In Washington, D.C., approximately 18 people per day end up in shelters or on the street after leaving hospitals, according to a D.C. government-sponsored report. Thus, between 10% and 20% of people in District-funded emergency shelters have arrived after leaving a health institution.

Many of these individuals arrive with bad legs, a sore back, gaping wounds, or other aliments that shelters are not equipped to deal with, according to shelter staff and advocates.

At one DC shelter, a man with a broken leg arrived, according to a senior staff member. “He had the iron rods on the outside [of his leg], and I said ‘you shouldn’t be here like that’ because you could see where the screw went into his leg and everything, and he said he was just ‘gonna be here overnight.’” The shelter employee added that the man was put in the front of the facility, where he could be watched, although he should not have been at the shelter in such poor condition.

“One guy had just had surgery, I think on his appendix or something,” said the senior staffer, “and he was bent over. He was still bleeding from the operation, and he said the hospital put him out.”

Sometimes the hospital calls in advance to make arrangements and give a heads-up to the shelter, but “other times the hospital will have them dropped off in taxicabs—any kind of ride they can get—leave them at the shelter and keep going,” said the shelter staff member.

“We've had some come here with colostomy bags, or various open wounds that need to be cleaned on a daily basis,” the staffer said. “They still need medical attention, and this is not a medical shelter, this is an emergency shelter.”

Due to liability concerns, shelter personnel are not allowed to assist residents who are unable to care for themselves. But individuals arriving from hospitals have nowhere else to go. “We’re not going to let anybody stay out on the street—that’s not what we do,” said Abdul Nuradeen, acting executive director at the CCNV shelter.

A committee of advocates and government officials is trying to come up with answers to alleviate the problem facing shelters struggling to help individuals needing medical care. The group has created a plan and developed best practices for discharging patients from public hospitals.

This committee, called the Discharge Planning Task Force, was established after Mayor Williams’ January 2005 release of Homelessness No More, the District’s 10-year plan to end homelessness. The Task Force developed a document, A Comprehensive Public Sector Discharge Planning Policy to Prevent Homelessness in the District of Columbia, which proposes a hospital discharge plan. The document applies only to public institutions, not private hospitals.

The recommended process calls for hospitals to fully analyze patients’ situations to ensure that they have stable housing and proper planning for employment and post-hospital care after discharge. It requires a follow-up evaluation no more than 30 days after release and again six months later. Referring a patient to the local homeless coalition for placement in a shelter must be only a last resort.

The Task Force is also recommending that another facility similar to Christ House, be created, recognizing that hospitals cannot be expected to hold homeless individuals for an extended period of time when there are no available facilities for placement, according to Steve Cleghorn, chief policy analyst for Community Partnership. Christ House is a 33-bed healthcare facility for the homeless where many men are often discharged to, as a step-down placement for homeless people too sick to go to a shelter after hospital release.

“There’s nothing wrong with the report, it’s just a matter of implementing it,” added Cleghorn, who was also a convener of the Discharge Planning Task Force.

The regulations have been mapped out, and the next step is having the Interagency Council on Homelessness (IACH) adopt the policy and find a way to pull together information and resources to be shared by all involved agencies, according to Cleghorn.

A similar discharge policy (the Model Resident Transfer and Discharge Policy for Nursing Homes and Community Residence Facilities) is already in effect in Washington for individuals under care of nursing homes and community residence facilities. That plan was legally mandated under the 1987 Nursing Home Reform Law. There is no similar law governing hospital discharge.

The nursing home discharge policy requires a full assessment of the resident’s physical, mental and psychological status before the resident’s release from the facility, in addition to aiding in locating alternative placements and facilitating the move.

Although the nursing home law does not specifically state that homeless shelters are not acceptable placement, it requires a safe and orderly transfer upon discharge, and that would preclude shelters, according to Jerry Kasunic, director of DC Long Term Care Ombudsman Program.

“Homeless shelters are not safe and orderly transfers,” Kasunic said.

After the proposed discharge planning policy is presented to IACH and approved, implementation documents will need to be created and followed by all District public-funded institutions.

For now, shelters are forced to deal with whatever injuries individuals may arrive with. “Ambulances bring by people who have been referred on a stretcher or in a wheel chair,” said Nuradeen. But discharged patients continue to arrive on a regular basis, forcing Nuradeen and other DC shelter staff to accommodate them. “[I do] whatever I can possibly do,” said Nuradeen.