homeless pt's?

[scrmblr]

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.

[LovelyLady01]

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?

i dont agree with what you are saying at all i think everyone is here for a reason. even though it may not seem like they have a purpose. only god knows. there are many people these days that struggle and are less fortunate without out any explaination.

also there are the ones who have talked down on the less fortunate (like you did) and then god gives them a slap in the face for a reality check.

[color=#2f4f4f]

:lol_hitti

i am not trying to judge but someone needs to get off their high horse because that sounds like the devil. i dont think anyone should talk negatively about anyones misfortunes or lifestyle. everyone has a story to tell but no one but that person walked a day or a lifetime their shoes.

:innerconf

[bethin]

I am not trying to judge but someone needs to get off their high horse because that sounds like the devil. I dont think anyone should talk negatively about anyones misfortunes or lifestyle. Everyone has a story to tell but no one but that person walked a day or a lifetime their shoes.

:innerconf

Exactly. I was trying to explain that but I guess it didn't come out right.

[bethin]

Wow, a lot of judgements running around in this thread. I do not feel qualified to make any judgements about the quality of a person, or their strenghth. I really do not see how any of us can even think we are qualified to make these decisions or make blanket statements about "The weak" It depends on how weak is defined and then it continues to get into a downward spiral of confusion.

As far as homeless people- they do come in to the ed. There are some creative ways to give them help, but if they do not meet the criteria for admission, we are just too busy to let them have a bed to sleep in- we have to discharge them. We have our Social Worker give them alternatives, and they can take advantage of them when they want to. If intoxicated, or mentally ill- we have a way to place either one. Most of the ED's I have worked at also have an area for these people that is reserved for them, so it doesn't "take away from the sick people" Our manager always planned for it, since it is not a new phenomena, it shouldn;t be taking any ED by surprise.

Tp be honest, I really do not spend a lot of my time worrying about these people... I do spend time volunteering at the shelter, collecting coats for the "Give a kid a coat" campaign,do ESL teaching, and every week when I do my shopping I buy about 10.00 worth of food and drop it by the local food bank of wherever I am...but I have realized that I am not going to change the world eintrely, so I try not to loose sleep over it. I don't really think I am cold-hearted, but to some this may seem that way.

You don't sound cold hearted at all. It sounds as if your ED is trying it's best to help people. Volunteering? Buying extra food for the food bank? That's far from cold hearted. I don't understand why you would think that about yourself. You do alot more than other people would or could.

[epiphany]

In a jungle, a mother lion must leave an injured cub because the survival of the rest of the pride depends on it. A human mother's efforts to take care of her less than perfect child, or a helping hand or compassion from one person to another, is a testament to the capacity of love. Our humanity is what separates us from animals.

[ojoern]

Well, I can see this discussion has become quite heated since yesterday. It is fraught with emotions for many.

I look at it this way: I do what I can for the homeless folks I see. Sometimes it's not much. Sometimes it is. Through all of it I keep two things in mind: 1. What I do can have a small or large impact on this person's life. 2. Something an uncle once told me, "Always remember that the entire purpose of someone's life may be to serve as an example."

It's a crap shoot folks. Trust your instincts....if you have them.

Joe

[rn/writer, RN]

In a jungle, a mother lion must leave an injured cub because the survival of the rest of the pride depends on it. A human mother's efforts to take care of her less than perfect child, or a helping hand or compassion from one person to another, is a testament to the capacity of love. Our humanity is what separates us from animals.

This is true.

But what is also true is that those intended to receive the love and compassion still have choices. They may, out of fear, anger, pride or for a thousand other reasons, push away the very things they need.

There are many who are temporarily homeless. A lost job, an illness, a fire, a crime. Blows such as these can put someone who has no margin out on the street. The ones who have kids may feel a heightened sense of panic as they worry about how they will feed their little ones. But they stand a better chance of qualifying for a place in a shelter and certain types of aid. Homeless women have a few more resources to draw on than single men. Unless it is life-threateningly cold, the guys have the Rescue Mission, the Salvation Army, and one or two other options that provide bare bones subsistence. Most of these places boot everyone out the door in the morning and don't let them back in until night. For the sake of the rest of the group, there are strict rules. If you indulge in drugs or alcohol or sex or any kind of threat or violence, you're out of there and you could possibly be banned in the future.

People who have lived functionally before being thrown a curveball have a pretty good chance to get back into the game, especially if they qualify for financial or job-finding assistance. They have the vision and the memory of what worked before. And they know the social rules. For them, homelessness is circumstantial and will change when their opportunities improve.

For others who deal with mental illness, addiction, and long-standing alienation, homelessness is a deeply entrenched mindset that tells them they can't hack it in the "real" world, that the dangers and demands of trying to function in a way that most of us consider normal is too overwhelming and will swallow them up and spit them out. This kind of thinking short-circuits attempts to improve their lives. What do you do when someone will take a meal and donated clothing and occasional medical treatment but has no interest in swapping out a corner in a derelict house for a room in a transitional living facility? I think you give them the meal and the clothing and the medical care and respect their choice to stay rough. Maybe they'll come around at some point. Maybe they won't. Maybe our standard isn't the only one that counts.

This is all written in relation to people who are not dangerous or blatantly dishonest. Being homeless is not a crime. The problem is that it's easy to confuse frustration with people who have rejected "normal" living standards with anger related to hurting others or manipulating the system.

This is not a simple problem. The needs are complex, as are the people themselves. What makes the most sense to me is to look at the homeless with the same kind of triage mentality you would for a mass casualty incident. Some homeless people will find a way out on their own or with the help of friends and family. Some will never find a way out no matter what is done for them. But there are those for whom assistance will make all the difference. It isn't a question of who is worthy, but rather who will truly benefit from the assistance. You give food and comfort to everyone but put the greatest amount of resources into helping those for whom it will do the greatest good.

[epiphany]

Well, I can see this discussion has become quite heated since yesterday. It is fraught with emotions for many.

I look at it this way: I do what I can for the homeless folks I see. Sometimes it's not much. Sometimes it is. Through all of it I keep two things in mind: 1. What I do can have a small or large impact on this person's life. 2. Something an uncle once told me, "Always remember that the entire purpose of someone's life may be to serve as an example."

It's a crap shoot folks. Trust your instincts....if you have them.

Joe

I totally agree.

[teeituptom, BSN, RN]

I feel for all the homeless, whether its temporary or long term, whether by choice or by need. But I also realize that Homelessness is a situation that has no chance of improvement under an Republican and uncaring administration.

[Nicky032605]

I can see what Jericho was trying to say, and I tend to agree. I myself had cancer a few years back in my late teens/early twenties. I went into remission fairly quickly. I have struggled with depression, social anxiety, memory loss, etc., so i suppose I can see it from a persons point of view who might be disadvantaged. Personally I believe that there are programs and people to help if you just can't hack it in this world (which I have felt myself sometimes) and you have to be strong, or you won't survive. This sounds cruel, I know. I understand the desire to help these people who really need it, and I feel the same way, but - I really don't believe that the emergency department is the place for this. If someone is mentally incapacitaed in any way like an above poster mentioned, then there is a duty there. I personally think it is a matter of instinct and good judgment. I have met people who choose to be homeless forsaking societys common lifestyle (like the story about the man who died of a heart attack in a box), but never asks anyone for anything. There are those who don't take advantage. I have seen a woman stand outside with a sign for food, yet her well fed dog was sitting right beside her. I think that if the people who do want to drink themselves into oblivion, and live a self destructive lifestyle, should be left to their own demise. I feel a desire to help people, but letting the ones that are just taking advantage continue to do so - WONT HELP THEM! :chair:

[tam-traumaRN]

I have been an ER nurse for many years. Over time as I have paid higher and higher taxes for social programs I have found my political leanings falling further to the right. This is particularly a difficult subject for me because I have a brother 32 years old who is a homeless, drug addict. I have watched him throw away his life, his career (succesful artist), college education (parents sent him to a private university) and his family. He has been arrrested nearly 50 times, has been in and out of jail, detox and rehabs. I have witnessed to him, cried for him, prayed for him and written to him; all to no avail. He is now facing a prison term and my elderly parents have yet again bailed him out and hired another lawyer for him (his last fired him). This has gotten so bad that my parents have chosen to no longer speak to me because I have voiced my opinion regarding tough love. My heart breaks and I do not see a light for him. I wait for the call that says that he has finally ODd or been killed. The only way I can cope is to treat all homeless as if they are my brother with common decency, respect and compassion. I support our local homeless shelter because I cannot financially support my brother for obvious means. But none of this takes away the pain that I feel or the heartbreak of an addicted family member.

[Warpster]

Those "choices" include lost jobs, divorces, and generally being kicked in the teeth by a country that hasn't cared about its people for a very long time. I've taken care of a lot of homeless people, and the one trait they all shared was deep gratitude, unlike the "bend my straw, fluff my pillow, bring me a magazine, you're my servant" suburban crowd.

One thing they've all said is that if you're not a drunk or substance abuser when you first fall through the cracks and end up on the street, you'll be one soon enough. It's a horrible way to live, and it's the only way most of them can cope.

I'm sorry, but I've rejected that judgmental attitude so many people have about the homeless. I know how close I am to joining them.

[rn/writer, RN]

I have been an ER nurse for many years. Over time as I have paid higher and higher taxes for social programs I have found my political leanings falling further to the right. This is particularly a difficult subject for me because I have a brother 32 years old who is a homeless, drug addict. I have watched him throw away his life, his career (succesful artist), college education (parents sent him to a private university) and his family. He has been arrrested nearly 50 times, has been in and out of jail, detox and rehabs. I have witnessed to him, cried for him, prayed for him and written to him; all to no avail. He is now facing a prison term and my elderly parents have yet again bailed him out and hired another lawyer for him (his last fired him). This has gotten so bad that my parents have chosen to no longer speak to me because I have voiced my opinion regarding tough love. My heart breaks and I do not see a light for him. I wait for the call that says that he has finally ODd or been killed. The only way I can cope is to treat all homeless as if they are my brother with common decency, respect and compassion. I support our local homeless shelter because I cannot financially support my brother for obvious means. But none of this takes away the pain that I feel or the heartbreak of an addicted family member.

Thank you for sharing your situation. We've been through a milder version of this with a number of relatives and friends. Some have come around. Some are still struggling. It's never easy to watch. And you have the added burden of seeing your parents go along for the ride.

Tough love is tough on the family members, but in most cases, it's still the right thing to do. I'm sorry you're going through such heartache.