Hospital collaboration with a Housing First program to improve health outcomes for people experiencing homelessness

Abstract

Purpose Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues. Design/methodology/approach This mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia’s inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice. Findings This collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed. Research limitations/implications While the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort. Practical implications This model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health. Originality/value Coordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness.

Homelessness: the imperative for a public health response

“…In our team's evaluation of 50 Lives, its impact on health outcomes has been a substantial focus 11 . Among those housed for one year or more, there has been a significant decrease in the number of emergency department (ED) presentations and admitted inpatient days, compared to the year prior to housing 10 .…”

What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography

“…The experience of other adverse events, such as traumatic childhood experiences, imprisonment, institutional care, substance use, relationship breakdowns and mental health problems are also associated with increased likelihood of homelessness [7][8][9]. Homelessness, housing and health are intrinsically linked [10]. People experiencing homelessness report poorer physical and mental health than the general population [11].…”

Trauma-informed knowledge, awareness, practice, competence and confidence of rural health staff: A descriptive study

“…Barriers to health care for those impacted by homelessness and family violence include previous encounters and experience with staff providing care. [18,19] Two Australian studies, [20,21] espouse the need for staff working with homeless people to be trained in trauma-informed care. It is reasonable to assume that people who are homeless have been exposed to a traumatising event, [9] either as the cause for homelessness (such as domestic violence) or homelessness itself being a traumatic event.…”