When Your John Doe Is Homeless
The patient, known only as John Doe, was difficult to see under the hodgepodge of tubing, the quiet clicking of the ventilator the room's only sound.
From all appearances he was homeless, but in the opinion of his nurse, who has had vast experience in dealing with patients just like him, everyone has a mother or a father, a son or a daughter, and homeless or not, it's a nurse's responsibility to do what he can to help find them. Usually it's just a matter of taking that extra few minutes to connect the dots. "Homeless people are very savvy and self-sufficient when it comes to survival skills," he explains. "They write important phone numbers on the insides of a hat, put them in their shoes, or sew numbers inside the seams of their coats. I go through every stitch of clothing."
If that doesn't turn up any emergency contact numbers or personal information, he examines the patient's body for needle tracks, scars or tattoos and if necessary, sends fingerprints to the police for a background check.
Sometimes the police's theory is that the homeless person had a desire to be a loner, and they see no need to reconnect them with their family after they are injured or dead. But the nurse is quick to disagree.
"Things change, [and] these people are still human beings. I believe that every homeless person is still a father or mother, [or a] son or daughter to somebody out there. These people may have done things they are not proud of, they may have mental illness, but their family has a right to know what happened to them."
From a hospital's perspective, a patient without an identity is a patient without funding. But once a nurse or a social worker positively IDs a patient as a US citizen, the hospital can help the patient apply for Medicaid and then get reimbursement for the bill.
"Identifying people is a reasonable endeavor. It is part of a holistic approach. When you locate family, you find a surrogate to speak on behalf of the patient, to be an advocate. The family should decide on the patient's follow-up and if the patient has died, the family should decide where they are buried."
For tools you and your staff can use to identify John Does download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.
Laura Greenwald, CEO/The Next of Kin Education Project firstname.lastname@example.org
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