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Homeless or otherwise Indigent Patients


Why does this population always seem to be the most needy, the most demanding, the most unappreciative and the most noncompliant......frustrating as we are the only hospital in town who takes these lovely folks....

On a different note, my boss gave me a script to study but my dog AIDET.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I work in psych in the inner city so we get quiet a few homeless patients and it hasn't been my experience that they are any more needy or entitled than other patients. Not that there aren't some who are unpleasant but I have also cared for many who are gracious. I'm no bleeding heart but as someone who has seen the results on the human body from being homeless in most cases I am extremely empathetic to their situation. Hang in there.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

Most people are homeless because they struggle with addiction and mental illness.

As far as noncompliance, think about it. They have no roof over their head or food to eat so do you think their priority is going to be taking a medication or following up with prescribed physical therapy?

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

I am laughing at bit at your question. I am sure you remember Maslow's Hierarchy of Needs. The very basics of their needs are not being met. They have no safety. No shelter. No reliable food or water source. No companionship. Most likely they also have no way of getting this rectified even after they leave the hospital. Whatever brought them in is still there, whether it is addiction issues, mental illness or other disease processes such as heart disease, diabetes, renal failure, CHF or what have you.

I never marvel that some of these patients are very demanding. They are powerless in every aspect of their lives. Give them a little power and it has to feel wonderful. I push a button and someone comes. Every time. Even if they are irritated or unkind, they come. Every time. If I ask for something, they bring it. If I need something, they supply it....even if that is simply their presence or responsiveness. It bears noting also, as mentioned above, that though we are probably very concisely treating their diabetes or CHF or other issues while they are with us, we are likely not giving much thought to treating their mental illness or addiction issues and have written these things off as untreatable. They may potentially get a new prescription for Metformin or insulin, be put back on their bipolar or schizophrenia medications, given medications to prevent withdrawal, given an Rx for Lasix, inhalers, Norvasc or whatever...but we all know after they leave they have no way to really follow up on these things, whether by access issues, financial issues, mental issues or lifestyle issues. Their lives are chaos and chaos follows. They are needy because they aren't getting their needs met. We are the closest thing they have to that.

macawake, MSN

Has 12 years experience.

Why does this population always seem to be the most needy, the most demanding, the most unappreciative and the most noncompliant......frustrating as we are the only hospital in town who takes these lovely folks....

Would it feel better if the needy, demanding, unappreciative and noncompliant patient was rich and lived in a mansion? I've met a few of those...

I understand that the nursing job can be demanding at times, but in my opinion all human beings have equal value and they all deserve the same access to healthcare regardless of social status.

If a patient is genuinely rude to me I don't appreciate it any more than the next person but I guess the question I'm asking you is, why have you singled out the homeless/indigent in your vent post? Personally I find it easy to understand that they can at times be a bit difficult/challenging because they seldom have a lot of joy, support/stability and security in their lives.

I think that not.done.yet offers a very good explanation of the situation of a homeless person.

Edited by macawake
added a paragraph

dirtyhippiegirl, BSN, RN

Specializes in PDN; Burn; Phone triage. Has 8 years experience.

So I guess you are not enjoying your renal position as much as you thought you would?

I think another important point is that the homeless almost "expect" to be treated poorly because they're not oblivious to how they are perceived by the rest of us. Many of them used to be "the rest of us". They come in with their defenses up, as a coping mechanism. Having their defenses up has become crucial to their survival. Imagine how draining that would be to the mind, body and soul to have to constantly be on guard and operating in defensive mode. Our bodies weren't meant to function in "fight or flight" mode non-stop.

Next, think about yourself. If all of your material possessions were stripped of you and you fought a daily struggle just to find warmth, food and water, do you think that makes you any less worthy of the kindness of others? Would that change "who" you are as a person? Do you think you might have days when you're bitter about your situation? It's difficult for us to appreciate what we have until it's gone. We wake up in a warm, cozy bed then turn on a faucet that spews forth warm, clean water. We look in our closets and choose from countless articles of clean clothing and choose what to wear that day. We use hair dryers and curling irons and lights that all use electricity to operate. We hop in our pre-warmed cars and maybe stop for a coffee on the way to work. We make sure we put our clean, hole-free hats, coats and gloves on before we make that walk from our car to the entrance at work. These are all things that most of us experience daily, yet we don't think about them because they're just routine to us. Take them all away though, and you'll surely feel the pain and inconvenience of their absence.

I think it would open your eyes and provide some much needed education if you spent some time volunteering at a shelter or even reading about some of these people's stories. You'd be surprised....some of them are brilliant, some are former college professors, etc. They come from all backgrounds and circumstances. Personally, I find their stories fascinating, because remember, a lot of people live only a few unfortunate events away from sleeping huddled on the street corner right next to them.

(I don't mean to pick on you or single you out....we all, including myself, take things for granted. It's like someone else mentioned with Maslow's Hierarchy...our basic needs are met therefore we are free to focus on other needs such as education, personal growth, relationships, etc. It's human nature. I just think we have to force ourselves into a "reality check" every once in a while. It's humbling and it enables us to empathize with others who are on a different level of the hierarchy than us.)

Edited by ICURN3020
Wanted to add...