The United States has an increasing rate of homelessness due to unemployment, an absence or low availability of affordable housing, high rates of mental illness, and physical ailments that prevent productive employment. Due to economics, these homeless tend to only receive medical care through the emergency department (ED). Since the ED is not equipped to handle social issues such as housing, these individuals are often discharged directly onto the street or to shelters. As a result, these inappropriate discharges increase re-hospitalization and poorer health outcomes among this population. The purpose of our study is to explore the issue of hospitals discharging patients to emergency homeless shelters in Allegheny County. Researchers sent mailings to all of the 16 emergency homeless shelters in Allegheny County for recruitment. As a result, 22 shelter administrators and staffs from 12 of the 16 shelters (response rate=75%) participated in a face-to-face, semi-structured interview conducted at their facility. Participants shared the number of discharges they received from hospitals in the past 12 months, the appropriateness of these discharges, and possible solutions to the problem of "inappropriate discharges." Shelter administrators reported receiving 415 discharges from hospitals; they deemed 91 (22%) of the discharges as inappropriate, meaning the patients needs exceeded the resources of the shelter. Even though a majority of participants reported that their shelter was equipped to handle the medical/psychiatric care of their population, their facilities lacked the means to treat those who needed extensive medical and/or psychiatric care. To address this issue of inappropriate discharges, participants suggested that better communication between hospitals and shelters as well as the development of a medical/psychiatric respite for the homeless population (50% of participants stressed the former and 32% the latter) would alleviate this problem. Shelters, aware that this issue is a multi-faceted one, recognize the need for multiple interventions at the individual, community, and government levels to successfully combat this problem. This is a significant public health problem because by addressing the medical and psychiatric needs of the homeless population both prior to and after hospital discharge may eventually reduce re-hospitalizations and improve the health outcomes of this population.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-06142007-143204 |
| Date | 25 September 2007 |
| Creators | Stallworth, Valerie Alexis |
| Contributors | Dr. Emilia Lombardi, PhD, Dr. Christopher Keane, ScD, MPH, Dr. James Butler, MEd, DrPH |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-06142007-143204/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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