Being sick and homeless: Where to go when hospital stay ends

January 4, 2010 

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SUN-STAR PHOTO BY MARCI STENBERG Julie Garber, a registered nurse at Mercy Medical Center Merced, talks to a patient about discharge instructions on Monday, Jan. 4, 2010. Mercy staff makes sure that everyone, including homeless patients, have somewhere to go when discharged.

MARCI STENBERG — Merced Sun-Star

Being homeless is never fun. Being homeless and sick can kill you.

For the homeless who end up at Mercy Medical Center Merced, the problem isn't their care at the hospital. It's their care after discharge that can make the difference between getting well or dying.

But the hospital has worked hard to make sure the homeless aren't just discharged back to the streets, where their medical needs may not be met.

State law requires hospitals to provide referrals for follow-up care for all patients. A law focusing on the homeless prohibits hospitals from dumping patients. It also requires them to recommend ways to improve the homeless person's transition back to the community.

Susie Brooks, a clinical documentation specialist at Mercy, makes sure every patient admitted to the hospital has a discharge plan.

Within 24 hours of being admitted to the hospital, every patient, including the homeless, is evaluated for discharge. "We determine and plan for discharge depending on what a patient's specific needs might be," Brooks said.

In the case of a homeless person, Brooks said where that patient goes depends on his needs. "If possible, we make arrangements for them to go to the homeless shelter," Brooks said.

But the homeless shelter only takes people who can physically walk into it. If a person can't do that, the hospital faces the problem of releasing a homeless patient when that person needs long-term care. Brooks said no long-term care facility in the county takes uninsured patients.

"We only discharge patients if it is safe for them," she said.

One source that has stepped up to help the homeless is the congregation at Sierra Presbyterian Church in Merced.

"Hospitals can get into a bind when they have nowhere to discharge a homeless person to," said Candace Adam-Medefind, a member of the church.

The church has worked with the homeless for years, Adam-Medefind said. One of the cases the church has helped with is an elderly homeless man who fractured his hip.

"He had nowhere to go, we ended up taking him and working with him," Adam-Medefind said. "He stayed at the church about six months. We were able to finally get him into housing."

The church has only about 25 members, and that limits the congregation in how much help they can give.

"We have no paid staff, we are working with an all-volunteer staff," Adam-Medefind said.

The church got some help this year with grants from the city of Merced and from Mercy.

"We will be able to house seven homeless medically needy people with these grants," Adam Medefind said.

Jan Emerson, vice president of external affairs for the California Hospital Association, said hospitals are required to have a discharge plan for all patients and to know what services are available to help the homeless.

"The hospital can't just put a homeless person in a cab and send them on their way," Emerson said.

When a homeless person can't be safely released to the streets, Mercy may end up keeping the patient longer than medically necessary to make sure the patient is being treated for their problems.

"We are proud of providing care to the community, regardless of their ability to pay," said Brooks. "We would not be able to live with ourselves if we put someone out on the streets."

Reporter Carol Reiter can be reached at (209) 385-2486 or creiter@mercedsun-star.com