and this is what happens" Or "you can't fix the planet" or "don't feed them, they just come back"

    I'm no bleeding heart. I do see that people made choices and took the road that lead them down these paths. I'm just curious to see what your feelings are about homeless pt's in the ER. Do you feel that they are "wasting your beds" are you able to go home and forget about the pathetic pt's? I guess I'm just looking a way to figure out why I feel guilty about having so much when people have so little.
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  2. 74 Comments

  3. by   papawjohn
    Hey Scrmblr

    You're a richer person because of the contents of your soul. Good for you for taking the interests of your Pt so seriously.

    Homelessness is a terrible problem here in FLA. There are stories of (always un-named) "cities up north" buying their homeless citizens "one-way bus tickets to Florida". In my city there are huge Condo's being built in the down-town area--1/2million $ apartments, $25,000 just to get into the lottery that will determine who has the right to buy one when it's finished!!! And the view these people will have when they step out onto their patio is an urban park filled with homeless people pushing their belongs around in stolen shopping carts!!

    It's a challenge to both the Right and Left. But the solution (whether conservative or liberal) has to be the Government. And government in the USA is in a sad state these days.

    Shaking my head sadly
    Papaw John
  4. by   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.
  5. by   Tweety
    Fortunately we have a social worker to help find these patients places to go from the ER, or inpatient.

    I feel for the homeless too. But we are there to take care of them medically, and perhaps point them in the direction of help, community resources. As cold-hearted as it is, we are not there to fix their homelessness and their broken lives.

    We have to detach with love and sometimes that means sending them back out into the streets to the life they were living prior to them walking into the ER.

    As cold hearted as it is, you have to acknowledge there are people that take advantage of ERs for warmth and a good meal. There's no harm in giving someone a hot meal, or letting them sleep off a drunk and get warm, but is that the hospital ER's mission?
    Last edit by Tweety on Nov 22, '05
  6. by   AuntieRN
    I used to work and live in a small town in Western Mass. We had an elderly man who was homeless. He lived on the side of the highway under a cardboard box. Visitors to our town were forever dialing 911 because they thought he was lying on the side of the road dead. He was not dead, he was usually drunk and passed out. He would occassionally come into the ER on really really cold nights. We would offer him food and a bed for the night but, he had to give up his bottle because he could not have alcohol in the hospital. You could not get within 3 feet of him either before he became very combative. Very difficult for the EMS and ER staff to try to treat him.This man would choose to stay out in the cold instead of giving up his bottle. People in the community would leave clothing and blankets for him by his site and he would not touch any of it. He did not want anything from anyone. Well come to find out....this man chose to be homeless. He had a couple of children and all kinds of money in the bank. He just chose to live in his cardboard box once his wife died and noone could convince him to live any differently. He lived like this for probably 10 years until one night when he had a heart attack and died. He died in his cardboard box though.
  7. by   scrmblr
    I think I will need to figure out why I feel so guilty for having so much when some have so little.

    I am new in the ER and I have not seen as much as some of you have. I hope that I can stay empathetic without it coming home with me, so to speak.

    Our social worker had gone home for the day. All he told me was "go to the hospital website and the resource page will give you some phone numbers
  8. by   traumaRUs
    I work in the Midwest and its cold. I'm an ER case manager and one of my jobs is finding resources for people. However, the homeless continue to strain our dwindling resources. I too feel very sorry for these people. If these people don't have a family that is involved, they end up in very precarious circumstances. Many die. It is so sad.
  9. by   ojoern
    I have a lot of mixed feelings about homeless people. You have all sorts of reasons for people to be homeless: loss of job/income, mental illness/substance abuse, plain bad luck, and personal choice. Homeless people are a strain on E.D.'s that are often under-resourced and overburdened as it is. Often their needs are few, though some can really suck up your time being needy and/or demanding.

    Personally, I have no problem letting someone get warm or feeding someone who's hungry as long as it doesn't become habitual, because that's not what the E.D. is for. I have a problem with positive reinforcement and enabling of repeated bad behavior and poor decision making. This happens a lot and is one of the reasons we have this mess. Some people are just doing what they have to in order to survive and I understand that quite well. Some people just want to continue in their dysfunctions and expect us to help them do it.

    I think you have to take it on a case by case basis.

    Thanks,
    Joe
  10. by   Jerico
    [QUOTE=traumaRUs]I work in the Midwest and its cold. I'm an ER case manager and one of my jobs is finding resources for people. However, the homeless continue to strain our dwindling resources. I too feel very sorry for these people. If these people don't have a family that is involved, they end up in very precarious circumstances. Many die. It is so sad.[/QUOTE

    It is very sad. Call me cold hearted but:

    People have to make many choices in life.

    Many don't have family involved because of their anti-social, non-conforming attitudes and behaviors. Others are on the street because they won't take their medications, stop drinking, or stop the drug seeking.

    In the majority of cities in the U.S. there is a wealth of programs available to help people UP and OUT.

    There are rules members of society must follow and it is a CHOICE to follow the rules in order to be helped UP and OUT. Like taking medications, like stopping alcohol, like stopping the drugs.

    The true sadness I feel is that life is too hard for some, so they succumb to the immediate "easy" way out.

    Then on the other hand I think: If a human being is not strong in mind and heart and soul - do they NEED to be here? Isn't it sad for the weak to have to endure life's trials and tribulations if they haven't the mind, heart and soul to survive?

    Do we do these people any favors by attempts at "saving" them?
  11. by   sjrn85
    Then on the other hand I think: If a human being is not strong in mind and heart and soul - do they NEED to be here? Isn't it sad for the weak to have to endure life's trials and tribulations if they haven't the mind, heart and soul to survive?
    Wow...I hope I am totally misinterpreting this. :stone
  12. by   Jerico
    How ARE you interpreting it?:stone
  13. by   sjrn85
    That it's better to just let these people die because they're of little value. (And I don't think it's amusing at all.)
  14. by   traumaRUs
    I too was wondering what this meant. However, my interpretation is that these people are pretty helpless and need more help than we can provide.

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