Hospital vs. Homeless

This is a topic that comes up a lot at work. What to do with a homeless patient who is medically cleared for discharge? There have been a lot of stories in the news lately about patient dumping. A few months ago, a hospital was accused of pumping a patient by Skid Row I think, who could not walk. No walker, no wheel chair, he was practically crawling to the sidewalk. These things are deplorable.

A few days ago, this story hit the news of another case of alleged patient dumping in Los Angeles County. The details of this case are muddy. Did the patient leave AMA? Did he have a bed available at the LA Mission? It's hard to tell. Besides, they don't 'reserve beds there'. It's a first come first serve situation. I suppose the best that can be done is to feed them, clothe them, pay for a taxi and drop them off at the mission or wherever they want to go.

The media is really good at demonizing the hospitals and making them look like this big money hungry facilities who don't really care about people. The media rarely looks at the real problem though.

What should be done about the homeless when it's time for them to leave the hospital?

It's bad enough that many homeless patients are getting free care in the hospital system. Non profit and for profit hospitals are legally or ethically required to offer some free care. A little less than 10% I think. But at what point is enough, enough? We had a patient in our hospital who stayed almost 4 months!! He was homeless, and a cash patient. Cash meaning, no insurance, did not qualify for medicaid after he was medically clear. Psych did not want to discharge this patient because he was mentally altered, had been homeless for 20 years, of course he was somewhat altered. Physicians don't want to be liable for discharging a patient back to the streets, for fear of the news and the possible litigation.

But a hospital is not a hotel. It is not the job of a hospital to supply three square meals, and a warm bed for people who are not sick, but simply do not have anywhere else to go. Patients like this increase our patient population, taking up beds that could go to truly sick patients. It takes nurses to care for these patients within there ratios. It costs money that could be spent elsewhere. I'm not saying that these patients should be thrown to the streets with no help, no support- of course not. But is it fair that the hospitals have to care for these people for months and months and months on end? This affects everyone. This means that beds are taken up for patients who are no longer really sick, and perhaps people have to wait longer in the Emergency Room for a bed on the medical floor. This means increased costs to care for everyone else. Is it fair to people who struggle to pair thier 200 copayment and 20% of care and stay for three days while this guy is a resident for free??

I'm not heartless. This is a major dilemma that faces our society. What can be done about the homeless in this situation? There's no answer. Hopspital administration doesn't know what to do. Discharge planners and Case Managers are pulling their hair out. I suppose this is why the politicians are not chiming in, they probably don't know what to do either.

For now the media seems pleased to blame everything on hospital administration instead of focusing on the real issues. No doubt it's a sad situation, but the world is full of them.