HOSPITALS DISCHARGING PATIENTS TO EMERGENCY HOMELESS SHELTERS IN ALLEGHENY COUNTY, PENNSYLVANIA: AN ECOLOGICAL PERSPECTIVE

Objectives: This study, utilizing the socio-ecological perspective, assesses the number of hospital discharges to shelters, their perceived appropriateness, and possible solutions to problems of inappropriate discharges. The socio-ecological perspective is employed to explore individual, community, and political factors involved in inappropriate discharging. Methods: Twenty-two staff and administrators from 12 of the 16 emergency homeless shelters in Allegheny County, PA were recruited by mailings (response rate=75%). A face-to-face, semi-structured interview was conducted with each of the 22 participants. Participants were asked to report on the number of discharges they received from hospitals in the past 12 months, whether or not these discharges were appropriate, and on possible solutions to the problem of "inappropriate discharges." Results: Participants reported a total of 415 discharges from hospitals to shelters; 91 (22%) of the discharges were considered to be inappropriate. The two solutions most often reported by participants to the problem of "inappropriate discharge" were to cultivate bidirectional communication between hospitals and shelters, and to develop medical/psychiatric respite for the homeless population (50%, and 32% the respectively). Participants believed that the responsibility for the problem of inappropriate discharges rested at multiple levels of the ecological system including the individual, organizational, and political levels. Participants proposed solutions that targeted homeless individuals, shelters, hospitals, and policy makers. Conclusions: Inappropriate discharges are a problem in Allegheny County, PA and better communication amongst providers and the development of respite services are possible solutions. The etiological nature of this problem rests at multiple levels of the ecological system including the individual, organizational, and political levels, and thus interventions ought to be targeting these levels. Public Health Significance: Ensuring that homeless persons receive appropriate follow-up care may eventually reduce the number of re-hospitalizations, improve the overall health of the homeless population, and aid in the fight to eliminate homelessness