Key Players' Interactive Experience
Doctors and Nurses
The need for doctors and nurses to be able to rely upon the absolute accurate identity of each patient is critical. In fact, the number one factor leading to medical error is mistaken identity. Emergency rooms are forced to wade through the fog of incapacitated individuals who cannot speak for themselves and, in the case of many legitimately ill homeless patients, there are also issues involving lack of trust and intentional misrepresentations of their identities. These circumstances lead to the unfortunate trappings of poor treatment, including fatal error.
Doctors and nurses are on the front-line of providers for homeless individuals, maintaining equal promise to uphold the Hippocratic Oath in their care. They also communicate patient needs to social workers who manage ongoing follow through. Doctors have the additional responsibility of working within a system which is the "business" of the hospital. The more they can provide accurate and expedited care to every person, the more they can be free of the pressures of hospital turnover affecting certain communities of patients who represent the great financial burden hospitals must bear.
These healthcare workers also rely, in many cases, upon clues that previous records provide them in emergent moments, including diagnosed allergies and even prescription histories. Access to this information most certainly provides best care and even life saving information. However, records between hospitals often do not transfer due to breakdown in the interoperability of software systems. This is especially rampant among hospitals which rely heavily or entirely upon governmental funding such as Stroger / Cook County Hospital in Chicago.
It is dangerous for doctors to make assumptions of any one patient based upon a stereotype they assign them. Ensuring that each homeless individual is uniquely treated is critical to their care. These individual success stories will lead back into their community spreading word of good treatment, trust and the experience of absolute privacy. Little by little, a new cultural belief will follow and so will a decreased inclination for homeless to intentionally misrepresent themselves based upon fears they hold to be true.
Trust: Homeless Patient Experience
A homeless patient has the right to receive good and absolutely accurate hospital care. Doctors live by the Hippocratic Oath which promises this equality of care to them. Many factors serve as unfortunate pitfalls for a homeless patient despite these intentions. Homelessness is extremely hard on a person and threats to their health are abundantly prevalent.
The number one reason for medical error is mistaken identity and any given homeless person’s circumstance can and does make them far more likely to become one of these statistics. A lack of address, social security card, driver’s license, insurance card, pharmacy record or individual medical record are enormous risk factors to their promise of equal and accurate care. Homeless individuals also share a common culture of mistrust and make intentional efforts to conceal their own true identities in order to hide from domestic violence or run-ins with the police.
Doctors and nurses deal with nearly impossible obstacles – especially in emergent cases. Behaviors of trust are imperative to a homeless person’s ultimate care and their front-line opportunity to gain such trust is experienced through doctors, nurses and clinically licensed social workers. Ongoing outpatient care would also include, in many cases, the routine of accessing prescriptions through off-site free-standing pharmacies. Accuracy of identification is critical to pharmacy protocol for any patient and pharmacies are at risk of the same pitfalls that hospitals are when homeless individuals lack traditional means of checks and balances with respect to identification upon retrieval of their medications.
Finally, homeless patients need to be guaranteed anonymity and privacy of care from the public domain, governmental and judicial systems. Homeless patients who are treated as unique individuals within hospitals will experience the most accurate, expedited care and will help bridge improved trust between their homeless community and the front-line hospital caregivers who serve to treat and protect them.
A Clinically Licensed Social Worker (CLSW) provides profoundly rich layers of assistance to homeless individuals in an ongoing manner. When critical medical needs and social cultures of a patient are improved upon both immediately and over time, it is the CLSW who shares trust and respect with the homeless individual most profoundly.
The CLSW interacts with doctors and nurses and is clinically trained to comprehend the language of the patient's medical care. It then becomes their responsibility to interact with the homeless patient and help facilitate care in multi-factorial ways. Emergent care is just the beginning in many cases. Shelter, proper nutrition, ongoing therapy, prescriptions and elements of social concern such as transportation or even regular provisions of clean socks can come into play. The relationships CLSWs have with patients are profound and exact positive change which includes a heightened sense of self .
Hospital social workers also advocate for patients through soliciting funds to cover their care. Federal provisions made to hospitals need to be justified and quantified and the social worker is key to authenticating needs and costs which equate to one another. It is in this way that the CLSW interacts with the finances of the hospital and engages with federal funding. The patient is kept free of this and is referred to by case and Medical Record Number (MRN) rather than by use of his/her given name, address or lack of address.
Hospital Financial Concern/Government
Hospitals receive support through federally provided funds but it isn't enough. They are left to cover massive sums in order to manage the costs of emergent care for people who cannot pay their own medical bills - especially due to homelessness. In fact, an inability to pay one's own mounting medical bills is the number one contributor to people becoming homeless to begin with. Ironically, once a person becomes homeless, they join a community of some of the sickest people in their own country. Homelessness is very hard on a human being.
It is necessary that hospitals account for the federal provisions they anticipate needing each year. In order to do so, they collect demographic data ongoingly and make assessments of need for the following year based upon the most recent data they obtain. This data includes several general factors including the age, gender, race, length of stay and resources consumed by people. It also includes an assessment of the most frequent categories of illness treated by a group. This data DOES NOT require or include individualized patient MRN (medical record number), given name or address.
Such data not only helps authenticate need for a hospital but it also helps establish measures of training for doctors and nurses. For example, knowing the top ten most readily occurring chief complaints coming through the ER for the month of January would be different than those occurring in June. Likewise, those occurring among young women would be different than those among middle-aged men.
This data is also useful when conceiving of provisions for homeless individuals who will receive ongoing cultural assistance. For example, it is useful to anticipate how many pairs of clean socks are distributed in a given month since foot issues are one of the most prevalent needs addressed from year to year across all demographics of patients.
Homeless patients often have a perceived fear of their identity being traced or tracked by hospitals in ways that they worry will hurt or endanger them. In actuality, the business of the hospital and the federal government deal in stats and generalities. Doctors, nurses and social workers serve as the go-between and they pivot between matters of clinical care for individuals and communicating the needs of those individuals providing them with the vast range of care that true holistic health requires.