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

hospitalstaph · Oct 9, 2007

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.

We usually try to get them a cab pass so that they can go to a local shelter. Most, however, decline the offer and just request some food, which we are happy to provide (atleast I am)

You should feel good about what you did. If you had the money to spare, it is the moral thing to do to help another. Morality does not require the recipient to be grateful and turn their life around. Are you naive and stupid? Not in my book:)

caroladybelle, BSN, RN · Oct 9, 2007

In NYC, the facilities had significant connections with shelters and charitable organizations, if the patient had a medical issue that required continued care. The appropriate OP/meds treatments would be provided. NYC probably had one of the most extensive social services that I had seen.

The problem comes in that all shelters come with a certain amount of rules to maintain hygiene, legality, moral integrity and safety. And unfortunately, there is a large population of homeless that refuse to obey even the simplest and most minor rules. They want to continue to live their lives without rules.....making them difficult to place or keep in a shelter....they fight over minor things, pee on the floor, use drugs openly.

I quite literally had a patient admitted for VRE infection of a wound...no veins...serious mental issues...walked off the unit for hours if he pleased. Social work set him up with all his meds, housing/meals, OP treatments...thousands of dollars of gratis treatment. Two days later we find him panhandling outside Mickey Ds, selling his meds and sleeping in the alley.

ohmeowzer RN, RN · Oct 10, 2007

we try to get them in shelters. we have had a few patients that insisted on going back on the street. so we let them go.

Altra, BSN, RN · Oct 10, 2007

I work in an urban ER and see many homeless patients. If they ask for help in getting a bed in a shelter then I get the social worker involved. However, as caroladybelle pointed out, many have been there and done that and come to the ER after being evicted from all the shelters in town for fighting, stealing or using drugs. I am very willing to provide these patients with food while they're in the ER and an extra something to take with them. I am also willing to be a little slow to discharge them in the winter if we are not crazy busy. If the waiting room is not full they can generally find a seat in the waiting room and many do sleep there. Security gets them moving in the morning.

I'm not blasting you at all. You did what you did as an individual act of compassion. However, I understand your coworkers' concern -- will that patient understand that you, ERTraumaJunkie the individual, did this ... or will he associate this "help" with going to the ER?

Without going into detail I have taken it upon myself to personally help a couple of people. But I did it after my shift was over and without using any hospital resources (including time or phone use, etc.) to do so.

Charity you provide as an individual is strictly between you & your conscience, but understand that you cannot involve the hospital without opening up a significant mess of legal exposure and social/safety issues that you will not be able to control.

sharona97, BSN, RN · Oct 10, 2007

If the patient was lucid, but homeless and needed medical attention and went to the er, I'd have felt the same way and probably did what you did. You never know when you are entertaining an angel...........

Levin · Oct 10, 2007

You really have to understand the subculture. If you want to deal with it.

Shelters are often not safe places.

Many have serious violance issues, that goes for womens and youth shelters as well.

Odds are you treat more homeless people than you realise, it's just that since they don't behave anti-socially and don't smell you'd never dream of thinking they were homeless, because of the stereotype that exists.

Levin.

trainer2070 · Oct 10, 2007

Here our shelters are full and the over flow shelter is just as full. We deal with dozens of homeless everyday and a a few hundred for the weekly total. Its the same people time and time again. They have the system down pat, I have chest pain, SOB or I want to kill myself, now take me back give me a bed a blanket and some food until you kick me out.

I can tell you for a fact that the average homeless person gets about 2 minutes to enjoy the comfy ED lobby chairs before we kick them out or tresspass them.

We have some housekeepers that feel sorry for them and give them their food and money. Then they wonder why the same person comes back everyday looking for them?

I'd be compassionate if it were one or two every now and then, but here its a full time battle keeping them at a distance or our lobby would turn into its own homeless shelter.

Elvish, BSN, DNP, RN, NP · Oct 10, 2007

I may sound like a bleeding-heart here, and so be it, but I didn't say it: "So help your brother along the way, no matter where he starts. For the same God that made you made him too.....these men with broken hearts." See my siggy line.

I have done similar things though not in the ER, as I've never worked there. If that's what you have to do to be able to sleep at night, then do it. I don't see as how you did a thing wrong. Thank you for your compassion.

My dad was at one point homeless after he & Mom divorced. I remember vividly on weekend visitation sleeping in a room of a church that allowed him/us to sleep there because he was a member and they had good hearts. It's one thing to enable, but it's never wrong to help. JMO.

HM2VikingRN, RN · Oct 10, 2007

..............

Elvish, BSN, DNP, RN, NP · Oct 10, 2007

Thanks for that reminder, Viking.

HM2VikingRN, RN · Oct 10, 2007

Thanks for that reminder, Viking.

You are so welcome! I think it is easy to forget what is really important. I view nursing as a form of ministry and I only hope that I am worthy of filling that role for another person.