the homeless that wander in...

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There have been times that I feel crappy about discharging some (not all) of our homeless folks especially when the weather is really cold and really hot because I know they have no where to go. The shelters are close already by time of d/c and some sign back in with a random complaint just to have a warm/cool place to stay in. Am I the only one?

**I'm talking when it is calm, no traumas or real sick pts in the ED.

Specializes in orthopedic/trauma, Informatics, diabetes.

If they end up on our floor, they don't leave unless they are placed somewhere.

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Specializes in PDN; Burn; Phone triage.

When I worked ER, most of our homeless weren't even interested in shelter or alternative housing options -- even during bad weather. For a variety of often legitimate reasons that I now better understand after having worked in burn for a while. (In the winter, anywhere from 1/4 to 1/3 of our burn patients on the unit are homeless at any given time.)

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Specializes in ED, ICU, PSYCH, PP, CEN.

Most places I've worked try to find a way to help them stay warm and dry and safe. The kindest thing I ever saw was one of our ER nurses gave his coat to one of our homeless "pts"

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We never discharge unless they have some where to go, especially when the weather is bad.

Who pays for them to stay? What diagnoses are used?

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When I escort the homeless out the ambulance doors, I say "Welcome Home!"

And they haven't bopped you upside the head yet?

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Specializes in Acute Care, Rehab, Palliative.
Who pays for them to stay? What diagnoses are used?

We just wouldn't send them back to the streets. Oh I'm in Canada so their stay is covered.Our usual diagnosis is "failure to cope" That covers a lot.

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Specializes in Emergency.

We just wouldn't send them back to the streets. Oh I'm in Canada so their stay is covered.Our usual diagnosis is "failure to cope" That covers a lot.

Same here, also in Canada. We'll sometimes pay for a cab/bus ride to take them to shelter/rehab/whatever, social work is really good about helping out. We have books of resources (everything from shelters to healthcare) that we hand out. We will also keep people overnight if they have nowhere else to go. Usual diagnosis is sadly ETOH intoxication, and we are officially letting them sleep it off.

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doesn't come under the heading of "enabling"?

Same here, also in Canada. We'll sometimes pay for a cab/bus ride to take them to shelter/rehab/whatever, social work is really good about helping out. We have books of resources (everything from shelters to healthcare) that we hand out. We will also keep people overnight if they have nowhere else to go. Usual diagnosis is sadly ETOH intoxication, and we are officially letting them sleep it off.
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Specializes in Acute Care, Rehab, Palliative.

We have a discharge planner that makes sure patients are being sent some where safe that they will be able to manage.Otherwise they will just be back in the ER anyways.Lots of people have no families and if they are elderly we keep them until we get them a nursing home spot.We had one lady for over a year.

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Specializes in Emergency.
doesn't come under the heading of "enabling"?

Yeah (assuming you mean enabling the substance abuse and not their homelessness), but we are also enabling wealthy people who want their splinters out, or think vomiting once a day while pregnant means they need a hospital admission, or just can't handle the cold they've had for 78 minutes, so it all comes out in the wash. I can actually understand the desire to hunker down in a warm bed and wash my feet if I lived on the street more than I can picture myself hauling my butt in for the sniffles without trying a tylenol first.

I don't really like it, I would love it if these people got clean, got off the street or even just sought out the appropriate resources in the first place, but c'est la vie.

We can kick them out, treat them badly, refuse to enable etc. but I really don't think that will change what they do (I believe someone mentioned above just moving on to the next ER). At least by getting social work involved we may reach some of them and facilitate some better choices (a girl can dream).

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Perhaps the way health care systems treat the homeless in the community is a reflection on the humanity and compassion of that community?

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Perhaps the way health care systems treat the homeless in the community is a reflection on the humanity and compassion of that community?

I'm not sure if it's so much the humanity and compassion of the community as it is homeless population of the community.... You can offer help and money and shelter and food to someone without those things, but if they have it in their minds that they only want alcohol or drugs, what are you supposed to do?

In my community there is a real problem with the homeless. Not in the sense that they are a nuisance or a problem, but in the sense that they rob, steal, and kill others for drugs and alcohol. It's also not that we don't have enough community support for them, we have a lot of shelters, food services, free health services, and transportation services for those who have jobs... It's just what they decided to do with all of the help we provide them.

Example would be I volunteer with a "soup kitchen" and we go out to these communities, and one night we had run out of bread to go with the vegetables, chicken, water, rice, and desserts we were serving, and about 15 people started screaming and throwing rocks and lit cigarettes at the staff saying "how in the f### do you expect us to eat without bread?! You dumb c####!!" now, unfortunately, we cannot go back to that part of town without added (and paid for) security.

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