At the end of this case study, you will be able to:
Married with two young children, John and his wife rented a two-bedroom apartment in a safe neighborhood with good schools. John liked his job as a delivery driver for a large food service distributor, and he had worked there for more than four years. His goal was to become a supervisor in the next year. John’s wife was a stay-at-home mom.
John had always been healthy. Although he had health insurance through his job, he rarely needed to use it. He smoked half a pack of cigarettes each day and drank socially a couple times a month. In the past he had struggled with an addiction problem—mostly alcohol and marijuana—but since having kids he had made some significant improvement in his drinking behaviors. John grew up in a pretty tough neighborhood and both his parents were alcoholics. He had endured some abusive behaviors from his father when he was younger and developed some problems with acting out in school. He eventually saw a school counselor and things settled down. He never followed up with any mental health counseling once he left school. Overall, his life appeared to be going well.
Watch the video to hear more about John’s story.
John's Story TranscriptTwo beers a night steadily increased to a six-pack. John and his wife started to argue more often. Then, about six months after losing his job, John stopped receiving unemployment checks. That week, he went on a drinking binge that ended in an argument with his wife. In the heat of the fight, he shoved her. The next day, John’s wife took the children and moved in with her parents. No longer able to pay the rent, John was evicted from the apartment.
John tried to reconcile with his wife, but she said she’d had enough. Over the next few months, John “couch surfed” with various family members and friends. At one point, he developed a cold, and when it worsened over a few weeks, he sought care at the emergency department. Hospital staff told him that he would be billed because he didn’t have insurance. John agreed, and a doctor diagnosed him with a sinus infection and prescribed antibiotics. With no money to spare, John could not get the prescription filled.
One evening, some teenage boys jumped John in the park, stealing his backpack and kicking him repeatedly. An onlooker called 911, and John was taken to the emergency department. Later that evening, the hospital discharged John. He returned many times to the emergency department for his health care, seeking treatment for frequent colds, skin infections, and injuries. Providers never screened him for homelessness or mental illness and always discharged him back to “home.”
Adapted from Terri LaCoursiere Zucchero, PhD, RN, FNP-BC, and Pooja Bhalla, MSN, RN
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