The global economic downturn has many social workers and clinicians alarmed by the growing the number of homeless individuals going to the nation's hospitals for health care. An influx of newly homeless, adding to large numbers of chronically homeless, is forcing healthcare organizations to take steps to ensure that they have legally compliant discharge planning protocols and procedures in place to avoid frequent readmissions or charges of "patient dumping."

Two forces are increasing the numbers of homeless patients who are receiving care at U.S. hospitals: Economic hardships are driving patients to homelessness, increasing the likelihood that they will require charity care, and adverse living conditions faced by already homeless patients who have chronic or acute illnesses are exacerbating these illnesses.

Many of these homeless individuals and families are routinely exposed to the elements, communicable diseases, violence, malnutrition, and drug and alcohol abuse. Their illnesses often are concurrent with psychological and substance abuse, making them more difficult to treat in an acute care setting. They also typically enter the hospital through the emergency department (ED), and if they cannot be transferred properly, they must be kept in the ED or admitted for treatment of their acute illnesses as inpatients.

Hospital staffs have names for such patients: All too often, the patients are referred to as "revolving door" or "frequent flyer" patients because-lacking health insurance and sufficient resources to care for themselves or their families-they tend to be readmitted repeatedly for the same conditions. They also are sometimes called "bed blockers," which expresses the frustration many caregivers feel in dealing with these patients' increasingly extended inpatient stays and the feeling that all of their efforts to deliver effective care are futile.

The use of such terms, while they may be seen as pejorative, reflects an unfortunate reality in the nation's hospitals, today. That is, many caregivers perceive that indigent homeless patients are using valuable assets and consuming the most expensive level of care to no good purpose. The problem is that often, after these patients have been diagnosed and stabilized in the ED, they are deemed not to require inpatient treatment and could be discharged, yet they remain in the acute care bed because they have no place to go to receive follow-up care after discharge. Even if discharged, they often return to the hospital in a short time because they lack access to follow-up care. Such results point not only to the problem of the lack of adequate care for these patients, but also to higher costs for hospitals that have not found a way to cost-effectively address these patients' needs.

Solutions to these problems can take many forms, but the authors of this article to be published in the March 2012 issue of hfm advocate that hospital finance leaders give special consideration to the following two:

  • Develop well thought-out and anticipated discharge policies to cover patients who lack stable settings
  • Develop a communitywide respite or recuperation program

Read this article in the March issue of hfm to learn how proper discharge planning and using medical respite care can significantly reduce the incidence of readmissions of homeless and other vulnerable patients.



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