SWs become detectives when patients have no ID
Missing persons database, Internet offer clues
When patients are admitted to the hospital with no identification and their appearance indicates that they may be homeless, if they are unconscious, confused, or otherwise unable to identify themselves, the Lutheran Medical Center social work team conducts an exhaustive search to find out who they are and if they have someone who can care for them after discharge, and seeks sources that can provide for post-discharge care to maximize quality and outcomes for the patient.
"We are a Level 1 trauma center, and a lot of patients with complex injuries come to us when they are unconscious and they have no identification. We get elderly patients who wandered away from home and are not able to tell us who they are. Sometimes mentally ill patients become homeless but they have family members who are looking for them," says Helen Hernandez, LMSW, assistant director of social work/discharge planning specialist at Lutheran Healthcare in Brooklyn, NY. "All the actions the team takes to identify a patient or family are in compliance with HIPAA regulations and to protect patient confidentiality," she adds.
The social work team starts by contacting the New York Police Department's Missing Persons Bureau and checks the National Missing and Unidentified Persons System (www.namus.gov) database. "We've found families for a lot of patients this way, including one family that lived in California. I truly believe that no man is an island. There is always someone looking for patients who come to the hospital homeless and confused. We just have to find them," she says.
If the social workers can get a name or a telephone number from a patient, they search the Internet for more information. "We have a lot of luck finding people with a database search. We've even found patients' Facebook pages," she says. The social workers also contact the city's Department of Homeless Services, which maintains a database of all shelter residents and has been able to discharge patients back to their shelters many times.
"Unfunded patients are a common problem because of the area we serve. There are a lot of patients who are homeless and who may or may not be documented. When we have an unfunded patient, we do a thorough investigation to identify resources for them," she says.
For instance, once they can identify homeless patients, the social work team conducts a search to find out if the patient has Social Security benefits. "Once the Social Security Administration loses track of people, the checks stop. We've been able to re-establish benefits for patients," Hernandez says. If patients are eligible for Social Security benefits or Medicaid, the social workers help them apply.
The hospital can sometimes get undocumented patients signed up for New York State Medicaid by applying for Permanent Residence Under Color of Law (PRUCOL). If patients are in this country with a work visa, they are not eligible for Medicaid, but if they can show that they have been working and paying taxes in the United States for 10 years, they can apply for PRUCOL, which makes them eligible for New York State Medicaid. "Using outside counsel, we apply for patients who need skilled nursing care, such as those who have ventilators or a percutaneous endoscopic gastronomy (PEG) tube. Then we apply for Medicaid and we can place them in a skilled nursing facility," she says.
When an undocumented patient has been in the hospital for six months with no change in his or her condition, such as ventilator patients or those in a coma, the hospital files a PRUCOL petition, with the patient's consent, notifying the U.S. Immigration Services of the patient's presence. If Immigration Services decides to not take action to deport the patient, the hospital can apply to New York State Medicaid, which will enable the hospital to discharge the patient to an appropriate level of care, such as a skilled nursing facility.
The hospital also has a medication assistance program that can provide medication for patients who are undocumented or uninsured. In addition, the social workers can connect patients with pharmaceutical companies for assistance. Some pharmaceutical companies require that people they work with have Social Security cards, but some will also provide assistance to non-citizens, she says. The team also can help unfunded patients connect with clinics that base charges on income.
"Regardless of their financial situation or previous living situations, patients who are mentally capable of it help dictate the discharge plan, Hernandez says. If the patient does not have the capacity to make decisions, the social work team, when indicated, attempts to find the patient's family and involves them in the discharge plan. If patients without the capacity to make decisions don't have a surrogate or family member, the hospital petitions for the courts to appoint a guardian who makes decisions for the patient.
During the hospital stay, the social workers try to develop rapport with patients and family members and collaborate with them on the discharge plan. "We try to build a relationship with the patient and families and gain their trust. We give them cards with our telephone number and try to be present when they talk to the physicians so we can explain the procedures and help them understand the patient's condition," she says.
Homeless patients can also present a challenge for the team. Some homeless patients just want to go back on the street. When this is the case, the social workers give them shoes and clothing and make sure they know where to get food and other assistance. "If they want to change their living situation, we help them apply for shelter with the Department of Homeless Services. It's up to them to decide, and we go along with what they want. In all cases, although patients may be resistant to some of the services we recommend, we always try to develop and implement a safe discharge plan with them," she says.