Homeless working the system, multiple admissions

Specialties Psychiatric

Published

What do you do with people that keep coming back every 2 weeks or some that think they are smarter by getting discharged from 1 hospital then going to another and saying the magic words.

As a society, what do we do with these people?

Specializes in LTC, assisted living, med-surg, psych.

Are you still a student? I'd really hate to think someone who hasn't even graduated would be so jaded already.

I echo what some of the other posters said: It is not our job to judge our patients. It is our job to care for them, to treat them like human beings, and to put away our personal feelings while we are at work. You don't know what those people's lives are like. You haven't heard their stories. And they all have stories, some of which might teach you something.

This is a big sore spot for me because I too am mentally ill and am losing my home because my illness makes it difficult for me to hold a job. I've worked hard for many years and it kills my soul to have to ask for food stamps, medical, housing assistance and the like. Mental illness is devastating and you just can't know until you're battling one yourself how far, and how fast you can fall. I didn't know. I do now.

'Nuff said.

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See many of my pts prefer to be in hospital to nursing home or group home so they get themselves kicked out of so may places and no one will accept them back, but they are little angels in the hospital, because they prefer it with us.

This is a problem inherent to hospitals everywhere. Hardly a novelty.

Chances are, it'll never go away. You see, the issue originates in the very nature of a hospital--that hospitals are obliged to give a ****, even about those folks who the rest of the world gave up on long ago. I'd argue that if it does change, healthcare's about to get a lot scarier.

Also, if you think it's bad out in civilian nursing, don't go into the VA/military system.

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Specializes in Pedi.
See many of my pts prefer to be in hospital to nursing home or group home so they get themselves kicked out of so may places and no one will accept them back, but they are little angels in the hospital, because they prefer it with us.

Or they really are so ill that the only place that they are safe is in the hospital. Group homes and nursing homes don't have the same kind of structured milieu that inpatient units have and, to be perfectly honest, many of the staff working in those homes often do not have the proper training to care for the mentally ill.

If you were mentally ill and discharged from the hospital but knew that you could not be safe on your own outside of it, you wouldn't look for help somewhere?

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Specializes in LTC.

When cutbacks were made and are made in healthcare, our state started with Mental health programs and a big portion of ER visits in my state are mental health issues. When you make so many cutbacks and these programs are closed, just what are these people supposed to do??? They know they need help and maybe just going to different hospitals they will get the help they need.

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Specializes in Hospice.

Then there are the children who have aged out of foster care systems ... people and families - often women with children - who finally fell off the edge of the minimum wage cliff ... homeless veterans ... people who just can't find work or who work for so little that they can't pay rent and eat, too (and, yes, it does happen). People for whom getting out of the weather right now really is a matter of life and death. If I was in a situation like that, I wouldn't much care who got upset or what law was broken, as long as I, or my kids, don't freeze to death overnight.

That's why it's a mistake, I think, to talk about the homeless as "these people" and accuse them all of acting like out-of-control junkies or sub-clinical criminals.

And yet ... there are out-of-control junkies gaming the system just as the OP described. There are people who don't know any other way to survive than to manipulate, lie and steal. There are psychopaths who just don't give a care who's hurt as long as s/he gets what s/he wants. And they all home in on the social services and health care systems because that's where the money and chemicals are.

I don't think there's any one-size-fits-all perfect solution.

Lots of us work in areas where the gamers first enter the system and then settle out: EMS, emergency rooms (sorry - I'm old), acute medicine, psych and surgery, ob/gyn, peds. LTAC, LTC and home care nurses catch the ones who've made it a career.

No one having to deal with that kind of behavior, day in and day out, can be unaffected by it. Boundaries can get pretty battered. Much damage can be done. How do we take care of these people? Our employers certainly won't and it's not the job of our clients to take care of us.

Not that I want either my boss or my patients that involved in my life.:cautious:

It's important, I think, to share survival skills. What I wouldn't give for a good old-fashioned 1970's self-help group ... but that's just me.

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This post just makes me sad on so many levels... granted I am still a student, but what ever happened to empathy, compassion, and non-judgmental thinking? It is so cold out this time of year...I would probably be the same way if I was cold, hungry, lonely, and homeless.

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Specializes in Hospice.
This post just makes me sad on so many levels... granted I am still a student, but what ever happened to empathy, compassion, and non-judgmental thinking? It is so cold out this time of year...I would probably be the same way if I was cold, hungry, lonely, and homeless.

Those things are easier said than done. Trying to turn them on like a light switch does more harm than good. They require self-awareness, which is pretty painful more often than not. One step at time ...

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I have worked the 3 acute units at our psych hospital for only 2 years. I have seen 9 patients (that i can recall off the top of my head) that have been discharged and readmitted. So far as these acute units, there are patients who are truly sick and go off their meds and can't keep track of them or thought they were better and didn't need them anymore - those are the ones I really like to help and watch get better. But there are some that come in and stay for narcotics, benzos, sedatives, dental care (alot from meth mouth and cocaine use), vision care (despite having received glasses their last admission), STD treatment, and various Axis III diagnoses. In the patient population, you've got the patient who has a different boyfriend/girlfriend every week, the one selling cigarettes at 5 bucks each, the tough gang members who will intimidate patients and staff but can't handle jail, patients who compete as to who gets the most attention (borderlines), you have the king and queen of the unit, and patients who threaten aggression or make a gesture just to get meds, etc. Our king says since he is the highest functioning patient on the unit, he should be in charge of the remote - his words. The king can be overheard talking trash about everything and everyone (patients and staff) but won't come to the nurses or staff regarding his gripes (except to get the remote). One day, he was attacked by a truly ill patient. He talked **** to the wrong person and got a piece of his face bitten off. This is not being jaded, this is the reality where I work. I take care of my patients everyday no matter who they are, but it is hard sometimes. So I can identify with adnrnstudent. Other people should not be too quick to judge her

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Are you still a student? I'd really hate to think someone who hasn't even graduated would be so jaded already.

No, been in this almost 3 years. Not Jaded at all, in Chicago, big culture of people working the system. I'm not talking about the real psych patients, I'm talking about the ones working the system, but sounds like it doesn't happen outside of Chicago.

Here, we fill up after the welfare checks are spent on the 1st and empty out before they are issued. Not jaded, just fact.

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Specializes in CEN, CFRN, PHRN, RCIS, EMT-P.

This is just a symptom of our broken system, a system that allows the rich to get richer at the expense of the poor.

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Specializes in Hospice.
No, been in this almost 3 years. Not Jaded at all, in Chicago, big culture of people working the system. I'm not talking about the real psych patients, I'm talking about the ones working the system, but sounds like it doesn't happen outside of Chicago.

Here, we fill up after the welfare checks are spent on the 1st and empty out before they are issued. Not jaded, just fact.

Nothing happens in Chicago that doesn't happen everyplace else, including the boondocks. Many of us have tried to make the point that, although you have every reason to be frustrated and angry, there are other ways to look at the problem.

More than one of us has been there and done that, some in many different settings and for way more than three years. Just thought you might be interested in reading other perspectives.

If bashing the homeless is what you need to do, better here than on the job.

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I work at a county psych hospital and I know exactly what you are talking about. drug addicts that don't want to work that just come in for meds or to get out of going to jail for something.

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