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 Mental Health, Gerontology, Palliative.
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?

Heres a novel idea. Perhaps their mental health issues weren't properly addressed in the first admission.

Specializes in Mental Health, Gerontology, Palliative.
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!

Dont know how much people get paid on disability where you live. Here its barely enough to cover rent and certainly not enough to live like a king

Specializes in Mental Health, Gerontology, Palliative.
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.

What sort of entitlement?

The sense of entitlement that health care should be a basic right as opposed to something a person only can get if they have the right health coverage?

1 Votes
Specializes in Psychiatric Nursing.

Certainly, health care should be a basic right, but that is a topic for another thread. I work in a state hospital, so our purpose is to serve those who have no private insurance. I do know how easy it is to become jaded, not because I'm jaded personally, but because I work with many nurses and clinicians that are. The clinical director/chief psychiatrist of my facility was actually investigated by The Joint Commission for giving an excessive number of patients a diagnosis of "malingering."

Specializes in Leadership, Psych, HomeCare, Amb. Care.

I think you really need to look at chronic mental illness and consider how it affects the individual. It affects thought processes, judgement and problem solving. There is definitely a small core of individuals who seemingly spend much of their time traveling from hospital to hospital, but they are a minority. Some may work the system, but many are being discharged with inadequate discharge plans into the community.

Treated like kings? I don't think so. Limited access to your own property, no ETOH, no tobacco. Locked unit, bedroom with a bed and a dresser, and that's it. One TV, maybe a radio, for the whole unit. A couple of shared phones in the hallway. Locked in with people screaming, swearing, threatening violence, with only the staff to intervene and keep everyone safe. Hoping you don't do something wrong to get on the wrong side of staff & get injected and possibly restrained. Eat when you're told, quiet time when you're told, bedtime when you're told. Hardly royal treatment.

We cater to no one, but treat everyone with respect. You act out, it will be dealt with. Bullying, threats, or violence simply aren't tolerated.

finally, they aren't entitled to unlimited services. Medicare days have a rolling, and a lifetime limit. Medicaid in Illinois is increasingly managed care. They give you X number of days, and that's it.

Hospitals get penalized if they have too many "potentially preventable re admissions" in less than 30 days. Discharge planning is much more important than it was previously.

so, yes Virginia, there is abuse, just as there is abuse of just every system that exists. Always has been, always will be. Sometimes it takes a little detective work to figure out how to break that patient's readmission cycle, but for the most part, it can be done.

Specializes in Psych.

A little late to the party but

We get those type of admissions too. We actually have a name for them when we call the doctor regarding the admission (One hospital seems to "cherry pick" admissions and we are the dumping ground). We just say its a &&&&Special. That means, Homeless, polysubstance abuse, no insurance who suddenly became suicidal when they couldnt get admitted to a rehab, to a medical unit or where told they did not meet inpatient criteria. Im expecting a lot of those type of admissions this weekend.... Full Moon, getting colder, beginning of the month and now spent all money on their habit and a doctor who accepts anyone with a pulse. These patients do cause increased chaos on the unit, can be very difficult to redirect and typically hate that a female is the one who is attempting to redirect the behavior.

1 Votes
Specializes in psychiatric nursing.

I work in inpatient psych and we have many clients who are repeat visitors. Some of them are malingering because they are homeless, looking to escape legal troubles, etc. I've had patients themselves tell me that they would prefer to stay in the hospital so they can get "3 hots and a cot".

It is not judgmental or uncompassionate to recognize that some people abuse the system. It is the reality of how the system is set up. There are not enough community resources to serve this population.

"What sort of entitlement?

The sense of entitlement that health care should be a basic right as opposed to something a person only can get if they have the right health coverage?"

Lol. Sorry. That is waaaaaay off base from what I am speaking of. Healthcare coverage has absolutely nothing to do with the the type of "entitlement" my unit deals with. Healthcare coverage, in fact, is irrelevant where I work. Coverage is a non issue.

Specializes in Hospice, corrections, psychiatry, rehab, LTC.
There is definitely something wrong with a system that discharges mentally ill people back onto the street with no home to go to!

Are you suggesting that the hospital needs to find housing for the people who have completed treatment?

I have run across people who are definitely gaming the system. One in particular, white male about 25 years old. Was on the phone pretty much constantly, seemed like he had an awful lot of people to call for someone who supposedly lived on the streets (this was before widespread cell phone use). One night I was sitting in the nurse station charting when I overheard him tell a friend, "I will tell them that I'm still suicidal for another day or two, and by then my check should be in." I immediately called his psychiatrist, who discharged him.

Another frequent flyer, substance abuser. Claimed to have migraines, yet claimed an allergy to every migraine medication known to man except morphine and demerol. Was laughing and joking with other patients in the day room in bright light, then she suddenly came out clutching her head and demanding medication for her "migraine". I called the physician, who said not to give her anything, and to let her leave AMA if she wasn't satisfied with that. She did, and about 30 minutes later I got a call from my own ER asking if we had just discharged her. I explained the situation that happened on the unit and that she left AMA after not getting medication for her supposed migraine. The ER nurse said "She is down here trying to get the same thing from us. I will send her packing."

I also found that, generally speaking, the homeless complained about the food more than other patients, which I found pretty ironic.

Specializes in School Nursing.

If assuring they have a safe place to be discharged to means 'finding them a home'- then I guess that is exactly what I am suggesting.

Specializes in Pedi.
If assuring they have a safe place to be discharged to means 'finding them a home'- then I guess that is exactly what I am suggesting.

In pediatrics, patients are not discharged if they do not have a home to go to. If that means they board on the floor until the Mom can get a placement in a shelter, so be it. An ill child cannot be discharged to nowhere. I don't see why it should be any different for a mentally ill adult.

Same problem where I work, and no they are not acutely psychotic, they just know how to work the system, they need to get out, get a job and pay for a place to live, just like I do. But its easier to draw a check than work. It makes me sick knowing that my hard earned tax dollars go toward their monthly checks and medical cards. I had a patient before that was spending her SSI check on crack, then came in with a medical card for treatment off of the crack, so not only are we supporting her crack habit with our taxes, our taxes are providing her a medical card to be detoxed, our Government is so messed up. Who is helping these people get SSI? And no I'm not talking about the true Psychiatric patient's for example who are severely depressed or have Schizophrenia, I am talking about the lazy people who don't want to work, so they play mentally ill to get a check & a hospital bed. It makes me sick! And please tell me why Psychiatric centers have turned into Detox facilities??? Go to a Detox place, I love when the detoxers get upset because they have to room with a Mentally Ill patient then complain about it. I tell them, I'm sorry this is a Psychiatric Center what did you expect?

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