This week I saw a 60 year old gentleman who had been admitted multiple times in the last 6 months with decompensated heart failure. He was not adherent to the medications . On questioning about his living situation he told me that he is currently living in the shelter and cannot afford the medications . He gets admitted to the hospital and spends more time in different hospitals in the Detroit area than he lives in the shelter .
Another patient was a 55 yr old M who had ESRD and was on dialysis . Due to insurance issues he was not accepted at the dialysis centre and gets admitted in the hospital for dialysis after few days .
These are examples which highlight how the health system is not efficiently utilized and resources are wasted . If there was a system to provide medications and adequate necessary help to the homeless it would be more helpful then keep admitting such patients .
As a physician it is a challenge to actually help such patients who require more than just medical care . Couselling for medication adherance and / or regular dialysis is not helpful until social situation is addressed .
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