HOSP-ITALITY ABUSE

[tskstorm]

Read the Full article here

ILLNESS-FAKER BUMS TREAT ERS AS HOTELS - ON YOUR TAB

These bums are costing you a fortune.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.

[joesph]

He should have to mop the floors and empty the trash when he wakes up.

[HERBIE1]

Anyone who works in a busy urban system probably has at least 6 regulars. I had a couple guys so often, I knew their life stories, DOB's and even SSN's by heart. That's disgusting, isn't it? Everyone knows there is nothing wrong with them- they are alcoholics, and like the guys in the story, only want a bed and breakfast.

[VentMedic]

Anyone who works in a busy urban system probably has at least 6 regulars. I had a couple guys so often, I knew their life stories, DOB's and even SSN's by heart. That's disgusting, isn't it? Everyone knows there is nothing wrong with them- they are alcoholics, and like the guys in the story, only want a bed and breakfast.

So what is your agency doing about it? Establishing communications with your local Social Services? Leaving a paper trail for easier followup? Or, are you just dumping the problem into the ED and bitching about it? Maybe you're not even bothering to fill out the PCR appropriately for tracking? Do you just expect the ED and Case Managers to do everything? The Case Managers have their hands full trying to prevent others from becoming homeless.

As far as the disgusting part, I feel the same way about obese, chain smoking EMT(P)s who suck up sick days, increase out of pocket insurance rates for everyone and then expect the government to support their fat, short of breath arses when they go out on disability from a line of duty injury they received while reaching for that last powdered sugar donut.

Edited July 12, 2009 by VentMedic

[WolfmanHarris]

So what is your agency doing about it?

The main program my service has instituted unfortunately is not well designed to deal with the homeless. Our Community Referral by EMS (CREMS) program is designed to get more appropriate services to patients who may need them via the Community Care Access Centre, which is a regional department that sets up various homecare and alternative care initiatives. Our program breaks down like this:

Common reasons to refer:

- Frequent calls to EMS

- Mobility issues

- Chronic orthopedic issues

- Hx of acute episodes of chronic conditions (CHF, COPD, diabetes, asthma)

- Impaired hearing or vision

- Mental health issues *

- Problems with catheters or drains (chronic)

- Palliative care

- Potential abuse or neglect (in conjunction with duty to report to PD)

- Problems with activities of daily living

- Hydration and/or nutrition issues

- Caregiver distress/respite

- Requires assistive devices (walker, handrails, etc.)

- Paramedic judgment that community care resources may be appropriate

Our basic procedure is to identify the need, obtain verbal consent from the patient (required due to PHIPPA), leave them with documentation for CCAC and call CCAC to leave a referral. Current CCAC clients are not excluded from this program as our contacting them can notify a case worker that their care may need adjusting. Transport is not required with this program, not does transport exclude them from being referred.

* Specific to mental health, for acute mental health crisis we have access to a help line where a patient that is not an imminent risk to themselves/others (and thus would be detained by PD under the Mental Health Act and transport compelled), is put in touch with mental health professionals who in consultation with us will arrange a response. Less severe cases will receive over the phone intervention and the patient will be left in their own care and more severe cases will receive an on scene response by a crisis team consisting of a mental health worker and a specially trained, plain clothes LEO who will take over the situation from there. This mid-range response is apparently uncommon as if it is felt they require care that rapidly, they will usually be transported directly to hospital. I can't speak specifics on this one as I'm yet to have a psych case at this service, so I'm going by written P&P and what I've been told.

[tskstorm]

So what is your agency doing about it?

I think we have finally began doing something about it, we have recognized the issue, and are trying to bring public attention to the issue so we can come up with a better way to deal with this.

I always picked up the same patient, for about 2 years ... everyday i worked without fail, sometimes more than once a day! I used to always be annoyed to have to pick him up, because as soon as the dispatch information came over, we knew who it was. My attitude was horrid, until the day we were dispatched to him in cardiac arrest. He had slept outside that night because his family wouldn't let him in intoxicated, and he didn't want to call 9-1-1 again that day as he had twice already. He froze to death, despite all efforts that was the last time I picked him up. I remember the last time he was alive and I took him to the ED he told me he loved me and my partner, and we were always so good to him. Now I find myself, missing picking him up, when I drive past where we would always pick him up from I think about him.

These chronic callers are definitely a drain on our systems, but they do need help, we need to find a better way to handle these issues.

[VentMedic]

These chronic callers are definitely a drain on our systems, but they do need help, we need to find a better way to handle these issues.

That's just it. Some in EMS take only the obvious problem into consideration which might be the intoxication issue. Few will do a thorough enough exam to see the ulcers and other signs of chronic disease processes that are occuring. Some in EMS will also refuse to transport these patients. Then, instead of what could have been a little patch up and buff up of the electrolytes in the ED will later become an extensive ICU stay tying up a bed possibly for weeks and then to a stepdown unit, med-surg and a SNF until well enough to be released.

Some cities have RNs roving the streets looking for homeless people with medical problems that need to be identified and referred to a clinic where NPs and PAs are taking the load off the EDs. At this time EMT(P)s in the U.S. are not educated or trained to recognize things other than emergent conditions. The idea is to get these people into the system with followup to while they don't become a problem for EMS. Often if they know someone is there to look out for them, they are no longer relying on 911. The national associations for NPs and PAs (as well as RTs and RNs along with many others) are addressing these issues and are working, sometimes even together, to broaden the reach of services. EMS is still searching for an identity and more letters in the alphabet to put behind EMT.

[HERBIE1]

So what is your agency doing about it? Establishing communications with your local Social Services? Leaving a paper trail for easier followup? Or, are you just dumping the problem into the ED and bitching about it? Maybe you're not even bothering to fill out the PCR appropriately for tracking? Do you just expect the ED and Case Managers to do everything? The Case Managers have their hands full trying to prevent others from becoming homeless.

As far as the disgusting part, I feel the same way about obese, chain smoking EMT(P)s who suck up sick days, increase out of pocket insurance rates for everyone and then expect the government to support their fat, short of breath arses when they go out on disability from a line of duty injury they received while reaching for that last powdered sugar donut.

Save the bleeding heart speech- not interested.

Every single one of these "at risk" patients are given information on homeless shelters, AA programs, rehab centers, detox options, etc. EVERY SINGLE ONE OF THEM, every time they are seen at an ER they are given a list of these options along with their discharge instructions. We see stacks of these forms among their worldly possessions. Every single one sees a social worker before they are discharged. EVERY SINGLE ONE. With a single phone call, the Department of Human Services even picks them up FROM the ER to start their recovery/detox/rehab/shelter assistance process if they want. They don't even need to be seen as a patient- simply show up at the waiting room and request services. All they have to to is take advantage of the help offered to them.

Many local charities and advocacy groups operate outreach services that go to the areas the homeless frequent and provide mobile health care, contraception, food, basic necessities, counseling, and more contact info.

If someone asks to go to detox(extremely rare), we contact the police for the transport since we cannot provide this service. 99% of the time, they are NOT interested in anything but a place to sleep it off and a "free" meal.

They CHOOSE not to take advantage of the help offered to them. If someone is not ready to change their lifestyle, you cannot force them.

Not my problem.

[VentMedic]

Save the bleeding heart speech- not interested.

No bleeding heart, just years of working in a city with these problems and trying not to add more to the existing problems.

There are EMS systems that do get involved in community issues even if you don't give a crap about healthcare issues. Lee County FL has a great model for them.

When they call, they area still your patients. You can ask many in EMS what alternative services there are and few know what happens outside the walls of their truck. Few could even provide a taxi number as an alternative.

Again, there are just as many EMT(P)s sucking up funds for smoking and obesity that also refuse to take care of themselves or take responsibility for their lives.

Not my problem

That says it all about you. It is a shame your type even deals with patients.

Edited July 13, 2009 by VentMedic

[HERBIE1]

That says it all about you. It is a shame your type even deals with patients.

My "type" takes excellent care of people who request my help- regardless of what their problems are. Look at the original article again-tell me what type of "help" are those patients requesting?

A significant part of our jobs is education and social work and I am more than happy to do that. I can refer them to any of a dozen shelters or agencies if that is what they want. THEY DON'T. Like a smoker, a drug addict, an overeater, or an alcoholic- you can offer someone all the help in the world, but until THEY are ready to accept it, they will not change their behavior-even if you are a well intentioned social worker wanna-be.

If I wanted to be a social worker, I would have followed that path as a career.

Again- save the bleeding heart, holier than thou lecture.