Managing the Homeless in Hospitals

Healthcare facility security departments, along with clinicians, local law enforcement and the community at large must work together to serve this challenging population, while keeping patients, staff, visitors and the public safe.
Published: October 22, 2017

Patients who are homeless cost about $2,500 more to treat per hospital stay than the average patient, according to a 2011 study by researchers at St. Michael’s Hospital. Despite these financial concerns, homelessness and how it affects hospitals and public safety isn’t normally a hot topic of conversation. It is, after all, an uncomfortable problem without a quick fix.

Whether you want to discuss it or not, however, if you are a security executive for a hospital located near a large transient population, you must be prepared to appropriately deal with the homeless.

Fortunately, healthcare facilities can work with their surrounding communities and local police to identify resources and make appropriate referrals. Hospitals that do this will be better prepared to address homelessness with compassion while reducing the costs associated with security and homeless patient treatment.

Homeless Population’s Reasons for Visiting Hospitals Varies

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If they arrive as patients, many homeless individuals present with serious physical or behavioral health issues, including injuries from fights, assaults, and drug and alcohol addiction. Some have jobs but can’t afford to pay rent or buy insurance.

“Hospitals become the source of primary care for the homeless,” says Summers Associates Senior Security Consultant Jim Grayson. “[Medical centers] end up footing the bill and supporting a large number of folks who are coming in for things that would be very simple to solve in a clinic. Something that could have been dealt with for nickels and dimes becomes a major problem with huge expenditures in a hospital and especially an emergency room.”

The intake process for these patients is complicated by the fact that they often bring with them many items, including backpacks, bags, sleeping gear, defensive weapons and even animals.

“They don’t want to leave those items on the street, so the security officer is often called in to help with additional searches,” says Donald Pilker, director of security and logistics for Virginia Mason Medical Center in Seattle. “It’s a challenge for security because we don’t want to interfere with them because they are welcome as patients. As a homeless situation, we have to try to stop them from coming further in.”

Hospitals often are attractive to members of the transient population who might not be ill but need to get out of the cold during the winter. They might start fires in the stairwells or parking lots to keep warm. Others may be looking for drugs, cash, food, clothing or other items they need to survive. Perhaps they want to use the restroom to bathe. Hospital staff must also be mindful that a transient who enters a hospital for non-medical reasons may become a patient if staff discover he or she is ill or injured.

Identification Poses Challenges During Intake

Another challenge is determining if the person is actually homeless.

“You have to speak with them,” says Linda Glasson, a healthcare security consultant and a past president of the International Association for Healthcare Security and Safety. “Sometimes, their address isn’t consistent, or if you Google the address, you find it’s not real. If you have a professional security department, involve them. My thing is, if you find someone and you’re not sure who they are, who is the best trained staff member to interview that person, especially if they act out? To me, from a safety standpoint, the best person to call is your security professional.”

This point is particularly important if the individual in question has a criminal background.

“Last year we had two persons admitted under a voluntary emergency petition for behavior health and then later assigned to our in-house behavioral health unit. In both cases, these persons were wanted for murder by the Baltimore Police Department,” says Roger Sheets who is director of security for Life Bridge Health in Baltimore.

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