He’s back… The frequent flyer with bed bugs in room 218. Contact precautions are in full effect. So, gown up and get in-and-out quick, okay team?
Frequent Flyer: not quite the world traveler that one might first suspect. When used in an intercity hospital, the moniker refers to “repeat customers”, patients that come to the hospital so frequently that healthcare workers know them by name. (Think Norm entering Cheers, but without the laugh track.)
The realities of serial hospital admittances notwithstanding, homeless individuals often face healthcare needs proportionally greater than other sectors of the population. Receiving high quality care to meet those needs, however, can prove to be elusive.
Like most public services, healthcare is only as good as it’s frontline workers. Regarding Canadian public health, where reduced income doesn’t provide the incentives to employees that it does in other countries, empathy is key: the desire to help, to do good, to work towards the betterment of patients and their families.
Studies linking compassion with effective healthcare have been done ad nauseum. Empathizing with patients “increases and speeds up recovery” and contributes to “more robust, creative, open clinicians.” This is a virtue that can be put to the test by both patient-dependent factors and personal bias.
I think it’s the smell, to be honest, notes one nurse. The nose recognizes a smell as foreign, and instinctively I want to avoid those scents. For a frontline healthcare worker, this type of reaction can have adverse consequences on the quality of treatment being doled out.
The veins of some of these patients are so hardened by scar tissue, observes a laboratory assistant. Before the needle hits the skin, I know it’s going to be a tough draw. It means spending more time with a patient that’s in the hospital because of their own choices. That might be a bit harsh…
Statements like these aren’t unique. Perhaps understandable seen through certain optics, hearing this repeated refrain from healthcare workers betrays the reality of underlying compassion fatigue in an already strained healthcare system. Less face time with one’s physician or nurse logically leads to unnoticed symptoms or misdiagnosis.
Then there are factors that are less perception-dependent. To keep frontline workers safe from scabies or bed bugs, they “gown up”. “Gowning up” is the process of donning and doffing additional personal protective equipment. This requires additional time, energy and equipment that puts strains on already limited resources.
Low-income seniors face limited care home facilities, which is another reality of Vancouver homelessness. Decreasing room availability presents increasing challenges for an aging population. Oftentimes, these individuals are too sick to stay home alone, but too healthy to be admitted as a hospital inpatient. You don’t have to go home; you just can’t stay here rings hollow when one doesn’t have a home. No surprise, then, that seniors in Metro Vancouver represent a shocking 23% of the area’s homeless population.
While stressors on healthcare are widespread and idiopathic, the negative impacts of an already taxed system are easier to identify. The irony is not lost on one Vancouver-area laboratory technologist: “We spend less time with patients that we don’t want to see because we view them as being in the hospital by choice. The limited facetime and our desire to clear beds leads to patients being discharged prematurely. And as a result of missing something the first time around, we end up seeing the patient again a few days later, sometimes presenting with the exact same symptoms. It’s cyclical, and we have to be better.”
Perception is reality, as the saying goes. Until the general perception about homeless individuals “choosing’” to need healthcare changes, the compassionate healthcare this marginalized sector so dearly needs will not become a reality.
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