L.A.: Hospitals can’t discharge homeless patients

Thanks to a new city ordinance, they get to provide some of the world’s most expensive free hotel service to patients who are well enough to leave but refuse. (WSJ health blog, Aug. 4).

More: Numerous interesting comments from readers including this from Throckmorton:

This is not just in L.A. but happens all around the country as well. Our area saw this increase with the rise in nursing home suits. Nursing homes are now very reluctant to accept patients who are at risk for decubitus ulcers, etc. This combined with the declining revenue has led to the situation where there are no places that will accept transfers from the hospital. As more and more patients fill the wards awaiting placement, the hospital has no choice but to divert those that need urgent care.

You may not be able to get a nursing home patient out of the hospital, but at least you will not have a problem finding them an attorney.

9 Comments

  • Well, I for one am confident that this will increase the quality of medical care for all patients as well as increasing the supply of available hospital beds.

  • Unfortunately, this is what happens when well-meaning people find out that hospitals have been dumping nursing home patients and nursing homes have decided not to accept any more “too sick” elderly. What SHOULD we do? I don’t think hospitals are the right place for indigent elderly, nor do I think that nursing homes should be forced to accept patients they can’t care for. But this started when homes that were caring for elders who had become troublesome, sent them to hospitals on the flimsiest of pretexts, and then refused to take them back. NOW what?

  • This is not just in L.A. but happens all around the country as well. Our area saw this increase with the rise in nursing home suits. Nursing homes are now very reluctant to accept patients who are at risk for decubitus ulcers, etc. This combined with the declining revenue has led to the situation where there are no places that will accept transfers from the hospital. As more and more patients fill the wards awaiting placement, the hospital has no choice but to divert those that need urgent care.

    You may not be able to get a nursing home patient out of the hospital, but at least you will not have a problem finding them an attorney.

  • While I am not a fan of this type of city interference, I can understand why they did it since these hospitals were using the homeless people to send bills to the government for federal money for helping out the homeless.

    However, turns out they really weren’t helping them out, but just looking to keep the beds full so they can make the claim.

    It’s a pretty bad situation and one where I would normally not want government intervention (although the way they are handling it is a little ridiculous), the government needed to step in to stop the hospital from taking tax money they don’t need or deserve.

    http://www.signonsandiego.com/news/state/20080806-1402-ca-healthcarefraud.html

  • My cross post from WSJ blog:
    After being properly convalesced, I propose dropping the formers patients off at something called “Motivation Training.” Perhaps legislators could shift the burden back on to the patients to have them work off their costs by paving roads, picking up litter, or something of the such. I know the ACLU might have a problem with this, of course. But it would solve the problem.

    I think this is one more “clink” of the hammer at the chiseling away of capitalism as our society moves ever closer to socialism. If one spends but a moment reading the comments at WSJ, one will notice that the dialog of such matters is changing, ever so slightly. There is an ever-growing presupposition that health care providers and insurers are not supposed to be making money. For some of these comment-contributors (and lots of Americans), believing in this “health care is a right” notion is required to even enter the health care debate/dialog. If you don’t pay homage you’re a heretic for even chiming in.

  • How about having them transported to the front porches of city council members, aldermen, whatever? It would draw those functionaries’ attention to the issue at hand.

    States and counties need to re-open the institutions that were closed down back in the late 70s. The warehousing aspect was indeed unsound and immoral, but the function was and remains necessary.

    There simply are people unable to care for themselves. Some of those are also unwilling to do so. They need humane and safe care to protect themselves and to protect society against their unbudgetable costs–and sometimes violent behavior.

  • John and Throck,

    If these are elderly or mentally ill homeless folks who are being turned out of nursing homes, then this is a failure of Medicare and Medicaid to properly pay for these folks. It sounds like the legislature is trying to find stupid ways of keeping these folks off of their books.

  • Xmas

    I think you are absolutely right. It costs about $180/day on average for a non-skilled nursing home bed. Medicare does not pay for long term coverage and Medicaid pays 60% of Medicare. It is actually cheaper to put them in a hotel room and order room service. When you add to the potential of litigation, nursing homes can’t afford to stay in business. As a result, they only want low risk paying patients. It is and always is about the economics.

  • […] hospital sues patient for refusing to leave [Happy Hospitalist; related earlier] […]