Complex health service needs for people who are homeless

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.