When a homeless man recently came to Mercy Medical Center Merced for help, the hospital was quick to take care of his medical needs.
But when it was time to discharge the middle-aged man, he needed more care than his doctors and nurses thought he would get if he went right back to the streets again.
“The homeless are thinking about living day to day, not about the future,” said Grace Sapien, director of utilization for Mercy.
Sapien, along with 13 other nurses and staff at the hospital, make sure the homeless, the elderly and other patients who need help after they’re discharged get that help before they leave the hospital.
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When that homeless man left Mercy, he had already met with adult protective services and clutched a fistful of papers that would help him get the medical care and the financial services he needed.
It’s not only the homeless that the social case workers, under Sapien’s management, help at Mercy. Sometimes it’s people who just need some help getting back home.
“We had an 80-plus-year-old man who was driving from New York to Northern California who ended up here after a car accident,” recalled Julie Garber, a registered nurse and case manager for Mercy.
The man, who was a little bit rattled by the whole experience, only wanted to go home. But there was no one to get him back to his elderly wife, no way to make sure that he could get on a plane, in a wheelchair and fly across country.
So Garber discussed the problem with the Salvation Army, and one of the Army’s volunteers offered to accompany the man back to New York.
“We all worked together, and he got home to his wife,” Garber said.
The case workers at Mercy have to have a discharge plan in place by law for every patient that comes to Mercy. That’s about 880 patients a month who are admitted to the hospital, Sapien said.Although a lot of people pose no problems at discharge, many desperately need the services of the social workers.
One woman in her 20s came to Mercy with cervical cancer. But because she was an undocumented alien, she couldn’t get any insurance or financial help.
Sonya Dew, a medical social worker at the hospital, went to work on the problem. She discovered a foundation that helps pay medical bills for women suffering from either breast or cervical cancer. The woman was treated and is doing fine.
Along with finding financial help, the case workers make sure that patients will have someone to care for them at home if need be, and that the home is a safe place for the patient.“If we have a 90-year-old who is going to be home alone, we try to get that person some help,” Dew said.
But patients always have the final say, Dew added. If a patient doesn’t want help, and insists that he will be fine, the case workers must allow him to leave.
One of the biggest problems that Mercy social workers face is when a person is ready to leave the acute-care hospital and go to a skilled-nursing facility, either for more medical care or for therapy. Because of a lack of those facilities in the area, some patients may end up staying in a hospital bed for months.
Staff at Mercy look all over the state of California, trying to find a nursing home that will take their patients.
“Skilled nursing facilities get such poor reimbursement rates from insurance companies that it’s difficult for them to stay afloat,” Sapien said.
The facilities work with the hospital, trying to find open beds, but sometimes the patient actually gets well enough to go home before a bed at a nursing facility opens up.
Mercy works with Adult Protective Services in Merced, along with the mental health agencies and others to help patients get the after-hospital care they need, Sapien said.
But with the changes that have happened lately in Merced, such as the closure of A Woman’s Place and the delayed construction of a new homeless shelter, the case workers at Mercy constantly face new problems.
But at the end of the day, when Sapien, Dew and Garber go home, they are fairly confident they have done all they can to help their patients.
“The patient is always the focus,” said Garber. “We have to provide a safe plan for them, but we also have to assure that there are beds available in our hospital for the community, too.”