Document diligently, send patients with needed items

When you must discharge a homeless patient with nowhere to go, make sure you document extremely well and avoid making mistakes that can cast your hospital in a bad light, experts advise. Here are some tips:

Document like you've never documented before.

Document in detail everything you've done to try to help this patient find somewhere to go, says Mary Jean Geroulo, JD, an attorney with Stewart Stimmel in Dallas. When Geroulo was a hospital administrator, she encouraged staff to meticulously record every step taken to find shelter or other resources.

Staff should document who they called, what they offered, and the patient's response. If you called 20 shelters or step-down facilities, document every single one rather than writing that you "called 20 places looking for shelter." Be sure to record any resistance from the patient to the options you offer. You want to create a record that shows not just that you tried to help the patient, but exactly how hard you tried.

"That's where some hospitals drop the ball," Geroulo says. "They actually do put a lot of effort into helping the patient, but then they can't prove it when someone claims they didn't."

You may have to get tough

Play hardball when necessary.

Not all patients who have nowhere to go are really without options, notes Linda Stimmel, JD, partner and co-founder of Stewart Stimmel. Often, for instance, an elderly patient has financial resources and could go home with a relative, but the family refuses to help. Sometimes the patient is reluctant to leave the hospital as well.

You still should work to provide options to the patient, such as placement in other facilities, but if the patient still will not leave the hospital, you may have to get tough, Stimmel says. Many times she has advised client hospitals to call in the family and give them an ultimatum.

"We've told them that we will start billing for the care, and we're going to file a lawsuit to get guardianship of the patient and take payment out of the patient's estate. Whatever money she has will eaten up by the hospital bills," Stimmel says. "You can't imagine how quickly they take the patient home. It works about 70% or 80% of the time."

Reid Cocalis, JD, an attorney with the law firm of Gordon Hargrove in Fort Lauderdale, FL, says he also has worked with hospitals to use that strategy. In one case, an elderly woman could not leave because her son would not make any arrangements for her care. Cocalis had to pursue an elder abuse complaint with the adult protective services agency by pointing out that the son was diminishing the woman's assets by forcing her to stay at the hospital.

"Only when he was faced with that complaint did he consent to the discharge and arrange appropriate home care for her," he says. "Usually, once you file a motion with the court, they know that you're serious and you don't even need to proceed through with the court proceeding."

Provide essentials for the patient.

The clothing issue is not negotiable. Any clothing is better is better than a hospital gown. But Geroulo also says it is a good idea to send the patient with a comfort kit of items such as a toothbrush, toothpaste, and soap.

Send paperwork with the patient.

The patient should have documents showing his or her current status and how the discharge took place, suggests Leila Narvid, JD, an attorney with Sideman & Bancroft in San Francisco. Particularly with patients who are mentally challenged or a substance abuser (but competent for discharge), it is a good idea for them to carry a summary of the most current treatment and what efforts were made to provide aftercare and shelter.

"That way, if they do seek help elsewhere, the other party will have the information to know what they need and what's been done for them already," Narvid says.

Consider sending an escort with the patient.

Many hospitals send a staff member with the patient when delivering him or her to a shelter or other location. While that is not always feasible for a busy facility, it is a good idea when possible, Stimmel says. The escort can help ensure the patient gets to the proper location and can record the final step, such as whether the person entered the shelter or refused.


For more advice on discharging homeless patients, contact:

  • Reid Cocalis, JD, Gordon, Hargrove & James, 2400 E. Commercial Blvd., Suite 1100, Fort Lauderdale, FL 33308. Telephone: (954) 958-2500. E-mail:
  • Leila Narvid, JD, Sideman & Bancroft, One Embarcadero Center, Eighth Floor, San Francisco, CA 94111. Telephone: (415) 392-1960. E-mail: