What do you do when you encounte someone with medical needs on the street?
Group Discussion Summary - Tacoma Pierce County Coalition to End Homelessness - May 6, 2022

General issues that came up.

• Lots of experience with people being released on the street when they should be inside continuing their healing. Haven't typically asked if they were in only in the emergency room or actually admitted.
• There are ongoing problems with inappropriate hospital discharges to the street (eg., a diabetic who had both feet amputated, a patient who had multiple facial surgeries for necrotizing fasciitis).
• There is resistance by hospitals to treating those who have been recently discharged “since they cannot do anything more.”
• People in pain cannot advocate well for themselves, and often there is no Primary Care Provider. Hard to access of what meds were given or information about aftercare.

“It is very frustrating that even for someone with many years of experience in advocacy around homelessness, medical, mental health—that people with medical conditions are not getting needed care. We may know the resources to refer people to, but there may not be anything there.”

“We shared a couple stories of people who experienced medical situations, and had overall sense of frustration at lack of coordination among groups and people being turned down at ER and at rehab centers. One person had a car accident, was living in car, and was released from hospital with no rehab and turned down for future visits at ER. In addition, there was poor treatment for one person prior to a stroke and lack of knowledge of medical professionals re a rare lifetime medical condition.”

Identified Gaps in Care

• Need for on-site care for chronic disease management (e.g., diabetic wounds) and general wound care.
• Need more places like CLR’s Park Place nursing care for homeless folks referred from the street.
• Need more involuntary admission centers for people in mental health crisis like RI International.
• Many foot care issues are unresolved and worsened by living unsheltered.
• Issue of people who fear and refuse hospitalization or medical attention due to addiction issues.

Recommended practices and available resources

• Providers should be trained to spot injuries/illnesses related to trafficking and DV.
• Should be a confidential network that limits opportunity for people to be victimized by human trafficking predators.
• Is important to check on people. Sometimes you wake people and they go right back to sleeping. Difficult to know if a situation develops later. We need safe sites.
• There is a medical outreach team at SeaMar (Elliott); SeaMar will be coming to a forthcoming Coalition meeting.
• Needle exchange van does wound care. Foot care remains big issue, but is not a 911 call.