Every day the national healthcare workforce comes face to face with grim realities manifesting from much larger systemic issues. Occasionally these matters receive media attention and, subsequently, the attention of the general public, which uses its collective power to sway public policy. Take, for example, suicides. Our healthcare workforce sees roughly 100 suicides (and 1,100 attempted suicides) daily, yet media attention on this issue is rare. Readers may remember news reports of 15-year-old Phoebe Prince, who committed suicide in 2010 after being bullied by her classmates. The general public, armed with this information, moved policymakers to implement stricter anti-bullying policies in many communities across the country.
Suicides are but one of the ugly facts of life often seen in our nation's hospitals. Every day, medical professionals assist people who lack the means to pay for their healthcare. They see individuals who must choose between better health or a lifetime of medical debt. They see patients who need medication but are unable to afford it. Who is responsible for making sure that these problems are recognized and are being addressed by policymakers? The answer is you.
The phrase "if it's not documented, it didn't happen" is common to many professions but is particularly relevant to hospital administrators and clinicians. While hospitals are good at reporting incidence of diseases for public health reports and services delivered for billing purposes, they largely fail to document social indicators that would improve policies and programs for people experiencing homelessness.
Knowing the prevalence of people experiencing homelessness seeking hospital care, particularly through emergency departments, would aid policy efforts affecting a number of homeless service initiatives. For example, initiatives to develop medical respite programs and emergency room diversion programs are dependent on hospital utilization trends of people experiencing homelessness.
ICD provides a code for homelessness (v60 for ICD-9; z59 for ICD-10), yet these codes rarely are used by hospitals. Without documentation, the general public and our policymakers are left unaware of many healthcare needs and trends affecting the homeless. In my work I hear of the struggles that hospitals, health centers and emergency shelters face in trying to assist people who are sick and experiencing homelessness. Yet policy and advocacy efforts are futile if they are based on stories alone.
As a member of the healthcare workforce, whether you are a clinician or an administrator you have a role in shaping public policy. Many providers serving people experiencing homelessness have asked me, "What can I do to help?" For RACmonitor readers, my answer is to make sure that your hospital is documenting homelessness using ICD codes. These codes allow policymakers to gain insight into systemic issues that largely are seen only behind hospital walls. With better data from our nation's hospitals, policymakers will be able to improve policy and develop more effective healthcare initiatives for people who lack housing.
Determining housing status can be complicated. Many patients may be reluctant to disclose the fact that they are experiencing homelessness. Fear of discrimination, embarrassment and even denial are all factors that may prevent disclosure. The following tips can be helpful in determining housing status accurately:
- Be sensitive. The term "homeless" carries a formidable stigma. Asking a person directly if he or she is homeless may not lead to an honest answer. A more appropriate way to determine homelessness is to ask your patient where he or she slept last night. Follow-up questions can gauge where a patient slept during the last several nights and where the patient plans to stay after being discharged.
- When asking about housing status, let patients know that their information is being used to best meet their healthcare needs and that the information will not be used against them.
- Do not assume that a person who provides an address is not experiencing homelessness. A number of people who are experiencing homelessness are able to provide an address. These addresses may be a former address, a relative's address, a place where they receive mail or the address of a shelter.
About the Author
Sabrina Edgington, MSSW, is the Program and Policy Specialist for the National Health Care for the Homeless Council.
Contact the Author
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References:HHS Secretary Kathleen Sebelius. Speech made on Sept. 10, 2010, World Suicide Prevention Day. http://www.hhs.gov/secretary/about/speeches/sp20100910.html
The Intent of ICD Code 514