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.

[Mander2]

I currently work in the ED of a County Hospital in a good sized city in TX. Therefore, the majority of our pts are either homeless, very broke or an illegal alien. Now after Katrina and the Houston hurricanes, we are the provider of care for all of the evacuees in our county. We constantly encounter those in need of everything. Thankfully we have social workers that will assist them in rx vouchers, bus passes, and getting set up on our "free insurance". Granted even with all of the assistance, I find myself frustratd with the lack of staff at the hospital, the lack of room to put people, but most of all the OVERWHELMING need for assistance! It is very disheartening to constantly see the amount of need there is. However, through continued prayer, I have been able to remain compassionate to the pt we see, and am praying that I never become hardened or cold to those in need, and I can remember to count each and every blessing I have no matter how insignificant. Hang in there, and never let your heart get hardened!

Chew a piece of Watermelom Bubbalicious, it'll make all your worries seem far away!

[traumaRUs, MSN, APRN]

I see one commonality from all of us: our frustration with the current system.

[moosicle]

I don't really want to get into my opinions of homelessness.

But, I have to mention one oddity in this natural selection argument being made. Now, I agree that natural selection is an evolutionary process and, indeed, is factual. However, isn't the central thesis of modern medicine/nursing practice that we are attempting to overcome (or diminish) our natural evolutionary processes? We inject insulin into diabetics to overcome the natural process of them dying; I think this idea should be extended to the mentally ill as well.

[Kasper1014]

I am a nurse in a LTC TB hopsital. The majority of our pt population are homeless. THey can be admitted anywhere from three months to 2 years and sometimes rarely longer depending if it a court order or if they are multidrug resistent. So our pt's can leave on work passes during the day to work or see family if they choose to. We also have SW's to help assistpt's with finding jobs or home arrangement upon DC. We have some homeless pt's who do work everyday, some several jobs. Still can't make enough money. Then we have pt's who all they do is sit in the lobby and their main goal is to get on disability. I have seen both extremes and most in the middle. Some of our pt's are extremely intelligent, very educated. Yet they choose to remain homeless, and they will tell you flat out they want to be on the street. And we have pt's who are mentally challenged and really don't have choice if they are on the streets or not. We also have pt's from Honduras. In America they are working several jobs, still not making enough and living on the streets. Yet they see nothing wrong with it and is it still more luxurious compared to Honduras, where they come from. We had one pt that had a job, he had several "Will work for food" signs on his bed side table. Every morning he would leave for "work" with his lunch, and come back in the evenings with his "paycheck". Ha! And we have the pt's the do work several jobs because they do have a family to support while they are in our hospital. I have seen all types and situations. Some I do feel sorry for, others I can tell are trying to milk the system for what it's worth.

Kassy : )

[VeryPlainJane]

I see the number one problem as a lack of affordable housing. An avg. American that makes min. wage or even over can not afford decent housing. They did a study in my city, to show how much one must make to have avg. housing, It was 15.00 an hour. Sad. Remember two weeks ago the house passed it's new budget. They slashed college loans and grants plus food stamps, but then gave themselves a fat raise.

[teeituptom, BSN, RN]

I see one commonality from all of us: our frustration with the current system.

Yes the current dominantly Republican system, that where its not a family oriented problem then they dont want to deal with it. That is what is so frustrating. Its easier for them to ignore callously the plight of the homeless. The attitude of our Republican society of if they dont care for themselves then why should we care for them. Its not that easy or simple of a problem. What are we going to do, wait untill their bodies start piling up in the streets. We need to help these people now. We are so concerned with human rights in Afghanistan and Iraq, yet we show so little care, concern, and compassion for those within our own country. We are spending billions of dollars over there, but we cry and complain about helping our own. So many of our homeless are veterans of Viet Nam, and Desert storm. They have shed blood for our country yet we complain about assisting them. I see something very wrong in this picture!!!!!!

[kadokin, ASN, RN]

We have numerous homeless shelters in our area. Yet, we still get in influx of the people in whenever it gets too hot, too cold, or too wet. Often it is because they are intoxicated and the shelters won't let them in until they sober up, or they have been barred for stealing and fighting.

I do get extremely frustrated when I have a very sick person sitting in the waiting room because our beds are full and 1/3 of the beds are taken up with these cases. It frustrates me also that all of the shelters offer programs for detox, job training and placement, mental health services and housing assistance. The problem being you have to WANT to participate in thse things. You can't MAKE an alchoholic stop drinking, or a schizophrenic take meds compliantly, or a thief stop stealing. That is a step they have to make for themselves with the available support systems.

I know that my sympathy/empathy for these members of society has dulled over the years. I don't think the ER has enough resources for the community as it is without being overwhelmed by persons who do not require ER tx, just a warm bed and a hot meal. Much less the workup for vague, bogus complaints that have to be done for fear of liability.

What is the answer? I don't know.

Yes, what is the answer. And to pawpaw John, would any other gov't in the world have better solutions? I think not. When poverty-stricken households still have access to cable tv and x-box, I kind of think our poor folks have it a lot better than poor folks in other countries. Just my .02 cents.

[kadokin, ASN, RN]

I see the number one problem as a lack of affordable housing. An avg. American that makes min. wage or even over can not afford decent housing. They did a study in my city, to show how much one must make to have avg. housing, It was 15.00 an hour. Sad. Remember two weeks ago the house passed it's new budget. They slashed college loans and grants plus food stamps, but then gave themselves a fat raise.

Yes! They ARE SHAMELESS OPPORTUNISTS and thieves of the worst kind! Vote these charlatans OUT OF OFFICE! The value of real estate/housing has grown to artificially ginamic proportions. One day, this bubble will burst, then what will we do? It is amazing the sea changes individual greed can reap.

[kadokin, ASN, 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.

I know this is a world of hell for you, but keep praying, God knows what he is doing. And keep us posted. We care.

[papawjohn]

Hey!!!

Papaw John has learned the hard way (the only way I learn anything it seems) NOT to talk politics or religion at work. I am a liberal. I support only one charity and it is a homeless shelter that practices "tough love" approach to homeless in offering them the chance to re-make their lives. They HAVE to go to AA meetings, or be kicked out. They HAVE to work, or be kicked out. They HAVE to do 'chores' around the place, or be kicked out.

I s'pose that makes their treatment plan "conservative". And I s'pose that only a minority of the homeless end up profiting from the plan. But it's the best that I can figure out.

I agree that many homeless people simply CHOSE to live on the street. And we are fortunate in living in a country that offers so much freedom that someone can make that choice.

I agree that a homeless person in the US is lucky compared to the lowest social group in the 'Third World', because of the overall richness of our society and the readiness of the American folks to offer individual and church based charity.

I am impressed that there is such a big response to this topic in this forum. Proves that we are a group with a special 'caring' response to these folks, even if our response is frustrated anger that they WILL not get off the street.

But the basic moral/ethical question remains (in my mind): If I lived in a million dollar condo and strolled out on my patio and looked down on a city park filled with dozens of homeless---would I feel like an ethical person who lived in a decent society?

Obviously, I would not.

So I am perplexed and frustrated like many here, but do not forget that it is essentially an ethical/moral problem for the larger (read: political) society, not isolated virtuous individuals.

Thanx for mentioning me after all the other responses, Kadolin. I guess that means you read the whole thread from start to finish? I bet you'll agree that altho there's a lot of disagreement here--we'd all be willing to try to solve the problem if offered the chance.

Papaw John

[VeryPlainJane]

Hey!!!

Papaw John has learned the hard way (the only way I learn anything it seems) NOT to talk politics or religion at work. I am a liberal. I support only one charity and it is a homeless shelter that practices "tough love" approach to homeless in offering them the chance to re-make their lives. They HAVE to go to AA meetings, or be kicked out. They HAVE to work, or be kicked out. They HAVE to do 'chores' around the place, or be kicked out.

Papaw John

They have to go to AA meetings? What if they are not alcoholics? I understand the job (even though finding a job and affording childcare can be very hard when you have nothing) and doing chores.

[papawjohn]

Hey VeryPlainJane!!!

Uh, I s'pose that a homeless person without any substance problems wouldn't have to go to AA. But such a person would be in a remarkably small part of the homeless population. I don't wanna seem like a know-it-all!!! I know what I do from the people who run this homeless aid place--but the lady who explained their program (believe it or not-claimed to have a PhD in English but to have become homeless because of a severe alcohol addiction) had BEEN IN this program. She made the absoluteness of the rule (AA or NA or both--depending on the nature of the addiction) seem like one of the BEST features of their program.

It also seems to me that the few people who end up homeless through loss of income but who have a job record and are willing to work (and do not WISH to be homeless) would find some sort of assistance and work themselves out of homelessness in a short time. Probably not move into my neighborhood or yours, but somehow would maneuver themselves into a group-home, then a trailer park, etc.

One thing about America--there is work here and one can live pretty cheap if you just gotta!! When the conservative side of this debate makes that point, they're completely correct. And altho I'm on the Left--I acknowledge that they are correct. (If it were not true--there would be no influx of illegals over the Mexican border. And many of them work at menial low-paid jobs and STILL send money home to their family. THAT fact cannot be forgotten in this discussion.)

Still, my question is: What should a large society do politically in the presence of this moral/ethical problem?

Papaw John