Complex health service needs for people who are homeless
Gaye Moore A C , Elizabeth Manias B and Marie Frances Gerdtz BA Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 5, 234 Queensberry Street, Carlton, VIC 3010, Australia.
B Department of Nursing, The University of Melbourne, Level 5, 234 Queensberry Street, Carlton, VIC 3010, Australia. Email: emanias@unimelb.edu.au; gerdtzmf@unimelb.edu.au
C Corresponding author. Email: dgmoore@optusnet.com.au
Australian Health Review 35(4) 480-485 https://doi.org/10.1071/AH10967
Submitted: 17 September 2010 Accepted: 7 March 2011 Published: 9 November 2011
Abstract
Background. Homeless people face many challenges in accessing and utilising health services to obtain psychosocial supports offered in hospital and community settings. The complex nature of health issues is compounded by lack of accessibility to services and lack of appropriate and safe housing.
Objective. To examine the perceptions and experiences of homeless people in relation to their health service needs as well as those of service providers involved with their care.
Design. A purposive sampling approach was undertaken with a thematic framework analysis of semi-structured interviews.
Participants. Interviews were undertaken with 20 homeless people who accessed the emergency department in an acute hospital in Melbourne, Australia and 27 service providers involved in hospital and community care.
Results. Six key themes were identified from interviews: complexity of care needs, respect for homeless people and co-workers, engagement as a key strategy in continued care, lack of after-hour services, lack of appropriate accommodation and complexity of services.
Conclusions. Findings revealed the complex and diverse nature of health concerns in homeless people. The demand on hospital services continues to increase and unless government policies take into consideration the psychosocial demands of the communities most vulnerable people efforts to divert hospital demand will continue to fail.
What is known about the topic? Homeless people have complex healthcare needs and are high users of emergency departments (EDs). The increasing demand on hospital services has led to a focus by the Australian State, Territory and Federal Governments on strategies to divert homeless people from presenting to the ED.
What does this paper add? This paper gives an insight into the experiences of homeless people and health service provides who are directly involved in their care. This insight gives important focus on the health needs and service responses that currently exist and the ongoing challenges that face homeless people and the health professionals responding to those needs.
What are the implications for practitioners? To adequately respond to the needs of homeless people safe and supportive accommodation is a crucial component of services required to try and break the cycle of representation to the emergency department. Individual engagement strategies with coordinated care between hospital and community are required to address the complex care needs and psychosocial issues.
Additional keywords: emergency care, healthcare service use, service providers.
References
[1] Wen CH, Hudak PL, Hwang SW. Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. J Gen Intern Med 2007; 22 1011–7.| Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters.Crossref | GoogleScholarGoogle Scholar |
[2] Moore G, Gerdtz MF, Manias E. Homelessness, health status and emergency department use: An integrated review of the literature. Australas Emerg Nurs J 2007; 10 178–85.
| Homelessness, health status and emergency department use: An integrated review of the literature.Crossref | GoogleScholarGoogle Scholar |
[3] Moore G, Gerdtz MF, Manias E, Hepworth G, Dent A. Socio-demographic and clinical characteristics of re-presentation to an Australian inner city emergency department: implications for service delivery. BMC Public Health 2007; 7
| Socio-demographic and clinical characteristics of re-presentation to an Australian inner city emergency department: implications for service delivery.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXmvValu7c%3D&md5=d2e746483d0e7787c27da5a275c60485CAS |
[4] Darbyshire P, Muir-Cochrane E, Fereday J, Jureidini J, Drummond A. Engagement with health and social care services: perceptions of homeless young people with mental health problems. Health Soc Care Community 2006; 14 553–62.
| Engagement with health and social care services: perceptions of homeless young people with mental health problems.Crossref | GoogleScholarGoogle Scholar |
[5] Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analysing Qualitative Data. London: Routledge; 1994: pp. 173–194.
[6] Bazeley P, Richards L. The NVivo Qualitative Project Book. London: Sage Publications, 2006.
[7] O’Brien AJ. Closing asylums for the mentally ill. Social consequences, Health Sociology Review Volume 14(3). Int J Ment Health Nurs 2006; 15 220–1.
| Closing asylums for the mentally ill. Social consequences, Health Sociology Review Volume 14(3).Crossref | GoogleScholarGoogle Scholar |
[8] Fulde GW. The homeless and the emergency department: a special relationship. Med J Aust 2003; 179 651–2.
[9] Romios P, MacWilliams J, Crawford S. Opening the Doors. In: Lawerence R, editor. Melbourne: Melbourne District Health Council; 1992.
[10] Gillis LM, Singer J. Breaking through the barriers: healthcare for the homeless. J Nurs Adm 1997; 27 30–4.
| Breaking through the barriers: healthcare for the homeless.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2szksl2kug%3D%3D&md5=9144b42c92ba6c09de5d20e5df4232a9CAS |
