A popular post of the day discussed patients overstaying their welcome. This was quite a shock to me and in my region the problem is the opposite. My experience has been totally different, and possibly more shocking than the stories of needy patients who aren't acute but remain beyond the usual length of stay--sometimes months, sometimes even beyond a year. What I've seen are patients discharged to the street without a place for recovery. This happens to the homeless, to the elderly who live with a spouse as fragile as they are, it happens with children whose parents are unable to care for their complex needs, and it happens to otherwise healthy adults who are discharged post-surgery and live alone.
For an example that may be horrifying but not terribly unusual, I had a patient who was homeless who had been injured when a car struck him as he was (legally) crossing the street. (The driver was later arrested for DUI and hit-and-run.) My patient had a compound fracture of one leg, broken ribs, internal organ injuries, and deep abrasions. He was in surgery for hours repairing the breaks and debriding the wounds. Less than 24 hours after surgery he was discharged with written/ paper prescriptions for pain meds and antibiotics, wearing a hospital gown and anti-skid footsie socks (his clothes had been cut off by the paramedics), and his other belongings were in a plastic bag. The hospital graciously gave him a walker and $2.00 for bus fare. It was winter and he had literally no where to go. Another homeless man 'took him in' at an abandoned construction trailer and the patient stayed there for a couple weeks (without pain meds or antibiotics). At least the other homeless guy shared food and blankets with him.
Elderly patients are also discharged after a medical crisis when they were barely able to care for themselves before the hospital admission. It also happens when parents have severely ill or injured children; some of these parents are performing tasks that RNs and respiratory therapists are trained to do.
Does anyone else see this happening in their hospital? Do these patients return when their condition either deteriorates or when they are simply in too much pain or unable to care for themselves?
Whenever someone says that "homeless people choose that lifestyle" I would like to slap the daylights out of them. Sure, there are some homeless people that do choose it. I watched a whole documentary on it a few years ago.
But the vast majority of homeless people would never have chosen their situation and I think its fair to say that most of them never dreamed they would be in such a situation. I'm sure we've all heard many times before that a large percentage of America's population is only a paycheck or two from homelessness.
I know so many people who literally don't have a single dime to their name for several days before payday. It's all gone before the next check comes in. So, if that next paycheck is missed they could very well find themselves on the street if rent cannot be paid. Not everyone has family and friends who are willing and able to help out in hard times.
There were so many people struggling day to day before gas prices went through the roof and I've often wondered how on earth some people manage now that gas prices have been outrageous for years now. I live in a rural area. We don't have any kind of public transportation here. If you want to work, you just about have to have a car to get there. And that car will require gas.
Sure, there are people living on the street who are addicts and their addictions are what lead to their state of homelessness. There are others, though, who turn to drugs and alcohol as a coping mechanism to deal with becoming homeless.
I think it's a shame that these things happen in this country. We have people living in multimillion dollar homes, carrying thousand dollar purses and wearing thousand dollar sunglasses but not too far away, people are living on benches and under bridges, eating out of garbage cans. Kids are catching the school bus from the broken down car their family is living in. It's ridiculous.
It's hard to get a job these days. I would imagine wearing ratty clothes and not having a phone number or address or transportation makes it exponentially harder.
I see it happen. Usually when the facesheet lists "self pay". I had a pt this past week who had no insurance. He was "the living poor" meaning works full time at a low paying job with no insurance. Being unable to work means not paying rent. Had an accident at home, broke a bone. The fracture he had is normally treated with surgery, but they dc'd him with a brace to " let it heal" . Oh and only 3 days of of pain medicine for this, which is going to hurt for a lot longer than that. Told to see pcp if he needs more, but can't drive with this injury. I had anotehr patient with a similar fracture that has had 2 surgeries in the past week and will be sent to our inpatient rehab for more treatment.
I see it happen. Usually when the facesheet lists "self pay". I had a pt this past week who had no insurance. He was "the living poor" meaning works full time at a low paying job with no insurance. Being unable to work means not paying rent. Had an accident at home, broke a bone. The fracture he had is normally treated with surgery, but they dc'd him with a brace to " let it heal" . Oh and only 3 days of of pain medicine for this, which is going to hurt for a lot longer than that. Told to see pcp if he needs more, but can't drive with this injury. I had anotehr patient with a similar fracture that has had 2 surgeries in the past week and will be sent to our inpatient rehab for more treatment.
My local hospital is famous for premature discharge. About a year ago, a man in a wheelchair ended up in the ER after he was hit by a car. He was discharged a few hours later, despite having a head injury. He was found dead in his bed the next morning. Apparently, he had an undetected skull fracture.
When I worked in assisted living, a resident went to the ER for some reason, and was discharged 3 hours later. She was shaking when she walked back in the door. When I checked up on her 4 hours later, she had a very high fever and altered mental status. I called 911 and sent her back to the ER. She was septic, and spent a few weeks in the ICU. She could have died.
Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
Sometimes I think our ED overtreats (future hubby is an EMS provider and takes people to my hospital's ED all the time, he firmly believes that they overtreat), but then I hear or read stories like these and I'm thankful for it. They admitted my dad for chest pain, watched him overnight on tele, and he did just fine. I'm glad they kept him.
Sometimes I think our ED overtreats (future hubby is an EMS provider and takes people to my hospital's ED all the time, he firmly believes that they overtreat), but then I hear or read stories like these and I'm thankful for it. They admitted my dad for chest pain, watched him overnight on tele, and he did just fine. I'm glad they kept him.
I wonder if those who are overtreated are well insured? I know when I was doing clinicals at a particular hospital, the patients on my unit had amazingly long hospital stays for seemingly benign diagnoses. One girl had an episode of hypoglycemia. Dangerous, yes but it had been about 10 days prior. I seen numerous patients admitted for week long or more stays for minor bronchitis. I've had bronchitis almost every winter of my life and I've never been seen at or admitted to a hospital. I know everyone is different but come on.
I had many patients who were feeling great with all symptoms resolved and tapping their feet, wondering when they were going to be discharged. It was bizarre, especially when we've teen told ad nauseum about how you have to get those patients out ASAP but not so soon that they'll be readmitted. My classmates and instructors agreed that the stays were curiously long.
I am sorry...I have read the thread and I see no evidence that the ortho patient required further treatment for his medical condition. He recieved surgery and discharge instructions. Precisely what is he supposed to remain in-patient for? I dmit I wish we could keep these patients due to their social situations but we would be flooded with patients if we kept them for psycho-social or economic reasons.
As for homeless population, we beg to differ. I work at a large urban teaching facility. I do see that many of the patients have psychiatric problems for which I am infinitely sympathetic. They get little to no care for their psych problems. This, I think, is very much society's fault.
On the flip side, many homless patients self-medicate with crack cocaine and if they recieve disability monies, spend them on crack and alcohol (yes the patients say so before you jump on me or they test positive).
I very rarely meet a homeless person who isn't largely responsible for the state of his or her housing situation. I have never heard a story about a job lost from a homeless person. The closest I have come are abused teenagers who flee from home or disabled people who slip through the cracks. My guess is that these patients account for 1-3% of the total homeless population that we see and we see a huge homeless population. Maybe its just where I am?
I know hundreds of homeless people because I've been directly involved in homeless projects for years. I don't know a single one who was 'largely responsible' for his or her homelessness. I know people who grew up in poverty, who were failed by their families, failed by society when they were children, and failed by society when they became adults. Those abused teenagers who run away and live on the streets become adults living on the streets. What changes in their lives that they will suddenly become capable of having trusting relationships and hold jobs and raise emotionally secure families? I know people who lived 'American Dream' lives before a horrible twist of bad luck turned their world upside down. I know of people who were born with learning disabilities and could never find meaningful employment. I know homeless people who were born with or became disabled and were limited in the jobs they were offered or could perform.
Not to say that every person who was abused as a child, or grew up with chemically addicted parents--or without parents at all--will become homeless. But, it sure increases your chances that your life will continue in poverty and the cycle of abuse, neglect, drug addiction will continue. Yes, some people break the cycle, but the deck is stacked against them.
The homeless are some of the most vulnerable in our society. They sleep in public places with no security. They are at the mercy of others for handouts. They are spat upon, verbally abused, and often the victims of violent beatings (usually at the hands of drunken youths leaving bars and clubs late at night). I've known of homeless men being humilated and told to 'perform' in order to be spared from being beaten... but after the laughter dies down, they're usually beaten, anyway. This is not a life anyone would willingly 'choose'. If they self-medicate, I don't blame them a bit.
We've all heard that most Americans are one or two paychecks away from homelessness. All it takes is for a personal crisis. Or, an economic downturn.
Not to challenge you, VICEDRN, but how many homeless people do you actually KNOW? It takes awhile to actually 'know' them and gain their trust enough for them to share their stories. (These are people who have some serious trust issues, and all of it stems from their being victimized as children, teens, or adults). Each and every homeless person has a story, and each one is more heartbreaking than the last. These are not folks who woke up one morning and decided it would be fun not to pay rent. It's easy to blame others for mistakes they made. Hindsight is 20/20, especially when you're looking at someone else's life.
First of all, the situation you described in your OP would never happen on my floor. At the very least, our social worker is responsible for arranging transportation to a local homeless shelter. I don't know how she gets their prescriptions filled, but she does it. Part of our discharge checklist is ensuring that the patient has transportation to a safe environment, with access to the medications they need. I can see no excuse for putting someone on the street (especially after they most likely cut off the only clothes he had in the ED) in a hospital gown, with no place to go, and no money to get his medications. What is more expensive, hiring a cab and paying for a round of antibiotics, or treating the patient in a month for the complications that can develop after an unsafe discharge?
The only abuse of this system that I have seen is with GSW victims. They are usually young with no insurance. They are usually pretty traumatized (understandable) but don't want to do PT or get up and walk. It is the "I got shot in the arm! Now I can't walk" mentality. I am sure there is a GSW out there that does not fit this stereotype, but I haven't seen it yet :-/
Thanks, Beckster! I've worked in a children's rehab and too many of the patients were GSWs. They're mostly young men (make that older children--anywhere between 13 and 18 years old) and they don't appreciate that this short rehab opportunity is limited and if they don't take full advantage, they'll never learn to walk, feed themselves, or use their opposite hand effectively (depending on their injury). I know exactly what you mean. I get frustrated, too, but I do have a hard time understanding what they might be feeling or going through. I've suggested to the social workers and docs that they go home if they're not cooperative and be allowed to return for the balance of their rehab once they realize how tough it is post GSW to do what used to be second nature. This is one time I do advocate shipping people out early--don't let them waste their rehab time while they're not mentally/ emotionally ready to take full advantage of it. But, let them come back when they're receptive. Costs a lot of money to have a person in rehab who refuses to leave the TV set and would rather sleep all day than go to PT.
That is an interesting thought. I work in an inpatient setting, so the issue lies mostly with finding an appropriate discharge "destination." I haven't seen a GSW that was eligible for rehab. They have all been fully capable of participating in PT, but refused to do so. That in and of itself disqualifies a patient for most of the rehab facilities in my area, as they all require that the patient is agreeable to a rehab program.
The worst case I have seen was a patient who was all set to go to a halfway house, but disputed his discharge 3 times. It required the teamwork of SW, 2 care coordinators, our associate director, and whoever is in charge of reviewing the patients that refused to be discharged, before we were legally able to d/c him. This is an inherently difficult population to work with because they are younger, are not usually the most personable people (they did get shot after all), and while their condition is acute, it is very dramatic. They are so caught up with the fact that someone tried to kill them that absolutely nothing else is important. Again, I understand the trauma, but it is difficult to snap them back to reality.
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CrazierThanYou
1,917 Posts
Whenever someone says that "homeless people choose that lifestyle" I would like to slap the daylights out of them. Sure, there are some homeless people that do choose it. I watched a whole documentary on it a few years ago.
But the vast majority of homeless people would never have chosen their situation and I think its fair to say that most of them never dreamed they would be in such a situation. I'm sure we've all heard many times before that a large percentage of America's population is only a paycheck or two from homelessness.
I know so many people who literally don't have a single dime to their name for several days before payday. It's all gone before the next check comes in. So, if that next paycheck is missed they could very well find themselves on the street if rent cannot be paid. Not everyone has family and friends who are willing and able to help out in hard times.
There were so many people struggling day to day before gas prices went through the roof and I've often wondered how on earth some people manage now that gas prices have been outrageous for years now. I live in a rural area. We don't have any kind of public transportation here. If you want to work, you just about have to have a car to get there. And that car will require gas.
Sure, there are people living on the street who are addicts and their addictions are what lead to their state of homelessness. There are others, though, who turn to drugs and alcohol as a coping mechanism to deal with becoming homeless.
I think it's a shame that these things happen in this country. We have people living in multimillion dollar homes, carrying thousand dollar purses and wearing thousand dollar sunglasses but not too far away, people are living on benches and under bridges, eating out of garbage cans. Kids are catching the school bus from the broken down car their family is living in. It's ridiculous.
It's hard to get a job these days. I would imagine wearing ratty clothes and not having a phone number or address or transportation makes it exponentially harder.