A ‘snap shot’ of the health of homeless people in inner Sydney: St Vincent’s Hospital
Caroline N. Chin A , Kate Sullivan B and Stephen F. Wilson C DA Notre Dame University, Sydney School of Medicine, 160 Oxford Street, Darlinghurst, NSW 2010, Australia. Email: aoi.sakana@gmail.com
B School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
C St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia. Email: knhsullivan@gmail.com
D Corresponding author. Email: stwilson@stvincents.com.au
Australian Health Review 35(1) 52-56 https://doi.org/10.1071/AH09824
Submitted: 12 August 2009 Accepted: 18 May 2010 Published: 25 February 2011
Abstract
Objectives. The poor health profile of people who are homeless results in a disproportionate use of health resources by these people. An in-hospital count of demographic and health data of homeless patients was conducted on two occasions at St Vincent’s Hospital in Sydney as an indicator of health resource utilisation for the Sydney region.
Methods. Two in-hospital counts were conducted of homeless patients within the boundaries of St Vincent’s Hospital to coincide with the inaugural City of Sydney homeless street counts in winter 2008 and summer 2009. Data collected included level of homelessness, principal diagnosis, triage category, bed occupancy and linkages to services post hospital discharge.
Results. Homeless patients at St Vincent’s utilised over four times the number of acute ward beds when compared with the state average. This corresponds to a high burden of mental health, substance use and physical health comorbidities in homeless people. There was high utilisation of mental health and drug and alcohol services by homeless people, and high levels of linkages with these services post-discharge. There were relatively low rates of linkage with general practitioner and ambulatory care services.
Conclusion. Increasing knowledge of the health needs of the homeless community will assist in future planning and allocation of health services.
What is known about the topic? The poor health status of people who are homeless has been previously noted in the USA, Canada and Scotland.
What does this paper add? Homeless people living in Sydney also have a poor health profile and a disproportionate use of health resources when compared to people in the general population.
What are the implications for practitioners? Health services for homeless people should be equipped to deal with mental health, substance use and physical health comorbidities.
References
[1] Census of Population and Housing. ABS; 2009. Available at http://www.abs.gov.au/websitedbs/D3310114.nsf/Home/census?opendocument?utm_id=GT [verified June 2009].[2] Homelessness Services. City of Sydney; 2009. Available at http://www.cityofsydney.nsw.gov.au/Community/HomelessnessServices/HomelessPersonsInformationCentre.asp [verified April 2009].
[3] Chamberlain C, MacKenzie D. Understanding contemporary homelessness: issues of definition and meaning. Aust J Soc Issues 1992; 4 274–97.
[4] Forchuk C, Brown SA, Schofield R, Jensen E. Perceptions of health and health service utilization among homeless and housed psychiatric consumer/survivors. J Psychiatr Ment Health Nurs 2008; 15 399–407.
| Perceptions of health and health service utilization among homeless and housed psychiatric consumer/survivors.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1c3ptlygtw%3D%3D&md5=b5b1087ff8feca6b724ee407966ac3b9CAS | 18454826PubMed |
[5] Ensign J, Santelli J. Shelter-based homeless youth – health and access to care. Arch Pediatr Adolesc Med 1997; 151 817–23.
| 1:STN:280:DyaK2svhtVOktg%3D%3D&md5=02f630bf53a98f29dde1e92d1bbf1728CAS | 9265885PubMed |
[6] Hwang SW. Homelessness and health. CMAJ 2001; 164 229–33.
| 1:STN:280:DC%2BD3M3mt1CksQ%3D%3D&md5=3fbe4d7b7cba50d9d792335b7838504eCAS | 11332321PubMed |
[7] Hwang SW, Tolomiczenko G, Kouyoumdjian FG, Garner RE. Interventions to improve the health of the homeless: a systematic review. Am J Prev Med 2005; 29 311–9.
| Interventions to improve the health of the homeless: a systematic review.Crossref | GoogleScholarGoogle Scholar | 16242595PubMed |
[8] Kershaw A, Singleton N, Meltzer H. Survey of the health and well-being of homeless people in Glasgow. Int Rev Psychiatry 2003; 15 141–3.
| Survey of the health and well-being of homeless people in Glasgow.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c3hslyhtw%3D%3D&md5=a32b008bd3a115fb77ca74d035275801CAS | 12745322PubMed |
[9] Power R, French R, Connelly J, George S, Hawes D, Hinton T, Klee H, Robinson D, Senior J, Timms P, Warner D. Health, health promotion, and homelessness. BMJ 1999; 318 590–2.
| 1:STN:280:DyaK1M7ls1yjuw%3D%3D&md5=9141c4a74eea764929464410f784dc42CAS | 10037643PubMed |
[10] Hwang SW, Bugera AL. Barriers to appropriate diabetes management among homeless people in Toronto. CMAJ 2000; 163 161–5.
| 1:STN:280:DC%2BD3cvgt1Kisg%3D%3D&md5=a04ba47cb99996c5927569a9283784e3CAS | 10934977PubMed |
[11] Crisis in Crowded Emergency Departments. Australian Medical Association; 2007. Available at http://www.ama.com.au/node/2913 [verified April 2009].
[12] Braitberg G. Emergency department overcrowding: dying to get in? Med J Aust 2007; 187 11–2.
[13] Fatovich DM, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005; 22 351–4.
| Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3gvVOktw%3D%3D&md5=9cdb202d0e89f0c5f406b91a413523b2CAS | 15843704PubMed |
[14] Richardson DB. The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Med J Aust 2002; 177 492–5.
| 12405891PubMed |
[15] Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 2006; 184 213–6.
| 16515430PubMed |
[16] Iemma M. A new direction for NSW. State Plan. Premiers Department; 2006. Available at www.stateplan.nsw.gov.au [verified August 2009].
[17] Kessell ER, Bhatia R, Bamberger JD, Kushel MB. Public health care utilization in a cohort of homeless adult applicants to a supportive housing program. J Urban Health 2006; 83 860–73.
| Public health care utilization in a cohort of homeless adult applicants to a supportive housing program.Crossref | GoogleScholarGoogle Scholar | 16779686PubMed |
[18] Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health 2002; 92 778–84.
| Emergency department use among the homeless and marginally housed: results from a community-based study.Crossref | GoogleScholarGoogle Scholar | 11988447PubMed |
[19] Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA 2001; 285 200–6.
| Factors associated with the health care utilization of homeless persons.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7ks12itg%3D%3D&md5=886a3e2e4b124b762b7df546130af0c8CAS | 11176814PubMed |
[20] Kushel MB, Yen IH, Gee L, Courtney ME. Homelessness and health care access after emancipation: results from the Midwest evaluation of adult functioning of former foster youth. Arch Pediatr Adolesc Med 2007; 161 986–93.
| Homelessness and health care access after emancipation: results from the Midwest evaluation of adult functioning of former foster youth.Crossref | GoogleScholarGoogle Scholar | 17909143PubMed |
[21] Van Ness PH, Davis WR, Johnson BD. Socioeconomic marginality and health services utilization among central Harlem substance users. Subst Use Misuse 2004; 39 61–85.
| Socioeconomic marginality and health services utilization among central Harlem substance users.Crossref | GoogleScholarGoogle Scholar | 15002944PubMed |
[22] Fulde GWO. The homeless and the emergency department: a special relationship. Med J Aust 2003; 179 651–2.
| 14636146PubMed |
[23] Esplin P, Mahony A, Wilson SF. The Community Outreach Medical Emergency Team (COMET): Setting up a new homeless service, an evaluation of the first six months. Nursing Monograph. Sydney: St Vincent’s and Mater Health; 2007: 42–47.
[24] Kushel MBMD, Gupta RMD, Gee LMPHJD, Haas JSMDM. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med 2006; 21 71–7.
| Housing instability and food insecurity as barriers to health care among low-income Americans.Crossref | GoogleScholarGoogle Scholar | 16423128PubMed |
[25] Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalisations among chronically ill homeless adults. JAMA 2009; 301 1771–8.
| Effect of a housing and case management program on emergency department visits and hospitalisations among chronically ill homeless adults.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXls1Wjt78%3D&md5=9f0fbb5d4273190286cae7a7b2f5460dCAS | 19417194PubMed |
[26] The Road Home – Homelessness White Paper; Chapter Six: Research. Department of Housing; 2008. Available at http://www.fahcsia.gov.au/sa/housing/progserv/homelessness/whitepaper/Documents/ch6.htm [verified May 2009].
[27] History of the AR-DRG Classification Development. Department of Health and Ageing; 2009. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/AR-DRG-History [verified July 2009].
[28] Policy on the Australasian Triage Scale. Australasian College for Emergency Medicine; 2006. Available at http://www.acem.org.au/infocentre.aspx?docId=59 [verified April 2009].
[29] Australian Hospital Statistics. Australian Institute of Health and Welfare, 2009. Available at http://www.aihw.gov.au/publications/index.cfm/title/10776 [verified July 2009].
[30] Hulchanski JD. A New Canadian Pastime? Counting homeless people: addressing and preventing homelessness is a political problem, not a statistical or definitional problem. Toronto, ON: University of Toronto, Centre for Urban and Community Studies; 2000. Available at http://www.urbancenter.utoronto.ca/pdfs/researchassociates/2000_Hulchanski_Counting-Homeless-People.pdf [verified 24 January 2011].
[31] Shapcott M. Backgrounder: Counting Toronto’s homeless people. Toronto, ON: The Wellesley Institute; 2006.
