Should we be discharging young homeless patients? Watch

Anonymous #1
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I'm sure the majority of the doctors on here have seen young homeless adults seek medical attention - having acute treatment and the priority being to discharge the patient as soon as possible. This is of course frequently compounded by alcohol and drug addiction problems, with the relevant input of those teams. But it is relatively rare to see homeless patients have prolonged stays with the team searching for appropriate accommodation.

It occurred to me that we would - rightly - never do such a thing with an elderly patient, where a prolonged "social" stay seems to occur more often than not.

Is there a double-standard here? Is this something which we have any capacity to change?
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seaholme
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What I've always seen is that physically fit and able people with no immediate care needs are discharged to a hostel/similar homelessness services if they have no alternative accommodation. A reasonable proportion (if we're talking about people who use drugs/alcohol) also tend to take self-discharge against advice, regardless of having somewhere to go. Social workers operate in hostels and homelessness services and can provide input on housing etc. for them - the key thing really is that they have no medical or assistance needs requiring them to stay in hospital.

Those who have physical limitations requiring assistance and care, or issues around their capacity/health, cannot be safely discharged somewhere whilst they wait for a suitable placement and package of care. This tends to be the elderly as the burden of morbidity increases as you get older, but it can also sometimes include younger people, and because social care operates like a snail (due to a whole host of issues I'm sure we're all aware of) they end up having prolonged stays.

There's a whole network of things like hostels and homelessness centres dedicated to housing people who are without accommodation. Unless you've got additional care needs that mean you need daily medical input or somebody to assist you with things like washing, mobilising etc., or you lack the mental capacity to make safe decisions and need to be in a place of safety, that sort of thing, you don't need to be in a setting where these things are provided i.e. hospital.

If you can be safely sent home, regardless of your age, in order to await some sort of change in your personal circumstances to be organised in the community - be it an increased package of care or re-housing - you will and (in my opinion) should be. I guess I don't see a double standard but the same standard being applied to everyone.
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Jamie
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(Original post by Anonymous)
I'm sure the majority of the doctors on here have seen young homeless adults seek medical attention - having acute treatment and the priority being to discharge the patient as soon as possible. This is of course frequently compounded by alcohol and drug addiction problems, with the relevant input of those teams. But it is relatively rare to see homeless patients have prolonged stays with the team searching for appropriate accommodation.

It occurred to me that we would - rightly - never do such a thing with an elderly patient, where a prolonged "social" stay seems to occur more often than not.

Is there a double-standard here? Is this something which we have any capacity to change?
"Is there a double-standard here? Is this something which we have any capacity to change?"

Yup.

40 year old alcoholic living on streets. Brought in due to mild cellulitis. Is given oral antibiotics and dsicharged.

Same patient living ina home which isa wreck. Fleas everywhere, rat droppings in house. Flys etc. Kept in until SS clean up their home. 'vulnerable adult'

Bonkers.
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iPhone X
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The system just seems to have a passion for creating vicious cycles for our most vulnerable, so it seems. :sadnod:
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nexttime
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Most homeless people i have ever treated have either self-discharged against medical advice or been kicked out for continuing to use whilst on the ward.

But for those that stick around the services in this local area actually seem to be quite good and they go to some kind of shelter quickly. In other areas they either get sent on the street or yes, they stay as inpatients until SS house them. Which took months in the instance i am recalling.
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Anonymous #2
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At least in my hospital, if young medically fit people who are also homeless are ready to be discharged they are - it isn't the responsibility of the social work team to find them somewhere to live and instead they are advised to visit the local services (homing advice centre? or something). Doesn't sit particularly easy with me and seems unfair.
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Etomidate
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(Original post by Anonymous)
At least in my hospital, if young medically fit people who are also homeless are ready to be discharged they are - it isn't the responsibility of the social work team to find them somewhere to live and instead they are advised to visit the local services (homing advice centre? or something). Doesn't sit particularly easy with me and seems unfair.
Which can all be done as an outpatient basis. Being homeless doesn't necessitate an acute medical bed. There is more wider harm done by occupying the bed than discharging a young, fit homeless patient.

Ultimately, it's very easy to take away self-responsibility with this mindset which then leaves the acute medical service left to tidy up the mess. An excellent example of this is hospital transport. I see patients on a daily basis who drag their feet when it comes to arranging their own way home because they know free hospital transport exists. They will argue, complain and confront, insisting there is literally no way in hell they can make the 5 mile journey back home. Then magically, as long as the nurse holds her ground, a friend or family member will appear to finally take them home and the burden of care will actually be shared rather than dumped on the hospital. Then as a result, the bedbound palliative patient won't have to wait 8 hours for her transport to the hospice.

The reality of most young homeless people is that their issues are often complex with a significant degree of self-inflicted problems, compounded by a repeated failure to engage with services that demand any degree of self-improvement. I don't mean to say this in a "go and get a job, you homeless bum!" kind of way, but when you have daily interactions with this group of people you soon discover that very few of them are in situations which are genuinely beyond their locus of control.
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frostyy
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I think that a question of who requires care more should be brought up. With a limited supply of care providers you can only help so many. How do you choose who?
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