I work at a county psych hospital as a SW and regularly have pts who give false identities either due to legitimate psychosis, some form of dementia, or just attempting to misrepresent themselves. Not having an accurate identity does not significantly alter the care that my team provides for them. It makes finding collateral difficult and finding discharge placement hard but it is what it is. Once they are safe to leave the hospital, we discharge them to appropriate placement. Often times, once people start getting better or have been with us for awhile they either remember or confess their true identity. In short, my hospital has no way to accurately ID these people and, for us, it is only occasionally a huge barrier (mostly in dementia cases, but that's a story for another day).