Nancy Hu, a Social Worker with California Hospital Medical Center, Dignity Health, would like to see lower readmission rates, reinfections and fewer visits to the emergency department for her patients. Nancy works with patients who are about to be discharged from the hospital and the majority of her caseload is individuals who are without a home.
“I see myself as someone who advocates for my patients and collaborates with the nurses, doctors and case managers to work towards a safe discharge,” shared Nancy, “The challenge is that when someone is not able to heal in a clean and safe environment, it puts the person at a much greater risk of another hospitalization and further exacerbating their illness, all of which can be prevented.”
Since 2015, National Health Foundation’s Pathways Recuperative Care has become one avenue for safe discharge of homeless patients from partner hospitals. Pathways offers temporary housing with medical oversight to individuals who are without a home. The advantage for patients is that they can heal safely and are given the support needed to adhere to follow-up care schedules. For partnering hospitals the advantage is peace of mind, “The hospital feels reassured that the patients are able to go somewhere clean and safe to heal while getting assistance with follow-up appointments and housing,” says Nancy.
Not every homeless patient opts for accepting Recuperative Care and not all are a fit. As a social worker, Nancy assesses each patient who is homeless to see if they are appropriate for recuperative care, if they are motivated to get housing, and those who wish to recover from their medical condition. Not all homeless patients want to be housed, “Personally, it makes me sad because it doesn’t have to be that way. But I also know that we all have rights to make choices that we feel is best for ourselves and to choose to take help when it is offered.”
On any given day, Nancy is balancing and prioritizing between a victim of crime, someone who is homeless and being discharged while it is cold and raining outside, and another who is dealing with a life changing/altering diagnosis. We at National Health Foundation’s Pathways Recuperative Care are grateful to Nancy and Social Workers everywhere who are providing essential care to patients at their most vulnerable; upon discharge from the hospital.