Chattanooga: Home care for the homeless
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Larry Rogers was working an odd job for a friend in June when he tumbled 30 feet from a tree, shattering the bones in his right leg bone from the knee down.
After surgery at Erlanger hospital, the 48-year-old’s bones are now held in place by a metal rod, poised a couple inches above his bruised and stapled leg, attached to screws that pierce his skin and reach into his thigh and shin bones.
Mr. Rogers’ condition no longer warrants admission to a hospital — just bed rest, careful tending and cleaning of his wounds. But the former stonemason from Harrison, who has been homeless for a year, had nowhere to go to recuperate when he was discharged from Erlanger on Monday, he said.
“I was a little bit panicked,” he said.
He can walk with a walker but cannot manage stairs or the bunk beds that are used at most homeless shelters. Erlanger staff put him in a cab and sent him to the Chattanooga Community Kitchen, where he has been living for five nights in a room that also is doubling as a storage space for the St. Matthew’s homeless shelter.
Medical advances, such as less-invasive surgery techniques, allow for many to patients to recover in the comfort of their homes from surgeries, procedures or illnesses that typically would have required a lengthy hospital stay, experts say. But for the homeless, their advocates and hospital staff case workers, quicker discharges after hospitalization
“The need is obvious,” said Charlie Hughes, executive director of the Chattanooga Community Kitchen. “This is not an indictment of the hospital. It’s an indictment of the system that we are having to operate under for the homeless community.”
RESPITE CENTER PLANNED
Advocates at the Chattanooga Community Kitchen are working to address locally what they call a serious flaw in the health care system.
The Chattanooga Community Kitchen is now building a 10-room respite center on its site in the 700 block of East 11th Street to provide individual rooms for those in need of a safe and clean place to recuperate. If medical care is needed, contracted certified nursing assistants will help, Mr. Hughes said.
The respite space is part of a $1.4 million renovation project underway for 17,000-square-f
The respite center ultimately could cut down on health care spending by giving homeless patients a real chance for a full recovery, keeping them out of the health care system, Mr. Hughes said. He recalled a man who had been discharged from a local hospital a couple years ago after being diagnosed with pneumonia. With nowhere to go, the man was found sleeping behind the Community Kitchen inside a Dumpster, he said.
“One of the things we have seen happen time and time again is, when someone’s released from the hospital and they go out into a camp or they’re staying under a bridge or they’re living in their car, the recuperative process just doesn’t have the opportunity to happen and they end up of course going back to the hospital,” he said.
With advances is take-home medical equipment and surgery improvements, case workers must struggle more and more to find placements for patients who are medically ready to be discharged, said David Mann, director of the case management department at Memorial Hospital. Memorial donated 20 hospital beds to the Community Kitchen’s planned respite center.
“More and more procedures are being able to be done as outpatients or even just overnight observation, compared to five or 10 years ago. You see much, much more of that now,” he said. “Even the ones that are in-patient, the hospital stays are a lot shorter than they used to be.”
With such short turnaround times, it’s also often harder for hospital administrators to argue that they should be compensated for longer patient stays through private and government insurers, he added.
Maryellen Howley, director of care management at Erlanger, did not comment directly on Mr. Rogers’ case, but said in general the hospital tries to house homeless patients as long as possible. She noted that it simply is not practical for a hospital to act as a homeless shelter.
When determining if a patient is ready for discharge, “we have very strict (medical necessity) criteria that we try to go by, though I think we are tremendously compassionate when we’re looking at discharging a patient,” at times boarding them weeks longer than medically necessary, she said.
But, “Erlanger can’t solve the problems (of homelessness) that people have had forever,” she said. “So many times they just have a lot of other issues going on,” such as estrangement from family or drug and alcohol problems.
Community Kitchen advocates have been stalled so far in their efforts to find a placement for Mr. Rogers at a nursing facility, so for now, he will remain at the Community Kitchen, said Brother Ron Fender, an Episcopal monk and outreach case manager at the Community Kitchen.
“We really need to find a nursing facility that could help him because we’re really not equipped to do what he needs,” he said.
