Harsh Winter and Economy
In addition to issues tied to the aforementioned harsh winter, it also is very apparent that the national economic turndown has not discriminated against the homeless; it appears that everyone is fair game. And in many cases it is the hospitals that are seeing the fallout.
Importance of the Hospital Length of Stay Meetings
During the last few years, LOS meetings at hospitals have shifted from merely focusing on safe discharge plans for patients to now identifying a safe plan at all. As case managers, social workers, nurse managers and others on the healthcare team try to produce safe, viable discharge plans for all patients, the list of homeless patients is growing longer. In turn, the time it takes to produce and execute these plans is taking longer, further depleting already limited resources.
Yet these meetings are invaluable. Whether held weekly or even daily, the meetings allow the healthcare team to review patients on a case-by-case basis, thereby allowing the institution to better prepare to handle the needs of the homeless in their service areas. Each case reviewed is another stepping stone in the learning process that can help with potential future cases.
However, many hospitals are adding another team member to sit at the table: the healthcare lawyer. The lawyer assists in planning for a safe discharge by reviewing any potential risks in the plan while also identifying any other legal remedies that may exist.
Moreover, it is the lawyer who can assist in identifying whether a patient is actually homeless. Identifying the true status of the patient is critical in order for the patient to apply for certain benefits or to seek judicial guidance and/or legal remedies.
How Does the Hospital Know If The Patient Is Truly Homeless?
Over time, people can become estranged from their families for personal, economic or geographic reasons. Sometimes families do not want to be found or even may deny knowing a homeless patient, however there are many times in which they have lost track of a relative and are surprised and excited to learn of the family member's whereabouts - albeit even if it's the hospital.
The social worker and the healthcare lawyer are often excellent partners in performing searches for family members as well as making calls to potential relatives. Calling potential relatives is both a skill and an art, and it is best left to the professionals. It is never a good idea to delegate the call to an administrative assistant since they may be faced with a myriad of reactions.
It is through this process that it can be determined whether actual homelessness exists. Sometimes a relative even may be willing to assist in providing resources for the patient or even take in the patient. Other times the healthcare team must go back to the drawing board, reviewing local resources and cross-referencing the patient's capabilities with those resources. At times there is no match. Other times additional physical therapy or occupational therapy may help the patient meet the requirements of community resources or shelters. In all, the healthcare team is charged to develop the safest discharge plan possible.
The Court System and How it Can Help
In some of these cases, judicial guidance can be sought in preparation for declaring guardianship and/or incapacitation. A guardianship is a legal mechanism designed to provide surrogate decision-making and financial management for a person who is no longer able to govern him or herself, assuming they have not made alternate voluntary arrangements.
There are different types of guardianships sought by hospitals, and rules vary from state to state. Often the guardianship can be plenary or temporary (with or without a possibility of becoming permanent), and in the event of an emergency a special medical guardian can be appointed.
These guardianships can be used in various situations depending on the needs of a patient. Since these can become costly, it is often important first to take the step to search for relatives, thereby avoiding not only the initial cost but the cost of unwinding the guardianship in the courts should a relative appear.
When a patient continues to remain in the hospital without a place to go, the length of stay for that patient (as well as for the hospital) climbs almost exponentially. As this occurs, billing, reimbursement, coding and medical necessity, among other factors, all come into play as RAC implications loom large. It is very important for hospitals to identify these patients early on in admissions, and to perform searches for relatives or file pleadings with the court to be sure the patient has a voice and protected rights as a safe discharge plan starts to take shape.
Cry for Help, Hope Endures
The cry for help by the homeless population is not falling on deaf ears in hospitals today; the matter is getting attention within the limited context hospitals can provide given their depleted resources. As we recover from the winter of 2010-2011 and still see faces of the homeless patients that remain in the hospital, we can only hope that the spring might allow other options to become available to them.
However, other seasonal conditions such as tornadoes, hurricanes and floods are just around the corner, and it is very possible that the homeless population again will surge at our hospitals.
We can only hope that more resources, shelters and families will present as viable alternatives to aid the homeless population before the winter of 2011-2012 begins. And hopefully we will not be seeing the same faces in our hospitals with the blustery return of next winter.
About the Author
Patricia Furci is currently part-time, In-house Counsel at several hospitals, providing legal services specially addressing inpatient issues, Case Management functions and Guardianship services.
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