Hospital funds, donations provide needed care

CMs take creative approach to finding resources

When indigent patients are ready for discharge but have post-acute needs, the staff at Carondelet Health Network in Tucson, AZ, sometimes dip into their own pockets to provide food, clothing, transportation, or medication to give patients the best chance for recovery after ischarge.

"When there's a real need and no other funds are available, the social workers and case managers will take up a collection among their colleagues to help the patient. Everybody dips into their own pockets to see that we do our best for these patients," says Winnie Coburn, RN, CPHQ, director of care management.

The social workers use their creativity to access community resources for patients who have no discharge destination. "We will not turn anybody out on the street unless we feel like they have a fighting chance," she says.

The staff get clothing for the homeless patients from a local Goodwill Store and tap into the health system's rescue fund to provide needed care for indigent patients. Money from the fund is contributed by private donors in the community and by the Carondelet Health Network staff.

The fund has a limit of $250 per patient, which can be used for medications, transportation back home or even, in some cases, lunch, Coburn reports.

"We go to every extent possible to find relatives or friends who can provide a home for these patients. If we find ourselves against a brick wall, the homeless have the choice to live on the street," she says.

Homeless patients often end up staying in the hospital for a long time if they're too sick to be on the street. The hospital can discharge patients to shelters, but they have to be ambulatory and they have to be able to take care of themselves, Coburn says. "As a religious organization, we go the extra mile. We're really creative and do whatever is necessary to ensure that the patients get the care they need."

In the case of homeless patients who need an IV infusion, the hospital typically keeps them until the treatment regime is finished unless the social workers feel that the patient would come in every day for treatment if discharged to a shelter.

"There are laws that require us to provide a safe discharge for patients, and we do everything in our power to comply. We keep patients if we have to and give them the services they need," Coburn says.

The attending physician sends a referral to social services when a patient is homeless and is likely to have post-discharge needs. "The doctors know some of these patients, and they feel like they can treat them and discharge them. They let us know if we can help in any way," she says.

The social worker interviews the patient and completes a needs assessment. "We do assessments on 80%-90% of the homeless patients. The exception is when the doctor knows them and they have minor problems," Coburn reports.

The social workers try to determine how patients got to be homeless, whether they came to Tucson that way or lost everything after they arrived.

"Each homeless person needs a care plan of his own. We try to tap into whatever resources we can, depending on the needs of the patients and where they want to go after discharge. Our social workers have to be really familiar with community resources, and we do everything we can to get the patients the care they need," Coburn explains.

Some nursing homes in Tucson will take patients with Medicaid pending. In addition, Arizona has a program that provides long-term care for eligible patients. "We have negotiated with nursing homes to take patients and to bill us. They will accept patients only if they know there is a discharge plan. When the hospital gets full, it's cheaper to put them in a nursing home and pay for it," she says.

The social work staff try to empower people to take care of themselves.

If patients have an addiction or a behavioral problem, the social workers try to tap into local behavior health programs, a task that has become more challenging as mental health resources have dwindled.

Staff can provide bus passes and taxi vouchers to take patients where they want to go.

"It depends on the severity of the illness and the severity of their social situation. Some patients don't want any help. They say they just want this one problem treated and that they aren't asking for help," Coburn says.

[For more information, contact Winnie Coburn, RN, CPHQ, e-mail: wcoburn@carondelet.org.)