2008 Legislation/Education and Community Health Fact Sheet: Resolution #2

Download 2008 Resolution #2 [PDF]

2008 House of Delegates Resolution: In Support of a Continuum of Medical Care for the Homeless in Order to Prevent Patient Dumping

• Some health facilities have engaged in a practice unfavorably known as ‘homeless dumping’, where patients who are homeless are transported to cities or vicinities that have support services , with the rationale that services might be available to the individual.
• At times homeless individuals have been dropped off in front of a shelter or treatment center that may have limited space available, leaving the person to fend for themselves on the street sometime within the next 24 hours. Although not in acute medical crisis, and therefore not protected under EMTALA regulations, these homeless individuals are at risk for compromised recovery from physical or mental illness or injury on the streets.
• "Respite care" has emerged to describe recuperative or convalescent services needed by homeless individuals with medical problems.
• Respite care has reduced the average number of hospital inpatient days (over a twelve-month period) for its residents to 3.4 days, versus 8.1 days for those who did not receive respite care, which allows for more “timely discharge from the hospital” (Buchanan et al, 2006.)
• Respite care programs have witnessed improvement in their residents’ health, access to healthcare, adherence to medications, income, and housing status.
• Increasing financial pressures on hospitals have caused consolidations and closures, so that the number of emergency rooms is decreasing despite increasing demand for emergency care in many communities.

What Can Nursing Students Do?

• Advocate for a continuum of medical care for the homeless in your state and community, including respite care after hospitalization coordinated between acute care hospitals and community organizations. A list of Respite Centers is available from the National Health Care for the Homeless Council, and other ideas for how to get involved in your state are available from the Respite Care Network;
• Support legislation that protects patients from homeless dumping practices, and provides adequate funding resources for preventative care, emergency care, and alternative discharge destinations for homeless individuals;
• Raise awareness about the effectiveness of respite programs in the United States, as well as the need for federal, state, and local funding of supportive group housing/group respite housing to meet the physical health, mental health, and safety needs of men, women and children who are homeless in America.
• Educate nursing students and discuss with faculty about the requirements, directives, and regulations of the Emergency Medical Treatment and Active Labor Act (EMTALA). Go to the EMTALA website developed by the Centers for Medicare and Medicaid (CMS); the Emergency Nurses’ Association, and www.emtala.com for more information and a compilation of legal and health care regulations involving EMTALA.

Resources:

American Organization of Nurse Executives (AONE) & the American Hospital Association (2009.) The Road to Economic Recovery: A proposal to support health care in America.

American Medical Association (2009.) Virtual Mentor: Refusal of Emergency Care and Patient Dumping.

Institute of Medicine (2006). The Future of Emergency Medical Care in the United States (includes Hospital-based Emergency Care: At the breaking point; Emergency Medical Services: At the crossroads; and Emergency Care for Children: Growing pains.)