Dumped in America

[HM2VikingRN, RN]

bill moyers in the nation: for america's sake

america needs a different story. the very morning i read the message from the progressive activist, the new york times reported on carol ann reyes. carol ann reyes is 63. she lives in los angeles, suffers from dementia and is homeless. somehow she made her way to a hospital with serious, untreated needs. no details were provided as to what happened to her there, except that the hospital--which is part of kaiser permanente, the largest hmo in the country--called a cab and sent her back to skid row. true, they phoned ahead to workers at a rescue shelter to let them know she was coming. but some hours later a surveillance camera picked her up "wandering around the streets in a hospital gown and slippers." dumped in america.

is this the america we want? where the sick and poor are turned away from our hospitals to die?

[Jo Dirt]

is this the america we want? where the sick and poor are turned away from our hospitals to die?

may not be the america you want, but it's what we've got.

the sick/poor/elderly are seen by the government as drains on society and it's a surprise to me they even called a cab to get her out of there. humans are expendible in the eyes of the government. it's all fine for them to spend untold amounts of money on war and for your sons and daughters to become maimed and killed fighting for the rich, but don't expect anything when you come back.

and if you're poor and sick don't expect anything, either. we're told healthcare is a privledge not a right. the world doesn't care.

[HM2VikingRN, RN]

I care enough to advocate for a better world. Thats why I posted the issue.

[pickledpepperRN]

I care enough to advocate for a better world. Thats why I posted the issue.

Thank you Viking!

Healthcare Index Page

[elkpark]

There have been a few other threads here on this same situation (the Kaiser hospital in LA discharging people to homeless shelters), and further discussion. This happens in every urban area of the country every day, and has for a long time -- it just hasn't gotten noticed and talked about much until lately.

I've worked in large, urban hospitals where we regularly discharged people to homeless shelters -- after they had been treated for whatever their acute, immediate problem was and there was no longer any need/justification for them to remain inpatients in an acute care hospital setting -- and, in my experience, Kaiser is going "above and beyond" to transport them by cab to the shelter. The hospitals I have known just gave people the street address and telephone # of the shelter and showed them the door (the same as they don't routinely provide transportation home to other clients who are being discharged).

I realize the story makes a great, sensationalist headline and tugs at everyone's hearts, but what do you want hospitals to DO? (Again, in my personal experience, which is all I can speak to,) hospitals often see and treat homeless people who had no place to live before they came to the hospital; the hospital social work departments (in my experience) do everything they can to try to find the person a more stable living situation while s/he is hospitalized, but that is v. difficult to do if the person doesn't have resources (and clients often refuse to go live in a more structured setting if you find it and offer it to them -- and I'm not spouting conservative slogans, I'm talking about my own personal experience)).

So, in those cases, what is the hospital supposed to do when the person is medically stable and ready for discharge??? Just let the person keep living there forever?? They don't put them out on the street -- they arrange a bed at a local homeless shelter and, in the case of Kaiser, even provide transportation to the shelter. That is an appropriate discharge plan for someone who has no place else to go. What other options does the hospital have?

I'm as much as a leftist/flaming liberal/bleeding heart as anyone else on this board, but I'm also a realist. This is a situation in which hospitals are caught in the middle of a much larger social problem, and it's not fair to hold hospitals responsible for the problem when they are doing the best they can with the resources they've got to work with.

[Katnip, RN]

While I deplore homelessness and the way people have to suffer, how was the hospital wrong? I'm no fan of Kaiser, but what is the hospital supposed to do?

The report admits it doesn't know how the woman was treated. We don't know if her medical problem warranted an admission-probably not. We don't know how severe the dementia is, or what is causing it. Malnutrition, maybe. But even if the hospital admitted every homeless person-which they can't-they'd end up back on the street and in the same boat they are now.

The hospital then sent her in a taxi to a shelter. You can't force someone to stay in a shelter if they do not want to. Many shelters are only open at night, anyway, so the people have to wander around until it's open. Or the shelter was too full.

I've met many inner city homeless folks who say they are in more danger in shelters than in the street.

It is definitely a system problem. Hospitals don't have the resources or legal right to make someone do something they don't want.

There are not enough shelters.

Most homeless shelters are in undesirable, unsafe neighborhoods. People who live in safer neighborhoods don't want homeless shelters in their backyard.

There is a stigma against most homeless people-the stereotype is they are all drunks and druggies. Often true, but not always.

The government and most private charities don't contribute enough to support good shelters. People in our society don't want to "see" we have such a huge problem. They'd rather put their money into adorable orphaned infants in third world countries.

I personally do what I can. But I don't see an end to this problem any time soon.

[KIAN]

I agree with you elkpark. It's great for people to find the problems and let others be aware of them but, what are their solutions? Who is held ultimately responsible?

[gr8rnpjt, RN]

Although Kaiser is the largest HMO in the country, it was not the HMO that sent the pt to the shelter in a taxi, it was the hospital. Just wanted to make that distinction. Also, as a case manager for a Medicaid HMO, I have learned that good case management starts with a good discharge plan, and I try to get the discharge plan on the date of admission. If the HMO is involved, there will be case managers and social workers within the health plan, as well as the case managers at the hospitals, who will be working on a safe discharge plan for the pt. Sometimes it takes all involved to work out a good discharge plan. This population is difficult to manage at best. Like someone else said, they were homeless before admission and lots of them refuse to be placed in a shelter. Sometimes the best discharge plan is the only plan that pt will agree to. We try to place pt's in personal care homes, most times they dont want to do that.

[pickledpepperRN]

Kaiser owns and runs its own hospitals.

The woman was dropped off in the street. No bed had been arrainged.

NPR : Kaiser Faces Charges for Dumping Homeless Patient

[ICRN2008, BSN, RN]

I ran into a situation once where one of my patients was homeless and had no place to go after discharge. They were concerned, with him being a post-surgical patient, about the risk for infection if he returned to the street or a shelter. In his case, they arranged for a short-term stay at a rehabilitation facility until his surgical wounds could heal. However, I have little doubt that he returned to the street after that. I feel for him, but it is up to him to turn his life around by making use of the resources that were provided to him.

At a certain point, when the individual is reasonably healthy, it again becomes his or her responsibility to take care of himself or herself. It is society's responsibility to find a solution for homelessness, but it is not each individual hospital's responsibility to find a stable living situation for every homeless person who walks through their doors.

Providing financial support to organizations like the drug rehab programs, job training programs, rescue missions and homeless shelters is an important way to help alleviate this pervasive societal problem IMO.

[hope3456, ASN, RN]

From what I can see, this happened back in March '06 but in Nov '06 is when charges were pressed against Kaiser, so the case is developing right now. It will probably be somewhat of a 'precedent setter' and hospitals everywhere will be watching to see what happens.

[pickledpepperRN]

Diana Bonta apologized. She did not make an excuse.

Kaiser advertises, "We want you to live long and thrive."

I heard on radio news that she has a diagnosis of Alzheimers. How is she going to turn her life around?

I pray we advocate for a dignified life for sick old people. I am sad that in my country we let old sick confused people be dropped off on a dangerous street where they have never been wearing only a hospital gown and paper slippers.

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