Hospital Discharge Planners and Homeless - An Intervention To Prevent Homeless Patients Released Into the Street

In the midst of health care reform, decreasing availability of funds, and downsizing within the County and private hospital systems, overburdened facilities can only accommodate seriously ill patients. As a result, many patients are released from hospitals to return home and convalesce under their family's care. However, homeless individuals do not have these support systems or housing options available to them. Recently there have been a number of documented incidents where homeless patients have been literally “dumped” into the streets of the downtown area of Los Angeles known as Skid Row to recover after discharge. Many of these individuals are often mentally and physically unable to maintain proper diets, and obtain medications and medical supplies to complete their prescribed treatment. Without assistance, their conditions deteriorate, and complications may develop forcing them back into the hospital. This endless cycle places an economic burden on the already strained health care system. The purpose of the intervention was to advance effective systemic strategies for discharge planning of homeless patients in Los Angeles and Orange county hospitals. The experiential training program provided hospital staff important information and the necessary skills and resources needed to initiate a comprehensive "rehabilitative" model for assisting chronically homeless individuals in obtaining housing and retaining good health after discharge. The innovative intervention comprised a four-hour workshop and ongoing technical support along with a countywide Resource Directory. Over 260 hospital planners and administrative staff attended one of sixteen trainings (Los Angeles hospitals: all 4 County; 7 Kaiser Permanente; and, 1 local community hospital; Orange County: 4 private hospitals) held from August 2007 through February 2008. All participants were asked to complete a pre- and post-test, and a 3-month follow-up survey to determine: 1) their change in knowledge and attitude concerning homeless patients and the resources they can access to assist these individuals at discharge; and, 2) the change in their skills to identify and initiate a rapport with homeless patients. Medical Chart reviews were used to determine: 1) the change in the number of homeless released to recuperate in the streets; and, 2) the change in the number of homeless patients re-hospitalized due to issues surrounding treatment adherence. In addition, personal interviews were conducted and protocol manuals were reviewed at pre- and post-intervention to evaluate the effectiveness of the trainings in institutionalizing the necessary systemic changes needed to operationalize the program at each of the participating facilities.