I’m a Kansas City social worker. Here’s why ER waits are so long, especially in the cold

I work in a Kansas City emergency room where I often assist patients with post-discharge needs. Many unhoused people do not want to go to homeless shelters, so they come to the ER despite not having any true immediate health concerns. The problem occurs regularly, with some people returning several days in a row, and even multiple times in a single day. This is called malingering — the act of exaggerating or pretending to have an injury or sickness to receive a benefit. Many people do it for attention, shelter, food and other basic resources we all need.

I have such empathy for people with nowhere to live. They do not intend to cause such disruption in the medical system. All they are trying do is to get their needs met. Sometimes, the ER is the only resource they can think of at the time.

But as cold weather approaches, the misuse of our services will only increase. Often, people without a place to live arrive on triage, indicating that they have medical complaints and need to be seen. These people are often willing to wait for hours — because if you don’t have a home, the ER is a warm place where no one will make you leave until you are seen.

And in the face of the “triple-demic” of COVID-19, flu and RSV, this is one of the causes of hospital overcrowding and delays in care for all patients.

By law, patients cannot be refused medical care. They must always at least receive a health screening to identify their needs. If patients indicate they need to be seen for homicidal or suicidal ideations, they remain in emergency room beds until a psychiatric hospital accepts them for care. This delay can last hours or days because of a persistent lack of psychiatric beds in our area. Often, a social worker will spend hours or days calling all the facilities available. I have sent patients on ambulance rides of three to four hours because there were no psychiatric hospitals with openings close by. These situations often occur when people arrive at the ER under the influence and claim to be suicidal. They will remain in a hospital bed until sober, then recant the threat.

People without homes are not homogeneous. Many suffer from mental health problems, substance abuse and poverty. Many of them do not want to go to shelters for a variety of reasons. Past bad experiences and fear of the unknown are real. Homeless shelters can be scary. They require sobriety, so some people needing help are denied admission after blowing into a blood alcohol detection device. Other shelters have other rules people must comply with, leading to delays. If people instead go to a hospital, we provide them resources as best we can.

Medical providers are frustrated when their resources are taken up not for health care, but for social needs. Social workers are frustrated because these patients often have resources they can access in the community but choose not to. And other patients with true medical needs are frustrated when they have to wait to be seen.

Our emergency room allows people who are discharged after the buses stop running to remain in the waiting room if temperatures are dangerously cold. This often means several people sleep there from around midnight until after 5:30 a.m. Patients sometimes arrive without proper clothing for the weather, which we are required to provide them with. Some arrive without medical equipment that they need to be mobile. And again, the emergency room is required to provide that as well.

If you have to visit an emergency room, please know that many people are trying to see you as fast as they can to treat your needs. But please know why delays occur, and help the medical staff figure out the solution to this problem.

Pamela Troutwine has been a social worker since 1990. She received her master’s degree from KU in 2000 and her social work clinical license in 2004. She has many years of child abuse neglect experience as well as medical social work. She lives in Independence.