The Legislature's answer to hospitals that discharged patients to the pavement was a statute with a checklist, and it reaches acute psychiatric hospitals by cross-reference to the licensing definition.

The short answer: not without a plan, and not without asking where you want to go. Since 1 July 2019, every general acute care hospital, acute psychiatric hospital and special hospital "shall include within its hospital discharge policy a written homeless patient discharge planning policy and process."¹ The policy "shall require an individual discharge plan for a homeless patient that helps prepare the homeless patient for return to the community by connecting him or her with available community resources, treatment, shelter, and other supportive services," guided "by the best interests of the homeless patient, his or her physical and mental condition, and the homeless patient's preferences for placement."¹ Unless you are being transferred to another licensed facility, the hospital must identify a post-discharge destination "with priority given to identifying a sheltered destination with supportive services": an agency or provider "that has agreed to accept the homeless patient, if he or she has agreed to the placement," your own residence as you describe it, or "an alternative destination, as indicated by the homeless patient."¹ Before you leave, the hospital must document that you were offered a meal, weather-appropriate clothing if yours is inadequate, a prescription and, where it has an outpatient pharmacy, "an appropriate supply of all necessary medication, if available," screening and help enrolling in health coverage, and "transportation after discharge to the destination" if it is within 30 minutes or 30 miles.² Every such discharge goes in a log.³ And separately, any mental health patient leaving a psychiatric hospital, a psychiatric health facility or a general hospital must be handed "a written aftercare plan prior to the patient's discharge."⁴

Who counts, and which hospitals

"Homeless patient" means "an individual who lacks a fixed and regular nighttime residence, or who has a primary nighttime residence that is a supervised publicly or privately operated shelter designed to provide temporary living accommodations, or who is residing in a public or private place that was not designed to provide temporary living accommodations or to be used as a sleeping accommodation for human beings."⁵ A car, a tent and a shelter clearly fit; someone moving between friends' couches likely does, as a person who lacks a fixed and regular nighttime residence.

The duty falls on each hospital "as defined in subdivisions (a), (b), and (f) of Section 1250" — general acute care hospitals, acute psychiatric hospitals and special hospitals.¹ That includes the psychiatric unit inside a general hospital and the free-standing psychiatric hospital. It does not reach the state hospitals run by the Department of State Hospitals.⁶ What happens after the 72 hours →

The statute also has a rule about the question itself. The policy "shall require a hospital to inquire about a patient's housing status during the discharge planning process," and "Housing status may not be used to discriminate against a patient or prevent medically necessary care or hospital admission."¹ You should be asked; the answer cannot be used to turn you away.

The checklist

Before discharging a homeless patient the hospital "shall document all of the following":²

  • the treating physician has determined your clinical stability, "including, but not limited to, an assessment as to whether the patient is alert and oriented to person, place, and time," and the physician or a designee has told you your post-discharge medical needs;
  • you have "been offered a meal, unless medically indicated otherwise";
  • if your clothing is inadequate, you were offered "weather-appropriate clothing";
  • you were referred to follow-up care, if medically necessary;
  • you were given a prescription if needed and, at a hospital with an on-site outpatient pharmacy, an appropriate supply of medication if available;
  • you were offered or referred to screening for infectious disease common to the region, and offered vaccinations appropriate to your condition;
  • the physician provided a medical screening examination and, if it shows that "followup behavioral health care is needed," you were "treated or referred to an appropriate provider," with a good-faith effort to contact your health plan, your primary care provider, or another provider "including, but not limited to, the coordinated entry system";
  • you were "screened for, and provided assistance to enroll in, any affordable health insurance coverage" you are eligible for;
  • you were offered transportation to the identified destination "if that destination is within a maximum travel time of 30 minutes or a maximum travel distance of 30 miles of the hospital."

None of it requires the hospital to "adopt a policy that would delay discharge or transfer of a patient."⁷ The statute is about how you leave, not whether.

The destination

Read the destination rule closely, because it is where discharges go wrong. The hospital must identify one of three places, "with priority given to identifying a sheltered destination with supportive services":¹

  1. "A social services agency, nonprofit social services provider, or governmental service provider that has agreed to accept the homeless patient, if he or she has agreed to the placement." The hospital must send the receiving agency written or electronic information about your post-hospital health and behavioural-health needs, and must "document the name of the person at the agency or provider who agreed to accept" you.¹ A shelter that has not agreed cannot be recorded as an agency placement; it can be a destination only if you yourself name it under the third option.
  2. Your "residence," which for a homeless patient means "the location identified to the hospital by the homeless patient as his or her principal dwelling place."¹
  3. "An alternative destination, as indicated by the homeless patient."¹

To make the first option real, each hospital must keep a written plan, updated yearly, for coordinating with "the county behavioral health agency, health care and social services agencies in the region, health care providers, and nonprofit social services providers," including "a list of local homeless shelters, including their hours of operation, admission procedures and requirements, client population served," and the shelter intake coordinator's contact details.⁸ Ask to see it.

One more limit: no hospital "may cause the transfer of homeless patients from one county to another county" for services "without prior notification to, and authorization from" the receiving agency.⁵

The aftercare plan, for every mental health patient

Housed or not, "when a mental health patient is being discharged" from a state mental hospital, a general acute care hospital, an acute psychiatric hospital, a psychiatric health facility, a mental health rehabilitation center, a skilled nursing facility with a special treatment program or a psychiatric residential treatment facility, "the patient and the patient's conservator, guardian, or other legally authorized representative, as applicable, shall be given a written aftercare plan prior to the patient's discharge."⁴ It must include, to the extent known, "the nature of the illness and followup required," medications "including side effects and dosage schedules," the "expected course of recovery," treatment recommendations, and "referrals to providers of medical and mental health services."⁴ You may name someone else to receive a copy.⁴ The hospital bill that follows →

What to do

  • Before discharge: tell staff you have nowhere to go. That triggers the homeless-patient process; the statute says the hospital must ask anyway.¹ Say where you would like to go, and ask which agency has agreed to take you and who there said yes.¹
  • At discharge: ask for the aftercare plan in writing,⁴ your medication or prescription,² and the ride.² If clothing is a problem, say so.²
  • If it goes wrong: this statute names no complaint route of its own. The county patients' rights advocate takes complaints about the rights of people in psychiatric facilities, and the Department of Public Health, which licenses hospitals, takes complaints about hospitals. Who is the patients' rights advocate? →

Worked example

A woman living in her car is admitted on a 5150 hold to the psychiatric unit of a county hospital. Three days later the psychiatrist clears her for discharge. Under the statute the unit must: record her housing status;¹ prepare an individual discharge plan that reflects her preference;¹ identify a destination — the social worker calls a women's shelter from the hospital's list, confirms a bed, and records the intake worker's name;¹ ⁸ offer a meal, a jacket, an appropriate supply of her medication from the outpatient pharmacy and a ride, the shelter being twelve miles away;² give her a written aftercare plan with her follow-up appointment;⁴ and log the discharge and destination.³ A discharge that skips these steps and ends at the kerb is the thing the statute was written to stop.

Q&A

Q: Can they refuse to admit me because I have no address? A: No. "Housing status may not be used to discriminate against a patient or prevent medically necessary care or hospital admission."¹

Q: I was told to leave and given a bus token. Is that legal? A: The statute does not say what kind of transport; it says the hospital must have offered transportation "to the destination identified," and that destination has to be a place that agreed to take you, your own stated dwelling place, or a place you named.¹ ² A bus token with no identified destination does not meet the description.

Q: Does this apply to a state hospital? A: The homeless-patient subdivisions do not.⁶ The written aftercare plan does.⁴

Q: Does the hospital have to find me housing? A: No. It must identify a destination, give priority to a sheltered one, coordinate with the county and local shelters, and document the steps;¹ ⁸ it is not required to delay your discharge until housing exists.⁷

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Sources

  1. Cal. Health & Safety Code §1262.5(n) — (n)(1) "Each hospital, as defined in subdivisions (a), (b), and (f) of Section 1250, shall include within its hospital discharge policy a written homeless patient discharge planning policy and process"; (n)(2) "The policy shall require a hospital to inquire about a patient's housing status during the discharge planning process. Housing status may not be used to discriminate against a patient or prevent medically necessary care or hospital admission"; (n)(3) the individual discharge plan, as quoted, "guided by the best interests of the homeless patient, his or her physical and mental condition, and the homeless patient's preferences for placement," and "The homeless patient shall be informed of available placement options"; (n)(4) "with priority given to identifying a sheltered destination with supportive services," and (A)–(C) the three destinations as quoted, including the duty to "document the name of the person at the agency or provider who agreed to accept the homeless patient"; (n)(5) information "in a culturally competent manner and in a language that is understood by the homeless patient." Section 1250(b) defines "acute psychiatric hospital." — california.public.law. Added by SB 1152 (Stats. 2018, Ch. 981) — legiscan.com.
  2. Cal. Health & Safety Code §1262.5(o) — "The hospital shall document all of the following prior to discharging a homeless patient," items (1)–(10) as quoted, including (o)(5) "an appropriate supply of all necessary medication, if available," (o)(8) the medical screening examination and "followup behavioral health care," with contact to (A) the health plan, (B) the primary care provider, or (C) "Another appropriate provider, including, but not limited to, the coordinated entry system," and (o)(10) transportation "if that destination is within a maximum travel time of 30 minutes or a maximum travel distance of 30 miles of the hospital" — california.public.law.
  3. Cal. Health & Safety Code §1262.5(q) — "Each hospital shall maintain a log of homeless patients discharged and the destinations to which they were released after discharge" — california.public.law.
  4. Cal. Health & Safety Code §1262 — (a) "When a mental health patient is being discharged from one of the facilities specified in subdivision (c), the patient and the patient's conservator, guardian, or other legally authorized representative, as applicable, shall be given a written aftercare plan prior to the patient's discharge from the facility," with components (a)(1)–(6) as quoted; (b) the patient "may designate another person to receive a copy of the aftercare plan"; (c) the seven facility types, including "(3) An acute psychiatric hospital as described in subdivision (b) of Section 1250" and "(4) A psychiatric health facility as described in Section 1250.2"; (d) "mental health patient" means "a person who is admitted to the facility primarily for the diagnosis or treatment of a mental disorder" — california.public.law.
  5. Cal. Health & Safety Code §1262.4 — (b) the definition of "homeless patient" as quoted, incorporated by §1262.5(r); (a) "No hospital, as defined in subdivisions (a), (b), and (f) of Section 1250, may cause the transfer of homeless patients from one county to another county for the purpose of receiving supportive services … without prior notification to, and authorization from, the social services agency, health care service provider, or nonprofit social services provider" — california.public.law.
  6. Cal. Health & Safety Code §1262.5(u) — "Subdivisions (n) to (t), inclusive, do not apply to the state hospitals under the jurisdiction of the State Department of State Hospitals"; (v) "This section shall become operative on July 1, 2019" — california.public.law.
  7. Cal. Health & Safety Code §1262.5(k) — "This section does not require a hospital to do any of the following: (1) Adopt a policy that would delay discharge or transfer of a patient" — california.public.law.
  8. Cal. Health & Safety Code §1262.5(p) — the written coordination plan, "updated annually," with (p)(1) the shelter list "including their hours of operation, admission procedures and requirements, client population served, and general scope of medical and behavioral health services available," (p)(2) referral procedures, (p)(3) "The contact information for the homeless shelter's intake coordinator," (p)(4) "Training protocols for discharge planning staff" — california.public.law.

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