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.
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