your idea makes a great deal of sense. but, since in involves local & state politicians actually taking the time to clearly explain & fund such an idea (as oppossed to releasing stories/studies to the media), it isn't likely to happen. more's the shame.

Living in the UK and experiencing not worrying over medical care is amazing. I sprained my ankle and actually thought about not having it looked at because I didnt want to have to pay for the ER visit. I get sick a lot and have trained myself to not seek help because I know how expensive it is. It's sad that people don't see that the medical insurance companies are literally bankrupting people who have no other choice but get medical attention. While I agree that Medicare and Medicade people do sometimes take advantage of what is given to them, that is a small amount of people, where are the majority of the people need it to live.

You might be interested in Malcolm Gladwell's article Million dollar Murray - which overs the same ground

Well it's nice to see that I think along the same lines as geniuses.

(Although it's *much* more likely that I've read that very article and forgotten that I'd read it).

The problem with the idea is precedent. Housing these folks eventually lets word out: If you want a free place to stay, just spend your days in the ER.

You might as well say "if you want a free place to stay, just mug a few grannies and go to prison". It's usually not about finding somewhere to stay. In the UK, you get help with housing anyway as part of welfare.

Unfortunately there's a certain number of people frequently attending A&E who, generally speaking, have a place to stay, but don't have the care necessary to cope with their ongoing mental or physical health issues.

As an example, let's take this lady encountered by Spence over at Siren Voices. No one would deny that a person with their throat cut open needs to go to A&E, but if she had been in *suitable* accommodation *with* the sort of 24/7 care she evidently requires, maybe she would be less likely to have been sitting alone with her stanley knife, in a car park at eek-o'clock in the morning, and wouldn't have needed to go to A&E at all.

Unfortunately even where Social Services are competent, they're still over-stretched and underfunded, so care tends to be very hit-and-miss.

Sure - part of the problem is setting a bad precedent that people might exploit, but another significant problem is this: "Eight of the nine patients have drug abuse problems, seven were diagnosed with mental health issues and three were homeless."

I'm over-generalizing, but those sound like folks who aren't going to take well to being put into supervised housing and 24 hour care/observation. So, unless you are planning on incarcerating them (for costing too much money?) the logical solution is something they won't participate in.

You may be surprised at the sorts of people who want treatment, but can't get it.

'Dry' alcoholic treatment centres are a case in point, they accept people but only if they aren't drinking, which, erm, makes staying there for a heavy alcoholic problematic at best.

2700 visits out of how many visits? What percentage of the total spend did their visits represent? What percentage of their visits were for legitimate clinical issues? What's the opportunity cost versus value of visits versus institutionalisation? Would setting up such a scheme in fact make any difference to the actual visit rate?

The ED visits are just the end of a long dysfunctional chain that is our healthcare system. If patients had a better relationship with their primary care physician, if doctors still actually made housecalls, if patients were treated in THEIR best interests and not those of the insurance company or institution to 'turf' them as soon as possible then maybe this would ease the burden on facilities by reducing the need for them in the first place AND be cheaper. Remember the old saying about an 'ounce of prevention'.....

Seconded! Thirded and fourthed, even.

In the high and far off times, the US, too, had care homes and mental hospitals. Sure, there were huge problems with some of them. But dumping the sick out on the street hasn't worked out real well for us.

Now we're gradually realizing that some people simply have to be cared for. But it's been too long since that was the standard way of doing things. (Some three whole decades. Who can remember that far back?) So we get the tired old myths about luxury hotels for deadbeats and welfare queens in Cadillacs. You know what? That didn't happen back in the day, nor does it happen in First World countries that treat citizens like human beings.

What's not a myth is that worrying about deadbeats costs real money. The average cost of medical care in "socialized" Europe is around $2700 per person. In the US it's closer to $5500, for much less care. A lot of that extra cost is lots of duplicate insurance companies, each with their own army of beancounters who do nothing but figure out how to deny care.

The lesson is clear. If you want to save money, put the deadbeats in hotels and the insurance beancounters out on the street.

The "million dollar Murray" problem:

http://www.gladwell.com/2006/2006_02_13_a_murray.html

Well it's nice to see that I think along the same lines as geniuses.

(Although it's *much* more likely that I've read that very article and forgotten that I'd read it).

Just have to remember, Fox News is very biased, utterly flash and unreliable. Not that it isn't necessarily correct, but I'd find another source before taking it as fact.

I did start off the article saying much the same thing, but whatever I wrote just seemed like snark for the sake of snarking, so I deleted it.

Glenn Beck for president!*

(*of the Moon, and only if we get to send him there...)

This houde for the people who need 24 hour care sounds like a good idea. All it needs is a name. Hmmmmmm, I know, what about calling it a Hospital !

Too simple ?

It's the difference between acute issues and chronic issues. The type of "24 hour care" you need for the week or so immediately after an A&E-worthy event is very different from the type of "24 hour care" you need for the next few decades after your condition has stabilised and you need to get on with your life but you remain physically or mentally unable to do so without assistance.

Speaking only from my own experience, I've never been in a hospital ward I'd want to spend more than a week in, tops - and even then I'd be looking forward to going home every single day of it.

Do you really think these 9 people would want to live together? Or that they'd get on with each other if they had to live together?

I'm dubious.

Such places do exist, as Phil says, but I thought they were called prisons, not hospitals.

I am going to mention the Margaret Haywood case, and thank everyone for getting her re-instated, she deserved a medal for what she had the courage to do, and I hope this will encourage others to not be bullied or intimidated by Senior management, Matrons, Sisters et el. Many in the nursing profesion are 100% dedicated, sadly there are a few that are like peodeophiles who actually get pleasure out of neglect and abuse. There are a few doctors that should not be allowed to practice as we in the UK have found as recently as a few days ago. You might wonder why I am posting this, it is because I was in 2010 a victime of the worse type of duty of care in The Royal Sussex County Hospital, where Margaret Haywood famously filmed for Panorama. I would have given anything for a nurse like her to have come to my aid, as would those had they been able to verbally say themselves, who she filmed. Heads should roll, as a deterrant, clean the NHS up, I question the NMC who's decision to ban her, what Margaret did was correct. Arguably what the NMC did is questionable, the nurses first duty of care is to the patient. Therefore what sort of relationship have they or did they have when making their decision, which was against the professions legal status but made instead in favour of the alleged powerful Brighton Universtity Teaching Hospital that the Royal Sussex is allegedly a part of? the £6figure salary + bonuses of the Chief Executive, Include the complaints managers et el, the Matron and Srn Nurses who allegedly covered up should be dismissed. Because in Feberuary 2010 BBC South Today Programme filmed there and it was very interesting indeed the Brighton Coroners report! Include the statement of the chief nurse and Huston they have a problem, it is still going on!
You see we were all probably brought up to respect certain professions, they were truthfull, they did not cover up bad deeds, neither did they lie, or do we now trust the lies we are told?

If we were all a vehicle we the public the consumer who pays their wages are the engine ,without us or our money, it would come to a halt. If it did we would probably get something better that actually works for the patient instead of the shareholder/corporateworker.

I had wonderful kind treatment from ambulance crew, and first responders, sadly from when they left me, it went so downhill so quickly you could not have made it up as fiction, nor need do I so. What is needed, is as of lawful right, that whistleblowers are listen too and not bullied. As of lawful right make deliberate neglegence a criminal offence and staff should not be afraid to come forward because of intimidation and what Margaret suffered. Without any deterrant and the strong lobby of the trusts in this country despite what these associations say, things will not change and that is a fact. If you think I am an idiot try something for yourselves. Each of your ambulance stations, law courts, schools whatever Parliament, house of Lords etc you think of them and just look, they are all either companies or corporations in their own rights. That means if you know where to look you will confirm this by using a search engine and looking up company house or credit agency etc. We do I agree need a rethink on the NHS the management we all know it is well heeled and top heavy, like the bankers they are laughing every payday at our expense. Public donations are paying for the latest equipment, without our knowledge and consent they are taking us private via the back door. If that is whatyou the public want okay, and realise that it is ultimately going to collapse, the best scenario will be lack of basic care standards if they can get any care at all, I think the real problem is the average member of public are so ingrosed in the tv soaps or football they have not woke up yet. If you are agreeable to taking this further please let the web owners know and we can start something going to get rid of the rich pen pushers. It is only those of you on the real front line or if you are a victim that you can actually see above the parapet what is actually going on in UK hospitals and the stress and pressure real nusing staff are under having been cut to the bone with their backs against the wall. 85% of the UK ordinary population in my opinion are like Ostriches and will be dismayed when they see the outcome of the calculated cuts yet to be announced. We can stop them affecting the real Medical and Clinical staff, and front line ambulance paramedics who have to sit out 12 hrs shifts in laybys to be nearer governent targets. No toilets for them unless they have friendly locals. If any of you 4 wonderful chaps read this who picked me up, I can never thank you enough.