Homeless working the system, multiple admissions

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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?

All right. I was trying to back out of this conversation because I was expecting some different responses, but now I'm in it.

I AM NOT bashing the homeless. What we do with them after a while; and answers I was expecting to hear is put the them on "the list." I happen to like some of our clients that don't have anything wrong with them other than they are working the system. They are actually pretty good people but we fill up and don't have beds for the real psych patients.

So, how can we help these people that refuse to stay in the shelters, nursing homes, and group homes we discharge them to because they LIVE LIKE KINGS in the hospital where we feed them better, have better TV, and treat them nicer.

Should Public Aid maybe limit their annual admissions? Should we put them on a non-therapeutic list. They are taking beds from the real psych patients.

I am genuinely looking for possible solutions. Not venting, not bashing.

And thank you PsychNursie, I knew I couldn't be the only person in the world that has encountered this.

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Specializes in psych, addictions, hospice, education.

My comment follows what I wrote and the OP wrote....

I wrote:

I think they must be desperate for food and shelter, in order to willingly be hospitalized, especially on a psych unit. I have huge empathy for them, and treat them with respect. Besides, if their lives are terrible enough, who can say their magic words, "I'm suicidal," aren't completely true?!

You wrote:

Are you kidding? They leave 1 hospital and march right to another within hours. They are working the system and living like kings! I don't even understand how hospitals are getting paid for this.

I got a patient I discharged from my full time gig and that night I went to my registry gig and he was there. Read the admission note. "Patient states he has been off meds for 2 weeks!" ROTF!

I'm not kidding at all. I've known many such clients. We call them "four hots and a cot." I think that a pretty well-known phrase. Just because they seek what they need in an inappropriate (to our way of thinking) way, doesn't mean I can show the feelings of negativity I might feel toward them. I still must treat them with respect and as much compassion as I can. I try reallllly hard not to be judgemental about what they are doing to fulfill their basic needs by being in a hospital.

Where I've worked, social workers have tried to help to a point, to find shelter for people who are working the system. The thing is, there aren't enough options. There are huge numbers of homeless and mentally ill people on the streets.

Clients who abused the system, where I've worked, have been denied admission, or their time in the hospital was short. As soon as the psychiatrist said they were not suicidal, they were discharged. This was usually within 24 hours. We also had a "do not admit" list. However, even people on that list could be suicidal, and how do we know for sure they aren't?? I don't want to assess that incorrectly.

The system needs repair. There need to be programs to help people get on their feet so they don't find being in the hospital a better option than being outside of it. I don't know what the answer is, but it's clear that the system is broken, or never really worked anyway.

Right now I work as a psychiatric consultant for a free clinic. Many of my patients are homeless or near-homeless. There isn't a single one of them who would choose hospitalization as a good option, but some of them would choose it if they were desperate. I would too.

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Specializes in Pedi.

I'm still having a hard time believing that patients in ANY hospital are "treated like kings".

If we discharge an oncology patient home and he bounces back later that day with fever we don't think he's faking it or working the system, regardless of what his home situation is. So why do we assume this with psych patients? Is it so unbelievable that a patient thinks he's ready to be outside of the hospital and then when gets out realizes he isn't safe so presents elsewhere looking for help? He probably goes somewhere else because he knows the judgment that's waiting for him at hospital #1.

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I'm so sick of the homeless that come in with this outrageous sense of entitlement. I mean ffs, you were out on the streets hungry and laying on concrete but you wanna come here a gripe about every little thing? And on top of that verbally abuse the staff just because you don't get your way or you hate our rules?

Of course not everyone is like that ....especially not the psychotics. But a good majority of our patients are. And I'm so sick of how they use the system.

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By the way, I work with a certain type of population that for some reason believes they are so special...I've worked in a prison with bona fide criminals who weren't as bad as the people I serve now.

If you're homeless with a crack addiction, i find it exceedingly distasteful to be as picky, as demanding, as self righteous as you are. Three hots and a cot with snacks and entertainment. nd you still have stuff to complain about. Ugh!

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If they are having a pattern of being readmitted from a group home, you make their hospital stay as uncomfortable for them as possible, no tv in the room , no phone, etc. This has to be coordinated by the floor manager, nursing coordinator... Ive seen this done before.

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

Why can't we talk about the root cause of this behavior as it relates to society and the current system in the U.S. that favors the well off ?

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Specializes in Geriatrics, Dialysis.

Tough question that! As a nurse I do the best I can do, regardless of the patient. As a society, that's a whole other issue. Funding being what it is long term care and housing for the mentally and psychologically challenged has greatly diminished. There just might not be other viable options for housing and regular meals other than facility hopping for some of these disadvantaged people. Sad situation.

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Specializes in Hospice.
Why can't we talk about the root cause of this behavior as it relates to society and the current system in the U.S. that favors the well off ?

Because such a conversation, while lots of fun, does nothing to help the OP deal with the manipulative freeloader in front of her. Drug addiction and other mental illnesses, criminals, those who are simply too hapless to cope will always be with us. When sensitivity to suffering becomes a hook on which to get a person - or system - to do your bidding, while putting absolutely no energy into being responsible for one's self, you grow calluses real fast. It's called compassion fatigue.

The key, in my opinion, is to develop personal coping mechanisms and support systems while you pressure facility management to address the problem of enabling/rewarding the behaviors.

Computer networks that can track doctor-hopping and multiple prescriptions has helped curb drug-seeking in some places. Eventually word gets around that XYZ Hospital is hard to hustle and substance abusers go elsewhere.

Hustling 3 hots and a cot is another thing altogether ... conditions on the street can get really dangerous really fast. A sharp cold snap or an extreme heat wave can kill ya if you're frail enough or have impaired immunity. Not to mention the scum who actually prey on the homeless. As others have pointed out, shelter beds are getting scarcer and harder to get. There are a small proportion of people who are homeless by choice - a very small proportion - but most are not. When it's a matter of survival, what are they supposed to do?

For instance, lots of homeless women flat refuse to go to shelters because of the near certainty of being assaulted. Google "Rosie's Place in Boston" - a shelter specifically for women founded because of the lack of security or safety in mixed-gender shelters.

So ... if the choice is to give in to a probable scam or send the person in front of you out into god knows what ... I'm at a loss as to what to do except keep trying. Does being a mentally ill, poor or personality disordered person merit a death sentence? It's hyperbole, for sure ... but it happens.

Of course, there's always the issue of misdiagnosing the problem, too. That's why we always need to check our assumptions.

Systemic solutions certainly need to happen, but figuring out what those might be involves some highly contentious subjects and we haven't yet learned how to do that.

What I'm afraid I see right now is that we are allowing the scammers to suck up all our available energy while people who really need and can use help get mis-labeled and turfed out the door. I think we need to decide what's more important: catching every last scammer and showing them who's boss, or helping people who have literally hit bottom and need a hand up. Who is more important to you?

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Specializes in Hospice.

Having worked in acute medicine at Boston City Hospital in the 70's and in AIDS care in the 90's I can tell you that the behavior of system-gamers is one of the hardest things nurses have to deal with.

The OP appears to be having a perfectly normal and healthy reaction to being manipulated, lied to and treated like an idiot. The question is what to do with it. This is why I personally have a big problem with being scolded about "compassion" and "caring" etc, etc, ad nauseam. It's a difficult and constant struggle to avoid getting stuck in the anger and nursing is not known for its support systems.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Please note several posts have been edited/removed for being off-topic.

Please keep any religious posts out of the discussion.

Thank you.

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Specializes in Psychiatric Nursing.

As a psych nurse of 11 years, I feel compelled to weigh in here. The OP is obviously frustrated with the large numbers of revolving door homeless patients. I consider myself to be a very caring and compassionate individual, and I treat every patient with the respect and dignity they deserve. I would, however, like to share a conversation between two of my patients that I overhead once... Patient #1 said to patient #2, "All I have to do is get admitted here one more time, and I can get disability." While I don't know what to do about those who work the system, I realize that they find their way onto my unit occasionally.

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