Tuesday, August 9, 2011

ER Demographics: Homeless Patients

Homelessness is a real touchy subject, especially for those of us in the healthcare field. For the purpose of this article, we are specifically talking about homeless patients, not homeless people in general. Not all homeless people require hospital services. With that said, hospitals endeavor to help everyone. Those of us in the emergency room especially receive the largest burden with homeless patients. That's because people without a permanent residence are entitled to quite a bit more resources then most people who walk in.
These include:
1. The right to have a social worker provided.
2. The right to public or private transportation (taxi voucher/bus pass).
3. Access to a listing of shelters, food services, psychological services.
4. Hospitals also have laws against "dumping" where they have to be medically stable and sober.
5. Hospitals also have to provide them with a bed until the morning.
And of course, all people are entitled to receive medical treatment regardless of their ability to pay. Essentially, we are to provide everything a person needs to get their life back together if they so wish.
Homeless sleeping in a park.
I'm not going to get into why people are homeless. I'm also not going to tell you what society should do about it (that's up to you and your beliefs). I am going to explain why many healthcare workers appear callous towards this demographic. I have seen it in some of my coworkers, and it happens to everyone a bit overtime. Patient A comes in drunk again. He/she was discharged 3 hours ago sober and told to check in at a shelter. Instead Patient A begged for exactly $9.31 for a cheap fifth of vodka. No joke, they know exactly how much money they need, to the cents! Usually the police/paramedics pick them up after they injure themselves from falling down (if you can't walk ,generally the police have to take you to a hospital).

Generally police check them into the nearest hospital.
I always remind myself that these people really are in a tough point in their lives. No job and no home. Any family they may have had is long gone. Even when they want to get sober, withdrawal is hard even with meds. A comedian recently said something funny along the lines of "People say you shouldn't give money to the homeless... that they will just spend it on drugs and alcohol." ... "Well, hell! That's what I'm going to do!".

Knowing this, it is still hard to help homeless patients. 95% of the time they come in because they are too drunk to walk and have been in a fight or hurt themselves. Often they are violent against ER workers, especially nurses and techs. They tend to be very vulgar towards staff and other patients. We can restrain them to some degree but laws are very strict on what we can do. When using Blood Alcohol Concentration (BAC), it is lowered by roughly 0.015% per hour. Take an experienced drinker with 0.5% (this is technically a "lethal dose" and easily tolerated by experience drinkers ), that is 28 hours until they are sober enough to leave. That's also 28 hours where we had a room we couldn't give to someone else.


  1. Good to know that someone is expressing something that is towards a part of people who are overlooked. Keep this up.

  2. this is great.. I hope I get to your ER if sick!:D

  3. Very interesting. Maybe they should implement a 3-strike sort of rule. To prevent people who go in and out of, and abuse, this system.

  4. The homeless are never greatful. They just know they have rights and abuse them. source: i work in healthcare

  5. Everything about homelessness is difficult, especially helping those who don't wish to help themselves. Great post!

  6. I saw my share of homeless when I volunteered at the ER

  7. You can see how by trying to help the needy, the system opens itself up to a huge level of abuse. As Allison said, maybe a 3 strike rule is the way to go?

  8. A homeless person broke into my fathers store on the coldest night of the year a couple years back.

    The police came because an alarm was triggere. My dad was called out there, and when he arrived the police gave him a choice; press charges and the homeless person would go to jail, or if he decided to not press charges they would release him. The Police officers also told him that sometimes homeless people do stuff like this to get out of the cold. Pretty sad stuff.

    I see the want for a 3 strikes rule, but think of it this way - what if there is need for a fourth visit to the ER? Just let them die because they happen to have absolutely nothing, and no one?

  9. When I was working reportable events at my towns hospital some of the nurses had to hide the Sterigel used to clean hands because homeless alcoholics would try to drink it =(

  10. i always try to help any homeless i come across, its too bad a lot of them are just looking for their next fix.

  11. It is interesting to learn that the homeless can receive better medical care than I would get.
    Since some homeless really are in need of help and are unable (or are too proud?) to get it.
    Whereas others just want to leech off of the rest of society for their next fix, or hit.
    I say if they want feed their vice they should have to work like the rest of us. If someone is homeless and is begging for money to eat, I am more than willing to buy food for them, or give the food I have on me away.
    Screw all the junkies and homeless that hang around in parks or by pay phones and constantly ask for "Just $0.25 man!" and say "What you don't have a spare quarter."
    I live in Victoria, BC, Canada and the homeless here are starting to become a real big nuisance and problem.
    /homeless people rant