Assessing hospital discharges to emergency shelters

Objectives: Homeless persons are being discharged directly from hospitals to the street, soup kitchens, and emergency shelters, likely resulting in higher incidences of re-hospitalization and poorer health outcomes. Our study assessed the number of hospital discharges to shelters, their perceived appropriateness, and possible solutions to problems of inappropriate discharges. Methods: Twenty-two staff and administrators from 12 of the 16 emergency homeless shelters in Allegheny County, PA were recruited by mailings (response rate=75%). A face-to-face, semi-structured interview was conducted with each of 22 participants. Participants were asked to report on the number of discharges they received from hospitals in the past 12 months, whether or not these discharges were appropriate, and on possible solutions to the problem of “inappropriate discharges.” Results: Participants reported a total of 415 discharges from hospitals to shelters; 91 (22%) of the discharges were considered to be inappropriate, meaning the patient's needs exceeded the capacity of the shelter to care for them. The two solutions most often reported by participants to the problem of “inappropriate discharge” were to cultivate bidirectional communication between hospitals and shelters, and to develop medical/psychiatric respite for the homeless population (50% reported the former, 32% the latter). Conclusions: Inappropriate discharges are an issue in Allegheny County, PA. Better communication and the development of respite may help to provide a continuum of care to the homeless population. Implications for public health: Ensuring that homeless persons receive appropriate follow-up care may eventually reduce the number of re-hospitalizations and aid in the fight to eliminate homelessness.