Sunday, March 29, 2009

Homeless and Heading to the Hospital

Homeless and Heading to the Hospital

Published March 26, 2009 @ 09:52PM PST

Around the country, if you're homeless, you're probably also wandering the streets without any type of healthcare coverage, unless you're one of the lucky few who receive Social Security Disability (SSDI) or Supplemental Security Insurance (SSI) ("lucky," is a matter of perspective here, but at least they have a small income and government sponsored healthcare).

Insurance is one of those things that, for many of the poor and homeless, we know exist but we've rarely been fortunate enough to actually have for any length of time in our lives. 

Most of the time, it doesn't matter, but when it's needed, it's usually needed very badly.

"Mike" was salvaging aluminum gutters from a home that had recently burned, trying to earn a few bucks to get him by.  Mike is a roofer by trade but was recently laid off due to a lack of work; a common occurrence in today's economic environment.

Mike lost his balance pulling on the gutters and fell over and he belly-flopped the 28 feet, bouncing off lower roof in the process, and by the time he hit the ground, he'd broke both his arms and crushed two lumbar disks (L1, L2) in his back. 

Mike spent 13 days in the hospital and underwent two surgeries (he's scheduled for a third in a few days... and there will be additional surgeries after that, he's been told).  The first surgery occurred on one of his broken arms shortly after he arrived.   Approximately six days later he was told that he would need a place to go soonbecause when they completed the second surgery they would be discharging him, since he had no insurance.  A social worker had visited Mike the second day he was in the hospital and filed for food stamps for him.  No discussion of housing, respite care or other arrangements occurred during that visit, and that was the last Mike saw of the social worker during his stay. 

As he lay broken and battered in his hospital bed, the staff told Mike he had two choices after they completed the second surgery; he could go to the local Mission or they could discharge him to the only respite care provider for the homeless available here in Nashville.  Mike was absolutely adamant that he wasn't going to go to the Mission because he had "no way to protect myself with two broken arms.  I'd be a sitting duck."  The respite site, while providing an outstanding service to many homeless individuals in Nashville, was also out of the question, since Mike would have to lay on a mat on the floor for the duration of his stay; a difficult proposition for a man with a broken back and two broken arms (because this agency deals with intoxicated individuals on a routine basis, they use floor mats rather than beds in order to protect individuals from falling out of bed while sleeping). 

So Mike was about to undergo his second surgery and upon its completion was also facing the daunting prospect of having nowhere to go, no money to purchase any prescriptions, no transportation to take him anywhere, and no answers from the hospital, or anyone else, for that matter, about who might be able to assist him in his time of dire need.

Mike had the second surgery 11 days into his stay and was discharged two days later.  By this time, he was able to connect with local outreach staff, who ultimately delivered him to the local "Tent City." Mike is recovering there today, courtesy of several concerned members of the camp who took him in and are helping him with everything from dressing in the morning to preparing meals to staying warm, dry and comfortable during the still chilly evenings here in Middle Tennessee. 

Mike's story is a common one among the homeless.  Most of us know that health care options for the uninsured are lean; for the homeless, it brings a whole new meaning to FUBAR and the problems usually start as soon as the person tells the hospital intake staff they are both homeless and have no insurance. 

It's no secret that only the critically essential services will be done to stabilize an individual who fits this description and those of us without insurance know we'll be getting the "bare bones" model of health care treatment; just enough to make sure we are able to walk, roll or be pushed out the door as soon as legally possible.  But most of us without insurance usually at least have a home to go to, and someone who cares enough about us to ensure we won't have to walk to that home when we're discharged, either. 

For the majority of folks on the street however, there will be no such luxuries. 

Mike's own situation was grim but he was at least taken to the ER via an ambulance.   For a large number of homeless individuals facing discharge here in Nashville (and you can almost certainly insert the name of your favorite city in place of Nashville, I doubt seriously it would be much different), the options for leaving and rehabilitation are sparse.  Contacting an outreach worker to lend a hand is a possibility, but the ratio of outreach workers to homeless individuals in Nashville is currently about 2,200:1 and just reaching one at any point in a given day is often a herculean task.  If it's before 8am or after 5pm, our sick or injured individual might as well try to bribe the hospital security officer, (although with what I haven't a clue), in order to sit in the lobby because they've got a long wait. 

And that wait may just stretch into a few days if the one or two outreach workers available for this kind of "general" street outreach are busy - and they almost always are.  Although Nashville's recent shift to utilizing the Vulnerability Index as a tool for triaging and prioritizing outreach to the most vulnerable of the homeless population was an important advancement in outreach, its implementation has severely curtailed the outreach available to those individuals who are simply "homeless" but without life-threatening illnesses or health conditions.  

The fact is, transportation away from the hospital is probably going to be by the most common method known to the homeless around the world, "pavement pounding."   Please imagine for a moment the discouraging task facing someone who is sick and/or injured enough that they must go to the hospital in the first place, but then must leave the hospital on crutches, with a walker, or in a wheelchair, knowing all along that wherever they're going to end up, it's going to be a damned hard trip to make.   Imagine too the utter despair that must accompany the realization that you've got no place to go once you've left the hospital property.  Toss in a little rain, perhaps a few snowflakes, and the situation becomes downright desperate, indeed.  Sadly, such homeless discharges are quite common, not just here in Nashville, but in cities across the country.   

In Mike's case, he had a definite stroke of luck, but only insofar as it took him from the hospital to a campsite.  If our homeless hospital dischargee is, like Mike, unfortunate enough to have to fill a prescription for damned near anything and isn't able to reach one of the outreach workers in this city, he/she has a quest ahead of them that would drive Indiana Jones to leave adventuring forever and drown himself in a bottomless bottle of cheap Scotch.

There are two primary methods of getting a script filled in Nashville; neither is very quick.  Incidentally, if you're hoping to fill a pain pill, forget it.  No one will fill Codeine or Hydrocodone (Vicodin, Lortab, etc), but if you've received a script for something stronger, it's in your best interest not to tell anyone anyway, since people have been robbed, assaulted and even killed for scripts of Oxycodone, morphine, Diluadid other potent analgesics.  Most folks I work with know all too well the hassles involved in getting pain pill prescriptions filled and don't even bother asking for them anymore.  Many simply attempt to scrounge up enough money to buy some alcohol and drink themselves into a pain-free zone.  Not the most efficient way of handling the problem but certainly one of the very few viable options available to them.

The first method in obtaining a prescription involves walking (or rolling, or hopping, or crawling) to the local supermarket to get a printout of the medication and the price for the number of pills in the prescription.  But not just any old supermarket will do; It has to come from a specific store, located near downtown Nashville, and getting to it from the "homeless" hospital means a 2 mile walk through one tough neighborhood. Once the necessary paperwork for the prescription has been procured from the store's pharmacy, the individual must strike out again, this time to a local agency, which is approximately six very large city blocks away.  Once at the agency, if funds are available - and this is a very big "if" indeed - a check is cut to the store for the amount of the prescription. 

The individual must then turn around and walk back to the store in order to pay for and pick up the prescription.  Sounds relatively straightforward, until you discover that A. the agency only fills prescriptions on certain days and B., funds are limited, to say the least.  To say the most they are usually nonexistent after about the 10th of each month.  Furthermore, most people don't know they must stop into this particular store first, so they end up having to make the walk twice, rather than once, which under the best of circumstances is difficult when one is sick, hurting or both.  If they happen to show up on a day when the agency isn't cutting checks for prescriptions, they get to do it all over again on another day. 

The other method involves engaging a friendly pastor or church and praying, no pun intended, that they will be able to fill the script for you.  This method typically involves considerably more walking, since the individual must be able to find a church both with the funds available and the willingness to provide the service; a rare combination for non-members of most churches. 

To be sure, Nashville's faith-based community is a Godsend (again, no pun intended) to the homeless population, since they provide the majority of meals, clothing and supplies necessary for life on the streets, but most don't advertise the services they offer so for the typical homeless individual, he/she is usually stuck walking from one church to the next, pleading with a pastor, deacon or priest for help.  Complaints of favoritism, forced prayer before services are rendered and other assorted "demands" by the churches are common among the homeless population but in defense of the faith-based agencies here, they see a lot of volume and hear a lot of stories.  Their overarching mission is saving souls and to that end, they use the tools available to them; prescription services, food, clothing, lodging, etc., to get people into the door in order to hear the "more important" message of salvation. 

Finally, there is also a donated prescription medicine plan available to some in the Nashville area but few homeless individuals are able to take advantage of it, primarily because they have no idea how. 

One bright spot in Nashville is the recent acquisition and current expansion of neighborhood health clinics specifically established to assist the poor and homeless in the community.  The homeless population is already reporting decreased wait times, better overall service, additional services such as expanded dental and vision, and a better chance at actually receiving meds directly from the agency itself, rather than obtaining a prescription.  A few have even received pain medication! 

Individuals who are homeless and suffering an illness or injury that requires medical attention often find themselves in an untenable situation, to be sure.  When one couples their personal misery with the costs incurred by society (read that: anyone who pays the exorbitant premiums on their healthcare insurance, not to mention general taxpayers who must bear the brunt of uninsured emergency responses) as a result of whatever their affliction may be, one thing is crystal clear; dramatic change is needed, and it is needed yesterday.

Help the Homeless Help Themselves!

Education for Liberation! Join Up!
Peter S. Lopez aka: Peta

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