[NurseRotten]

HMO settles case of Skid Row patient dumping - CNN.com

LOS ANGELES, California (AP) -- More than a year after an elderly hospital patient was found wandering a crime-ridden area in a hospital gown and slippers, the nation's largest HMO agreed in a settlement with the city to changes aimed at ending the dumping of homeless patients on streets.
Kaiser Permanente will create new protocols for discharging homeless patients in its chain of hospitals, train staff and allow a retired U.S. district judge to monitor its progress, officials said Tuesday.

What do you guys think about patient dumping? We can't keep them in the hospital forever. Case managers, what steps should hospitals take to improve and expedite difficult patient discharges?

[Suesquatch]

Well, here in NY we hang onto them until we can find a nursing home bed.

They might be expensive, but turning the sick and incompetent out to die is simply inhumane, and beneath us.

[TrudyRN]

mixed feelings; It is completely inhumane BUT it is also not right to expect hospitals to pay for caring for these folks plus for illegal immigrants and other uninsured, plus do it all on what they are reimbursed for care by Medicare, Medicaid, and insurers.

Hospitals can afford only so much.

What's the answer? Very complex. Has to involve government, I guess, since we can't seem to get it together without Big Brother telling us what to do. One element - cut the salaries of lawmakers and hospital executives.

[NurseRotten]

We discharge to homeless shelters if the patient does not qualify for a nursing home bed. To expedite discharge, we have a nurse-initiated case management referral based on questions asked during admission. If we start working on discharge at admission, we can move them faster.

I remember one case in particular, the patient had a 35+ year history of ETOH abuse. His son was a firefighter and paramedic. The patient said that if we discharged him to a shelter he would leave and move back to his spot behind a service station that he had been calling home for a number of years. He did eventaully go AMA.

Sometimes, despite our best efforts to assist people, they simply do not want the help. And that is the patient's right.

[Suesquatch]

A shelter may be all that can be provided but it isn't the street.

And if someone wants to drink/drug himself to death it's their right. But we really need something better in place to deal with the deinstitutionalized mentally ill.

[Fire Wolf]

And if someone wants to drink/drug himself to death it's their right. But we really need something better in place to deal with the deinstitutionalized mentally ill.

I agree that there needs to be something for the homeless and the mentally ill. The government thought they were doing someone (who?) a favor by early discharges and refusing to keep patient's "locked up in looney bins."

And no matter how "stable" someone is on their medications, patient's often cannot afford to continue them as outpatients, or they stop taking them and have psychotic episodes which land them right back in the hospital.

Medical floors have patients with such high acuities that they are not capable of handling a mental patient off their medication along side 6 other's needing one on one monitoring or they'll crash. The ETOH patient's in withdrawal are placed right beside the fresh MI with chest pain that you are monitoring while the one across the hall is on a heparin drip and TPN and so on.

What has happened is that the mentally ill have become "the homeless." Correction facilities are now 50 to 80% filled with people who are not really criminals, but are mentally ill and unstable. They receive little to no treatment most of the time in the correction facilities and the goverment has only shifted where they "house" them.

I see people every week who come to the hospital only having left the one across town the day before. Being diabetic they go eat a box full of chocolate covered cherries and then come in DKA. Or homeless renal patients will skip a couple of dialysis appointments and come in needing emergency dialysis.

They literally live "in" the hospitals and only rotate through and we all pay the bills.

Sigh.....it can be very frustrating.

[NurseRotten]

I agree that our system is broken. But what is the solution?

[pickledpepperRN]

Originally Posted by NurseRotten

I agree that our system is broken. But what is the solution?

Good discussions about that here:

http://allnurses.com/forums/f100/

http://allnurses.com/forums/f287/