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.

[babynurselsa, RN]

I think there are a couple of different groups as you have also alluded pawpawjohn. There are the TEMPORARILY homeless, due to loss of job or huge financial setback, etch. There are those who have made a lifestyle choice to be homeless.

The temporary homeless get up and out and do what they need to do to change their situation. They get a job or even two, they accept assistance and get back on their feet.

Then there are those that drink literine, lysol, huff carbuerator cleaner, or $2 vodka. They check into the ER and CLAIM to have had a sz, or chest pain, or difficulty breathing or detox. Or maybe they laid down beside the road and any number of helpful citizens called 911. They arrive to a nice warm room in the ER and begin demanding dinner and extra blanket and that you stand there and change the channel on the tv until you find them a show they want to watch. Then you do the obligitory workup for thier complaint while they smirk at you. They curse the social worker and/or the psych nurse for waking them and demand they leave the room. Then they sober up throw all of the community resource referrals on the floor as they leave to start this vicious cycle all over again. All of this while I have chest pains, lols with pnuemonia and difficulty breathing, CHFers etc sitting in teh waiting room waiting for an available bed.

My frustration lies in teh fact that you can have all of the resources in the world and they are useless to someone WHO DOES NOT ACTUALLY WANT HELP OR TO CHANGE THEIR CIRCUMSTANCES. I understand the heartbreak for these families of these people. But unfortunately one of the freedoms of this country is the right to abuse the system, break your mother's/father's/sister's/brother's/childrens hearts and destroy yourself slowly if that is what you want to do.

I still don't have the answers to fix this problem. Sometimes I wish there was a way that the hospitals could just say NO, this is your 107th FREE visit to our ER this year and we are not going to deny sick people tx any longer so that you can sleep it off here in one of our beds instead of jail.

I know this sounds harsh and it may be. I have no problem stretching already thin resources for someone who has no resources and is sick and needs medical care. I am just tired of stretching the same few resources for those who don't want help.

[Warpster]

Babynurselsa wrote "My frustration lies in teh fact that you can have all of the resources in the world and they are useless to someone WHO DOES NOT ACTUALLY WANT HELP OR TO CHANGE THEIR CIRCUMSTANCES. I understand the heartbreak for these families of these people. But unfortunately one of the freedoms of this country is the right to abuse the system, break your mother's/father's/sister's/brother's/childrens hearts and destroy yourself slowly if that is what you want to do."

I'll tell you what, when we become omniscient we can tell which patients to help and which ones to simply send to hell, bypassing the streets entirely.

As for me, I try to help anyone who asks for it. That homeless guy who reeks of Everclear (and worse) who got in by claiming about nonexistant chest pain is still asking me for help, and it's up to me to figure out what he really needs and to point him in the right direction to get it, if there's any to be had.

Again, living on the streets is a horrible way to exist. Most of those folks didn't wake up some day and decide "Gee, I want to be a homeless skid row drunk! That's the ticket!" Face it, we live in a country that is hostile to anyone who isn't young, healthy and well educated. Nobody actually wants to be homeless, nobody wants to be addicted, nobody wants to be mentally ill, and nobody wants to go without simple human dignity.

"All the resources in the world" generally exist elsewhere, not here. Our country has become stingy.

[babynurselsa, RN]

I do not see our country as all that stingy at all. Our communities, our churches and any number of agencies exist all around us. It all depends on what an individual CHOOSES to accept in the way of aid. I cannot MAKE a drunk stop drinking, a schizophrenic take his meds, or a huffer put down the aerosol can. I CAN link them with agencies that will help them if they choose to get help with these problems.

The ER is not there to give out sandwiches to drunks. It is there to care for those who are emergently ill or hurt.

[GIGGLZZ]

This question really strikes a deep cord in me. I feel anyone in the emergency room is in need of my assistance, homeless or not. As a nurse I care for all injuries, self inflicted or not. These individuals have a host of medical problems. Poor nutrition, communicable diseases, addiction, mental illness, are just a few of the ailments they present with. I know that they may not adhere to my teaching, but it is my duty to try. I know that they may not accept the referrels for social assistance. To me it does not matter. This patient is in my care for what ever reason and I will do my best to care for him. I can not solve his social issues but I can't solve any of my patients social issues. I can feed his current hunger. I can administer the IV's and medication that has been ordered. I can give him a warm blanket and speak to him kindly. I remind myself that this patient is the reason I want to be a nurse. He may be the most person in "need" that I have met all day. I will give every patient, regardless of my percieved judgement of his situation, my best, compassionate, professional care.

I feel sad when I see nurses perform less than their best when a "repeat" customer enters the emergency room. I understand the frustration of the extra workload and the absence of beds. However, rather than place my frustration on the patient I would rather use my energy to advocate for alternatives. In some communities there are facilities where these people's needs can be met without using the emergency room to "dry out".

Maybe that is an answer, until then I will continue to offer what ever is in my abilitly to assist any of my patients.

What do you think? I am curious to know if I am just being nieve.

[papawjohn]

Hey Y'all

Doggone it!!! I really didn't mean to get pulled into this thread. As far as the ER Nurse's description of the impact of "trolls" on the delivery of emergency medical care--you are of course correct.

The issue is that some solution to this problem needs to be found OTHER that an Acute Care Hospital Emergency Room.

Obviously, we nurses in ERs and MedSurg units are not going to solve the problem of chronically homeless/dependent and demanding people. Thats why I say a solution--assuming one can be found--will happen in larger political and social actions.

Once upon a time there was a CRIME: Vagrancy. I s'pose that was putting the problem of the homeless onto the PoliceDep't which has other things to do with their time. When it became 'de-criminalized' to be homeless--it ended up in the ER's lap. Where it also doesn't belong. We need to stop passing the buck and figure out what we're going to do to-or-for-or-with these people but figure it out as a whole society.

Last thing I wanna do is seem to be putting ER staff down because of their totally justifiable frustration.

Papaw John

[babynurselsa, RN]

http://www2.ktul.com/news/stories/1205/283260.html

Now multiply this by let's just say 3 ER visits for each arrest. Let us say that Each ER visit costs $500. I am being EXTREMELY conservative here.

3900 x 500 = 1,950,000. This individual has LOTS of friends who are not so far behind him in arrests or ER visits. I can think of AT LEAST 10 by name right off the top of my head.

Many times the officers will send an individual to the ER rather than transport them in their own car. One reason being that the jail will not accept someone who is extremely intoxicated. Another reason being that they don't WANT to put them into their cruiser.

In the article you will see mentioned just some of the resources available in this community, not all.

I will repeat yet again, I do not have the answer to this problem. But, I do not think that the answer lies within the ER.

I DO NOT think that a price should be placed on human life. Though this is just a glimpse of some of the money that our hospital systems are eating in non-reimbursable care. Would there be a more effective way for these dollars to be spent on a WHOLE GROUP of like individuals???????? Something that would be more effective than routine lab work, a banana bag, occupied bed space, occupied staff, and pages of shunned referrals?

[LoriAlabamaRN]

My question is, why haven't they gone on public assistance? Every day I drive past a huge public housing complex, seeing nicer cars than mine parked in the lot. I have had Medicaid patients come in with their manicured nails, braided up hair and cell phones, 3-6 kids, and yet have never held a job and don't intend to. Why should they? When they have illegitimate children they get nice houses, even condos, and the government pays for it. These are not disabled people. They could get a job at Walmart, McDonalds, really anywhere. But they won't, because they can sit back and watch their cable TV and eat steak bought with food stamps. I even overheard one lady (on her cellphone of course) saying she was gonna get knocked up as quickly as possible, because a fifth child would get her an extra $600 a month. I would vote for anyone who would be willing to cut these people off after one year of welfare. And NOT increase the payments one cent for having illegitimate children. I would require them to have a Depo shot while on public assistance. And no more than one year of assistance out of every 20 years.

As for the homeless, I do feel for them. I think that the majority of them belong in mental care houses, and not dying on the street. When I was in NYC I was devastated by the human wreckage I saw. I don't understand why they can't be in public-assistance housing when the others can.

[traumaRUs, MSN, APRN]

I live in Illinois and we are one of the strongest welfare to work states. There is a limit of 5 years that a person is allowed to have TANF which is TEMPORARY Aid to Needy Families and there are only two levels: with and without children and it doesn't matter how many kids you have - you get the same amount. You might get an additional few dollars in food stamps, but that is all. There are several programs that will put the needy through school also. I help to run my church's Food Pantry and we provide food for about 30 families/month. We have many people with needs. In the ER I am also seeing more older homeless - those over 50 or 60 that have been working minimum wage jobs all their lives, but got laid off, lost their housing, whatever and they are now homeless. So...I guess we haven't solved the world's problems here, but at least this has given many of us food for thought.

[KatieBell]

I live in Illinois and we are one of the strongest welfare to work states. There is a limit of 5 years that a person is allowed to have TANF which is TEMPORARY Aid to Needy Families and there are only two levels: with and without children and it doesn't matter how many kids you have - you get the same amount. You might get an additional few dollars in food stamps, but that is all. There are several programs that will put the needy through school also. I help to run my church's Food Pantry and we provide food for about 30 families/month. We have many people with needs. In the ER I am also seeing more older homeless - those over 50 or 60 that have been working minimum wage jobs all their lives, but got laid off, lost their housing, whatever and they are now homeless. So...I guess we haven't solved the world's problems here, but at least this has given many of us food for thought.

TraumaRus- I'm a huge fan of Wlefare to work- when it works. Recently I met a young lady in the ED with her child- and she was telling me, "Yes I used to get welfare, but now I have "real insurance" for my baby, and I feel so good to be making money for him" SHe had done some secretarial training through a TANF type program, and she really inspired me...made me have some hope for these situations. I just wish more people felt like her....

[egood]

Lori Alabama RN-----I totally agree with you! I believe that people may need public assistance at some point in their lives, but it should be limited. Too many people abuse the system . My mother was a single mom, she worked her orifice off to provide for us. she has no college degree, but she did what she needed to do for us. She eventually remarried, but ended up divorced, pregnant (2nd child), and lost her job (lay offs). At the time of her divorce and job loss she was 6 months pregnant. She went on unemployment and eventually welfare. This lasted a total of about 5 months. she found a job when my my brother was about 2mos. old and she went off welfare and went back to work------hence -public assistance for a limited time when in need. She has since had a job and continued to sacrafice and work her orifice off to give my brother and I a life. I respect her and am so proud she in my mother. She instilled in us life is not easy, it takes sacrafices and hard work. I am so glad she did not abuse the system, because I believe it becomes a way of life for a lot of the people on PA, and it goes on from generation to generation. The people who ABUSE the system sicken me, while people like my mother worked and sacrafice their whole life and their hard earned money goes to the abusers. Again- I believe people may need limited assistance at some point in their lives- and thats ok- but eventually they need to be responsible productive people.

[egood]

Oh, one other thing, the ER is for EMERGENCYS!!!!!!!! I don't understand why that is so hard for people to understand. A person with lets say a stuffy nose :angryfire is not an EMERGENCY. Patients who are in an emergency are not being treated in a timely manner and are suffering because people(not only homeless) are coming to the ER for non-emergent situations. It's so unfair and frustrating.

[Jerico, 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.

OH PLLLLEEEEESSSSEEEEEE! What a ridiculous statement! Under WHAT administration EVER has homelessness gotten better? It will ALWAYS be with us regardless of the "administration"!

Why don't we just go to a socialist or communist administration and all the world will be right!