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.
It's possible that neither the OP, nor the homeless person is Christian. I wish we could keep religion out of our discussions about nursing practice.
Helping someone on your own time is wonderful, but I would not want my hospital seen as a provider of services that we are not set up to deal with. There's definitely a need, but ER's are overwhelmed as is.
Friendly moderator note. I can appreciate how some people use their religion in their nursing practice, but we would also appreciate the long Bible quotes not to be your posts. Perhaps saying something like "my religion asks me to do such and such.......those whose posts I edited please reconsider. I don't want this thread to deteriorate to a discussion between the religious and the non-religious. Thanks.
I discharged an 82 year old to the streets yesterday. She didn't qualify for a nursing home because she had no nursing skills needed and was a walkie talkie and took no meds. She got a monthly check, had adequate money in her pocket and made her decision, although we offered her alternatives.
Usually if you come from the streets, you go back to the streets. However, we should treat each and every patient with the same compassion and understanding and nonjudgment.
I'll let the ER social worker talk to them about possible shelter options, but like others have said, if they have been kicked out of all the local shelters, or refuse to follow shelter rules (want to drink, use drugs, etc..) then they go back out onto the street. I think it's great you paid for the guys motel room, but I personally wouldn't do it. Now he is going to expect that every time.
Specializes in cardiology, psychiatry, corrections.
It seems that most of them do get turned back on the streets, at least where I am. I am a paramedic and used to work 911 for a lower middle class suburb. There was a homeless alcoholic we used to run on DAILY. (He has passed away since.) The two closest hospitals used to get ticked at us whenever we brought him in. Sometimes he was offered a local shelter, but he usually refused. He chose to live on the streets, and he had relatives nearby who had tried to help him, but couldn't and finally gave up on him. He was a nice guy when he wasn't drunk. I had even dealt with him at times when he wasn't. Once he walked up to my ambulace one cold winter night just to talk. My partner was sleeping in the back on the stretcher, so I let the man sit in the front with me and warm up. BELIEVE ME, I would have NEVER done that for just anyone, but I knew this guy and he was harmless. I joked with him, saying "isn't it strange to be in the front of the ambulance rather than the back?" He chuckled and said that I probably knew him better than he knew himself, that I knew his DOB and SSN and that the cops would track him down so fast if he did anything. We talked for about 20 minutes, then he left.
This topic also made me wonder: what do ER's do about psychiatric patients who state they are suicidal but you know they really just want off the streets or out of their current living situation for a few days? If the ER doc refuses to admit the pt, then the pt harms him/herself, can't the Dr or hospital be liable?
ERTraumaJunkie, that was a very nice gesture on your part, most other nurses would not have done that and you deserve Kudos :yelclap: but I would definitely stick to my guns and not help that pt like that again or he may continue to come to you when in trouble.
I consider myself a very compassionate and helping person. However, I've come to realize that I can't save the world and as an individual with limited resources, there is only so much that I can do. My thoughts are that I am a nurse and professionally that is how I help people. I see my role as directing others to the appropriate agencies, etc., that can specifically aid them.
Unlike the OP, I live in large city where there are more resources to help the homeless.
On another somewhat related note, while riding the bus l witnessed a young man boarding the bus near one of our large hospitals in a hospital gown and paper slippers. A hospital employee (I don't think a nurse) accompanied him and was evidently paying his bus fare. I never could quite figure that one out. Many passengers on the bus attempted to offer help, but the "patient" seemed comfortable in just getting to his destination.
Wow. We atleast send people out dressed. Wehave cheap sweats available to give away if we need to cut clothes off, or they are too disgusting to touch more than once. At $10 per item I'd say it's worth every penny.
The op's problem was a rural area with not a lot of options, plus it was a Sunday.
We've done the same thing on occasion. There are no options here and the nearest shelter is 70 miles away.
We had a homeless teenager give birth - with no place to go on discharge. We all chipped in and bought her a week at a local motel and called a local church (mine), who found her a woman's shelter.
Each given location and situation has its own logistics. As such one needs to to look at them individually. My current practice location does not provide cab rides period end of discussion.....but one can never say never because on rare occasion the patient family services department will offer to pay for it. Then that creates the problem of the next time that same patient is here..."well you got me a cab last time." Course if you attempt to assault me, my staff, my security officers or other patients or sneak your drugs in to my hospital then you are not going to get crap from me.
canoehead, BSN, RN
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