Table 3.

Perceived shortcomings of California Senate Bill 1152: examples from key informant interviews.

Perceived shortcomings of SB 1152
Increased initial staff burden and stress	“The biggest panic came from the social workers who work in the ED. They hit the ground running. So, it was quite overwhelming for them for a while. We had to do a lot of care in there just to calm the nerves.” – Care Coordination Director, Non-Profit, LA County “The IT people had to build into the nursing progress notes, the whole part about homelessness. It was rough in the beginning, but I think [nurses] do it okay now. A lot of grumbling about it like, ‘Don’t we do enough?’” – Social Worker & Nurse Case Manager, for profit, Humboldt County
Increased utilization of resources and time	“We do as much as we can, but some of the testing and the assessment that we do are maybe wasteful, because it’s a repeat of everything, but it’s a new presentation. So, the physician has to do everything, the testing, we do lab work, and the whole nine yards. So, I don’t know if some of that is redundant and wasteful.” – Social Work Manager, non-profit, LA County “Again, we have a lot of homeless people. So, it’s gotten to the point that our social worker and our seasoned staff kind of know all our homeless people that visit the ED frequently. And they kind of know that they’ll either accept or deny whatever resources we have to offer. So, it’s almost to the point where we already know what they’re going to say as soon as we see them. And, you know, I mean, but we still have to go through hoops. It is a mandated requirement.” – Nurse, county, LA County “We have a lot of homeless populations showing up in our emergency rooms. Some of them are pretty savvy with the Senate bill, so we have to provide food and clothing and then find a destination point. And so our resources get heavily consumed, going through this populous of patients… But they have [been savvy] even without the Senate bill.” – CNO, non-profit, Humboldt County
Limited scope of the law	“Say, there’s a homeless person, police will pick them up, bring him to the hospital, drop them off. And it’s really not an appropriate place to drop off… in [theory], [SB 1152] is a good idea, but it really [is] a Band-Aid. Because it sticks the hospital with making this plan, and the hospital is really not an appropriate place to make a long-term plan for someone. Even when we connect the patient to…agencies…it’s still lacking. Mental health is a huge piece that’s missing because we don’t have the resources to really treat people like we should treat them. So, I think really, what we’re just creating is like the cyclical, patient relationship with the hospital. We do our discharge properly, they possibly get housing if they wanted, many say no… a lot of times, they don’t fit the criteria to go to these recuperative cares, and then they end up coming back again.” – Clinical Social Worker, non-profit, LA County “[The law] helped with something more immediate. But it didn’t really help with something long term, which I think is a drawback with the law…there could be other long-term solutions that may need to be addressed.” – Social Worker, county, LA County “SB 1152, I think comes from the feeling that we need to intervene and we need to hold somebody accountable. And the hospitals in this case are the ones that were chosen to be accountable. Do I really think that’s the answer? No, but do I think that we can and should be involved? Yes. So that’s where it stands.” – Nurse Administrator, county, LA County “[I want the state legislators] to know that it’s an interdisciplinary approach, and then it’s not just something that we could fix in the hospital. We have to be able to work with community partners and just along the continuum of care to meet the need. So, I think that if hospitals are held to such a high standard, then I feel like every other agency before and after should be held to a high standard.” – Social Work Manager, non-profit, LA County