Hospital Care of Homeless Patients with Dr. Joe Mega

Up My Nursing Game

Overview
Patients experiencing homelessness can add extra layers of complexities to emergency or inpatient care. Dr. Joe Mega provides some much needed perspective about the needs of our patients experiencing homelessness and how healthcare professionals can care for them more effectively.
Belongings

• Homeless patients are often concerned about their belongings being stolen due to theft or abatement
• If a patients is concerned about their belongings, ask if there is someone they can call to look after them OR find out if there are any services that can check on the patient’s belongings while they are hospitalized

Pets

• Pets are often like family members to the homeless and there is a hesitancy to be separated from them
• If this is a concern for your patient, look to see if your local animal shelter can keep the animal while your patient is hospitalized

Substance Abuse

When people are in the throes of addiction, this is often their #1 priority and they live in fear of experiencing withdrawal

• Make sure that you are addressing your patients substance abuse concerns by asking questions like “When did you last drink/use and how can I help keep you comfortable?”
• Opioid withdrawal can be treated with buprenorphine (Suboxone)
• Alcohol withdrawal can be treated with benzodiazepines, gabapentin, phenobarbital, etc. Check out Episode 6: Acute alcohol intoxication and withdrawal syndrome for more info.
• Methamphetamine-induced agitation can be treated with benzodiazepines and antipsychotics such as mirtazapine or risperidone.

IF YOUR PATIENT IS BECOMING UNCOMFORTABLE DUE TO WITHDRAWAL SYMPTOMS AND WANTS TO LEAVE THE HOSPITAL
Ask questions like these:

• “I want to help keep you in the hospital. How do you think we can do that?”
• “How much do you usually drink a day and how does how you’re feeling now compare to past withdrawals?”
• “When was your last drink?” or “when did you last use?”

Present the situation to the physician in a constructive way such as “I’m worried that the patient might leave, because they’re starting to feel unwell. What do you think about giving them something to help prevent withdrawal such as x, y, and z”

Food
It’s important to put it in the context of how easy it is, for someone with resources in home to access food, and then compare it to a person who doesn’t have a home. Just opening a refrigerator and getting access to some to what they want to eat is, is not a convenience that most people have.

Be Trauma Aware
The homeless have often experienced extreme trauma and horrible experiences that either contributed to their homelessness or resulted from it.

It’s important to be “trauma informed” and consider reframing your mindset from “What is wrong the patient” to “What happened to the patient?”

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