You don’t have to work in the emergency department at UC Davis Medical Center to know that California’s homeless population is increasing. The reasons are many, and readily apparent throughout the community.
Hospitals in California, for example, experienced a 28% rise in the number of homeless patient visits over a two-year period (2015-2017), according to California Healthline. Hospitals like the medical center are often the only places where people without homes can receive care.
However, rising numbers of homeless patients isn’t the only challenge UC Davis Health is facing these days. Safely discharging patients who don’t have stable housing can be a very difficult and labor-intensive part of the care process.
Since January, the medical center has treated more than 500 homeless patients. Clinical social workers typically have between 5-10 homeless patient cases per week. Their workload may be challenging, but the patients themselves face the biggest hurdles.
“Everybody has a story,” says Jane Maurer, a clinical social worker at the medical center. “Most people don’t just end up homeless overnight. There is usually a significant life event, or several, that got them to that point.”
New state law
Maurer says a new state law governing the discharge of homeless patients helps remind everyone that those without homes often struggle in the healing process after a hospital stay. Such patients usually have little more than what they can carry. It means social workers must a lot of time working to connect their patients with the community resources they need.
“A lot of people struggling with homeless people don’t have things like a cell phone or access to transportation,” Maurer says. “Maybe they’ve lost their photo ID. Our work includes advocating for many of those basic needs that we sometimes take for granted. Without these basic needs met, everything becomes exponentially more difficult.”
Well before the state’s homeless discharge law went into effect, staff at UC Davis Medical Center worked diligently to ensure that patients without homes had an appropriate healing plan in place when they left the hospital. More than a decade ago, UC Davis Health join forces with other health systems in Sacramento to fund an interim shelter for homeless patients.
Task force dedicated to helping homeless patients
Today, the medical center has dedicated homeless patient task force. It has updated its policies so that people with unstable living conditions aren’t simply discharged to the streets.
“There’s a now a legal mandate governing what hospitals must do for their homeless patients,” says Marcella Williams, chair of the medical center’s Homeless Task Force. “But our teams, from social workers and nurses to physicians and discharge planners, have been doing many of these things for years because it helps ensure better clinical outcomes.”
Williams, who oversees Clinical Social Services for UC Davis Health, points to food, medications and transportation as among the items homeless individuals often need when they leave the hospital. The medical center’s practices are now even better coordinated and focused to ensure great care.
Making sure patients aren’t overlooked
Caseworkers usually start by determining a patient’s housing status. No one’s essential healing needs are overlooked. Doing early assessments of patients can help reduce hospital visits later on.
The new efforts also include screening for infectious diseases and vaccinations. Care teams make sure patients have appropriate clothing for the weather conditions. They also ensure individuals leaving the hospital have an adequate supply of prescription medications.
There are now five different ways of identifying homeless patients. That includes determining a person’s housing status during the hospital registration process. The emergency department and admissions staffs also review every patient’s residency information. Additionally, social workers and physicians do their own evaluations.
No patient is overlooked or ignored when it comes to the extra care and support they might need because of their housing situation.
“A benefit of the new law is that it’s further increased the collaboration between our hospital and the community resources that homeless individuals truly need,” notes Joleen Lonigan, a director in Patient Care Services and a member of the task force. “Homelessness isn’t simply a hospital issue, it’s a community issue, a problem that we as a society have to address collectively.”
Helping homeless patients takes teamwork
Lonigan says medical center staff rigorously pursues solutions to provide temporary housing, treatment and other services for homeless patients before they can leave the hospital. It can take a lot of time to accomplish because community resources remain limited and are often at capacity. However, ensuring a “warm hand off” – from the hospital to a community resource provider – offers results that are better for patients and their health.
“This is a big team effort,” adds Williams, who credits Pharmacy, IT and individual physicians -- along with Nursing, Discharge Planning and Clinical Social Services – with embracing the new approach to addressing homeless patient challenges. “There’s a lot more to be done, especially at the community level. We simply need more beds in the community and more support services to ensure lasting health care and health for people without homes.”
The challenges do seem overwhelming at times, but Williams remains upbeat.
“When you’re a social worker, staying positive and hopeful is the key to accomplishing everyday tasks and making a difference, however small, in someone’s life,” she says.
Maurer adds that while community resources to address the homeless problem remain inadequate, the state’s new law has helped draw more attention to the issue.