Hospitals grapple with challenge in caring for homeless--respite care facilities

[TexasTowelie]

The patient, a homeless man with substance abuse problems, had been hit by a car and was taken to a hospital for treatment. Upon discharge, he went back to the woods, where he’d been living.

Three days later, he returned to the hospital. This time, the ambulance crew stuffed him into a body bag because he was covered with his own feces.

“He was alive, but he had no ability to care for himself,” said Donna J. Biederman, an associate professor at the Duke University School of Nursing.

“It was just a really horrible, undignified situation, and he actually stayed at the hospital for probably 60 days,” said a recent study co-written by Biederman. The study looked at how homeless people were being released from hospitals in Durham, N.C., Duke’s home.

Read more: http://www.dallasnews.com/news/metro/20141128-hospitals-grapple-with-challenge-in-caring-for-homeless.ece

[font color=green]The article continues with the situation in Dallas and the lack of respite care facilities. A poignant story since I was in a similar situation earlier this year.[/font]

[Warpy]

1. They can't treat the homeless the way they do people with homes and families

People used to convalesce in the hospital and that allowed them to build up strength before they went home to confront housework and jobs. These days, they're pushed out as soon as they're medically stable on oral medications.

That doesn't work for homeless people. They can't care for themselves appropriately out in a tent or under a tarp in the woods (or worse) and they will always bounce back in record time.

Perhaps when we start to see Medicare extended the way it might have been had Joe Lieberman (I-worm) not been in office, we'll see convalescent units for people with no homes and elderly people with no families to care for them.

Something's got to give, bounce back patients are always a lot sicker than they were on the first admission. What we are doing is not working.

[greymattermom]

2. everyone has this problem

People are dismissed from the hospital with no ability to care for themselves and nowhere to go. This happened to me, even though I'm well off. My sister required help from all of her friends, including me, after foot surgery. She would not have been able to manage without that help. A handicapped room in a motel 6 with on call help would have been much better than sending her home to her townhouse with stairs. Everyone needs this. The quicker and sicker plan is terrible.

[ColesCountyDem]

3. I was fortunate to have a surgeon who refused to discharge me.

In 2008, I had emergency surgery for a perforated colon. Post-operatively, I developed MRSA in the wound. The infection was treated aggressively and, after 3 1/2 weeks, I was theoretically 'stable' enough to be discharged, according to my insurance company.

My insurance company notified the hospital and my surgeon that they would cease to pay for my hospitalization, because I met their criteria for discharge. Fortunately for me, my surgeon knew that I had no one at home to help me, were I to be discharged. Furthermore, my insurance did not provide for a visiting nurse or a homemaker, and I was too ill to manage my own wound or to care for myself at home, so my surgeon decided to fight my insurer's decision to force my discharge. The fight lasted almost a month, but my insurer finally relented, and I was allowed to stay in the hospital for 3 1/2 months, and then discharged to the hospital's inpatient wound-care center for an additional 3 months.

I was fortunate enough to have had a surgeon who was willing to 'buck the system' and a hospital who was willing to stand behind him. Had I not had the two of them, I would no doubt have been sent home and days later returned to the hospital sicker than I was upon discharge. Ironically, had that course been followed, my insurer would have paid for my more expensive treatment upon my re-admission.

The problem with discharging patients as soon as they are medically stable affects the homeless in a particularly vicious and callous manner, but it can and does affect even those who are not homeless. One giant step that could be taken toward solving this problem would be to let physicians make medical judgments about discharge, rather than insurance company bean counters.