By Robert A. Oeser
Counterpoint Winter 2018 • Commentary • Page 17
This commentary is from a document provided by its author to the Brattleboro selectboard at a public hearing to discuss repeal of a “begging” ordinance – Sec. 13-2. Begging prohibited. “No person shall beg in or upon a street or other public place.”
The letter from the ACLU of Vermont that could be credited with moving this discussion forward sets forth the legal restrictions [on begging ordinances].
But there is a part two, as that letter goes on to claim: “Numerous communities have created alternatives that are more effective.”
A link in the letter leads to a report, Housing not Handouts. There, I found this seemingly uncontroversial advice:
“Prisons, jails, hospitals, mental health care facilities, and foster care systems should develop and implement plans for discharging people from those institutions or systems of care directly into housing with supportive services as necessary.”
However, in only the last few months, I stumbled across a number of scenarios which seem counterproductive:
- In the beginning of May, I encountered a woman lying on the steps of a building. She had been discharged from the Retreat to the temporary overflow shelter, which closed a few days before. A few weeks earlier she had been arrested for violating conditions not to drink alcohol. Representatives of several local social service and non-profit organizations had already tried to engage her, to no avail; the only alternative offered was voluntary readmission to the Retreat.
- Some months ago, I spoke with nurses at the Retreat who explained that discharging someone to the shelter, or even to the Drop-In Center to get a tent, is considered a “discharge plan.”
- Most recently, a patient’s unit social worker admitted that there was no verification of the habitability of her intended residence and the discharge plan consisted of her calling a longer-term recovery program each Friday to determine bed availability. Her phone then became inoperable.
Federal regulations already provide that all patients likely to suffer adverse health consequences upon discharge ought to be provided with adequate discharge planning.
In my opinion, there needs to be a much stronger common-sense effort to “reassess [the] discharge planning process … to ensure … responsive[ness] to discharge needs” [cf. 42 CFR 482.43].
Common sense should dictate that immediate follow-up after a period of inpatient treatment is crucial.
This is not to say that there aren’t “discharge plans,” at least on paper. One patient admitted she had the paper … somewhere. But the days after discharge are crucial, and there needs to be a clearly identified “go-to” person so that the recently discharged person can work to resolve issues as they arise.
To wait until the programs listed on the discharge plan may actually materialize is too late. By the time the patient gets to the top of a waiting list, another crisis intervenes … another emergency room visit, another readmission; more town resources are used if not wasted.
Putting resources into enhanced discharge planning may not be a guarantee, but what might work, might work.
As the Brattleboro Retreat is a key stakeholder in this community, it ought to play a larger part in this conversation and be a contributor to next steps, perhaps to develop a model program to better coordinate and support community services to address the types of shortcomings as those outlined in this letter.
Oeser reports that the day before his comments to the select board, he met with Konstantin von Krusenstiern, vice president of development and communications, and Kirk Woodring, chief clinical officer, at the Brattleboro Retreat.
At that meeting, he said the administrators made the following points, among others:
● It is permissible for patients, after discharge, to call the Retreat to speak with their former unit social worker for support and guidance, but as time lapses, staff are less and less able to give medical advice.
● Lack of housing is no reason to stay in the hospital. On the other hand, there are some attempts to vary discharge dates to coincide with start dates of residential programs due to begin after discharge. The Retreat also now provides a funded worker at the Groundworks Morningside Shelter.
● In the works is a research program with Dartmouth to provide certain discharged patients with tablet devices loaded with therapeutic software. The patients would need to answer questions posed, and a nurse would follow up every day. If the patient did not respond to the questions, police could be called to conduct a welfare check.
Robert A. Oeser is a resident of Brattleboro.