End-Of-Life Care For Homeless Patients

The Journal of the American Medical Association | 17 December 2006 | Perspectives On Care Editor

[shrinkermd]

I am posting this to document how long people can actually be "homeless" (50 years since age 16) and how long they can survive almost daily substance habituation (Heroin) and yet quit when they are old and ill.

The issues of homelessness are more complex for the troubled and troubling alchohol and substance habituation user. This is an extreme case, but problems similar to this are common.

[Jorge]

I hope this doesn't turn into the usual homeless bashing thread on FR.

It breaks my heart to see people living on the streets.

I donate money to homeless shelters here in Philly regularly.

[shrinkermd]

Yes, I applaud your efforts. I ran a residential facility for the serious and persistently mentally ill for almost 15 years. I changed my mind completely as to what the problem is.

The people I received off the street were uniformly serious ill with dual disabilities (usually) of substance habituation and mental illness. Not infrequently, they had been kicked out of hospitals because they "used" and out of treatment facilities because they were "psychotic." This was only one problem. The real problem was the inclination of the afflicted to spend years doing drugs and alcohol. So much so it became their only real goal.

As a consequence their social functioning dropped to virtually nil and they failed at placements since they did not pay their rent, keep the place up or just simply went drifting off.

Before the 1960s this problem was handled by civil commitment. People who could not care for themselves or were incapable or unwilling to cease self-destructive alcohol or drug use were committed to institutions.

Then we had a revolution where commitment became difficult and hospitals were closed because they allegedly relied on enforced hospitalizations. The consequence was and is all of these people are on the streets.

Supervised living situations or support help but they will eventually prove unworkable for a significant portion of these individuals. Apparently in the guise of giving the seriously impaired "their rights" they are being left to die with their "rights on."

Without a way to ensure that people remain off substances and on necessary medications for long periods of time well meaning efforts will fail.

In the meantime, spending more and more may help at the margins but the basic issue is when is a person allowed to chose or decline treatment when they are mentally impaired?

Libertarians and liberals answer in the negative. That is never should a person be forced into treatment. This in spite of good data showing the outcome for alcohol treatment is quite good early when civil commitment is required. Ditto for the other major disorders.

[Jorge]

Libertarians and liberals answer in the negative. That is never should a person be forced into treatment. This in spite of good data showing the outcome for alcohol treatment is quite good early when civil commitment is required. Ditto for the other major disorders.

I agree with you completely on this.

If I wasn't pushed into a crack rehab program by a judge threatening me with the alternative of prison I don't know if I ever would have recovered. Period.

And I was a straight A student who graduated first in my college class with a perfect 4.0 GPA.

I NEEDED that incentive from the court requiring my committment.....and years later I thank God for it. And for that judge.

I have my life back now as a result.

[Salvation]

Pro-life bump.

[Grizzled Bear]

I donate money to homeless shelters here in Philly regularly
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My wife does a lot for our local Rescue Mission. One of the best things about it is they hold their clients accountable.

With God's grace some of them learn to hold themselves accountable.

[gcruse]

I'm sorry, but I think part of the problem is calling vagrant drug addicts and winos homeless, an appellation created to garner sympathy for the plight of people who have chosen, in the face of myriad social services and expenditure, to live the life they are living.

You get more of what you subsidize and less of what you discourage, and the population of bums proves it.

[Freedom'sWorthIt]

God bless all those who minister to the homeless....I am seeing so many young homeless people around now. It is very heartbreaking. Jorge - your post is hope for many who seem hopeless. I hope and pray others "out there" have someone who comes along and give that motivation that so many no longer have to get help and get well.

[Jorge]

My wife does a lot for our local Rescue Mission. One of the best things about it is they hold their clients accountable. With God's grace some of them learn to hold themselves accountable.

Excellent.

I try to donate to Christian based missions that give people a vision of hope that includes personal responsibility and reliance on God that supercedes the cirumstances in this present world.

I think all of us need that type of hope...but especially those who are alone on the streets.

[EEDUDE]

There, but for the Grace of God go YOU.

Many of these people are so ill, both emotionally and sometimes physically, that they have no alternatives.

Compassion is not inconsistent with conservative values.

[TAdams8591]

I agree with your post. It is terribly sad. How good of you to donate your money!

[gcruse]

"There, but for the Grace of God go YOU. "

Nope.

[Jorge]

God bless all those who minister to the homeless....I am seeing so many young homeless people around now.

Actually I can sympathize because I lived on the streets when I was 16 years old, for almost a year.

For me, to see someone sleeping on a grate in Philly, knowing this is someone's child, brother or sister...and see where they have ended up, is beyond words.

[Jorge]

"There, but for the Grace of God go YOU. "

Nope.

YES YOU.

Please don't tempt God with such ignorant responses.

For your own sake.

You don't know what could happen to you tomorrow.

[Diddle E. Squat]

Before the 1960s this problem was handled by civil commitment. People who could not care for themselves or were incapable or unwilling to cease self-destructive alcohol or drug use were committed to institutions. Then we had a revolution where commitment became difficult and hospitals were closed because they allegedly relied on enforced hospitalizations. The consequence was and is all of these people are on the streets.

Excellent post (#3 in its entirety) and thread, I hope many will read it and give it some thought.

[GovernmentShrinker]

For unclear reasons, resection was made con­tingent upon cessation of drug use and was not done.

Unclear to whom? Lifelong drug addicts who refuse to quit until they are physically unable to go out and get the stuff do not deserve one cent of medical care at the expense of taxpayers.

While I agree with you that involuntary commitment is what's needed in many cases, even that shouldn't be allowed to become a huge drain on taxpayers. Few people with an inclination to live this way will ever become productive citizens, and the current maze of regulations and laws wildly inflate the expense of running of inpatient mental institutions, and prohibit requiring the patients to perform valuable work to support the operation of the institution. The money would be better spent on higher quality care for people who really have no ability to help themselves, even under confinement and pressure (severely retarded, brain-damaged, Alzheimer's patients, etc.).

[Grizzled Bear]

part of the problem is calling vagrant drug addicts and winos homeless
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Kinda like calling people who consider flipping burgers (only one example) "beneath their dignity" unemployed?

[gcruse]

Kinda like calling an IQ of 50 'differently abled.'

[derllak]

Exactly. I wouldn't be so cocky as to make such a statement.
I'll bet 90% of homeless people never would have imagined it happening to them.

[Grizzled Bear]

Exactly. I wouldn't be so cocky as to make such a statement.
I'll bet 90% of homeless people never would have imagined it happening to them.
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I do sympathize because sometimes bad things happen. I can even sympathize when people make bad choices.

I run out of sympathy when people refuse to take responsibility for themselves (except for those who are incapable, of course).