Shelter-based convalescence for homeless adults in Amsterdam: a descriptive study

Abstract

BackgroundAdequate support for homeless populations includes shelter and care to recuperate from illness and/or injury. This is a descriptive analysis of diagnoses and use of shelter-based convalescence in a cohort of homeless adults in Amsterdam.MethodsDemographics of ill homeless adults, diagnoses, referral pattern, length of stay, discharge locations, and mortality, were collected by treating physicians during outreach care provision in a shelter-based convalescence care facility in Amsterdam, from January 2001 through October 2007.Results629 individuals accounted for 889 admissions to the convalescence care facility. 83% were male and 53% were born in the Netherlands. The mean age was 45 years (SD 10 years). The primary physical problems were skin disorders (37%), respiratory disorders (33%), digestive disorders (24%) and musculoskeletal disorders (21%). Common chronic conditions included addictions 78%, mental health disorders 20%, HIV/AIDS 11% and liver cirrhosis 5%. Referral sources were self-referred (18%), general hospitals (21%) and drug clinics (27%). The median length of stay was 20 days. After (self)discharge, 63% went back to the previous circumstances, 10% obtained housing, and 23% went to a medical or nursing setting. By March 2008, one in seven users (n = 83; 13%) were known to have died, the Standard Mortality Ratio was 7.5 (95% CI: 4.1-13.5). Over the years, fewer men were admitted, with significantly more self neglect, personality disorders and cocaine use. Lengths of stay increased significantly during the study period.ConclusionOver the last years, the shelter-based convalescence care facility users were mainly homeless single males, around 45 years of age, with chronic problems due to substance use, mental health disorders and a frail physical condition, many of whom died a premature death. The facility has been flexible and responsive to the needs of the users and services available.

Epidemiology of respiratory pathogen carriage in the homeless population within two shelters in Marseille, France, 2015–2017: cross sectional 1-day surveys

“…The sheltered homeless population in our study was characterized by a high proportion of migrants of North African origin with a high prevalence of smoking habits and chronic respiratory diseases. We observed a high prevalence of respiratory symptoms and signs (35%) in line with the results of a survey conducted in Italy and the Netherlands [17,18]. Dry or productive cough, rhinorrhoea and dyspnoea were the symptoms most frequently observed, suggesting that both upper and lower tract respiratory infections affect a significant proportion of sheltered homeless people during winter.…”

Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature

“…The notion that intermediate care might itself fill some of these gaps raises questions about scope and remit and how far this should extend into the territory of longer term care. According to Van Laere, De Wit, and Klazinga (), the high mortality rate among users of a Dutch medical respite scheme might be explained by the fact that the homeless population in Amsterdam most commonly comprises people with mental health challenges and long‐term opiate users and alcoholics who are not able to live independently and depend on fragmented services. Many intermediate care schemes for people experiencing homelessness currently provide palliative care to compensate for the lack of provision elsewhere (Hendry, ; Van Laere et al., ; Whiteford & Simpson, ).…”

Mortality and Life Expectancy in Homeless Men and Women in Rotterdam: 2001–2010

“…This study extends the available evidence from a limited number of countries by including data from the Netherlands, with results on mortality and life expectancy of a comprehensive homeless cohort from Rotterdam. Another study performed in the Netherlands also investigated mortality of homeless people, but focused on homeless in convalescence care only [13]. Moreover, our study examined mortality in the period 2001–2010, thereby extending and updating the evidence base.…”

“…Excluding studies which deal with a specific group of homeless people, e.g. persons in convalescence care [13], [17], persons with mental problems [18]–[20] or rough sleepers [12], mortality among the homeless has only been studied in the USA (Philadelphia [4], Boston [7], [21], [22], New York [1]), Canada (Toronto [3], [5], Montreal), Denmark (nationwide [10], Copenhagen [11]), Sweden (Stockholm [2], [18]), and the United Kingdom (Glasgow [9]). Of these, only 4 described mortality of homeless cohorts in the 21 st century [2], [9], [10], [15].…”