The Case of a Homeless Patient Needing Home Care

Bui, Simonetti, Benson, Malek and Anderson
Published 10/8/2015

A 44-year-old man was admitted from the emergency department because of an infected and painful venous stasis ulcer.  He was hospitalized 2 weeks ago with similar complaints as well as alcohol intoxication.  He had stopped drinking since the last discharge but has had difficulty with wound care while staying at local emergency shelters or sleeping on the streets.  He improves during this hospital stay with daily wound care and antibiotics.  You deem he is ready for discharge but will require continued dressing changes and oral antibiotics over the coming weeks.  He does not have health insurance and does not have secure housing.

Q: Which of the following options has the best chance of healing his wound and preventing readmission to the hospital?

1. A. Contact a local emergency shelter to ensure that he has a bed waiting for him on discharge

2. Refer him to a community clinic specializing in homeless individuals for daily dressing change

3. Make arrangements for him to enter a medical respite program upon discharge

4. Transfer him to a skilled nursing facility for continuing care

5. Refer him to a residential drug and alcohol rehabilitation program

Fast Fact:

Homeless individuals rely heavily upon hospitals and emergency departments for health care and psychosocial needs.  Medical respite programs offer homeless individuals housing and services to allow better recovery from illness and stabilization of chronic conditions. Models of care range from collaborative arrangements with local shelters or motels and visiting clinical teams, to stand-alone facilities with 24-hour medical care.  Studies have shown that medical respite programs reduce future hospital admissions and hospital days, reduced 90-day hospital readmissions, and reduced hospital length of stay among homeless patients.  Such programs may also decrease emergency room visits for homeless patients.

Reference:

• Doran KM, Ragins KT, Gross CP, Zerger S. Medical respire programs for homeless patients: a systematic review. J Health Care Poor Underserved 2013; 24:499-523

• Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 2009; 301:1771-8