No abstract

There is little agreement in the recent academic literature about how the concept of homelessness should be defined. This is more than just a theoretical problem, because it becomes difficult to urge governments to meet the needs of homeless people, if the parameters of the homeless population are unclear. This paper reviews ‘conservative’, ‘radical’ and ‘conventional’ perspectives on homelessness in modern society, and it argues that it is possible to adjudicate between them. The paper proposes a socially constructed definition of homelessness based on the notion of minimum community standards. It argues that this culturally relative position provides a theoretically meaningful framework for understanding homelessness in the 1990s.

This article uses information from a large administrative database (N = 3941) to outline five ideal typical pathways into adult homelessness. The pathways are called 'housing crisis', 'family breakdown', 'substance abuse', 'mental health' and 'youth to adult'. Then we explain why people on some pathways remain homeless for longer than others. People on a housing crisis or family breakdown pathway do not form strong friendships in the homeless subculture or accept homelessness as a way of life. Their homelessness is shorter. In contrast, people on the substance abuse and youth to adult pathways often become involved in the homeless subculture and engage in social practices that make it difficult to exit from homelessness. Their homelessness is longer. People on the mental health pathway also experience long-term homelessness, but they do not endorse homelessness as a way of life. They remain homeless because they have few exit options.

Aim. This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives. The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of representations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. Design. The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 ( 5 1 . 5 % ) were admitted and 246 ( 1 1 . 5 % ) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results. There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5. 5 % decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6. 17 days per patient in October 2002 to 5 . 37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as 'frequent flyers'). Conclusions. Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a Journal of Clinical Nursing (2006Nursing ( ) 15 (8): 1033Nursing ( -1044Nursing ( . doi:10.1111Nursing ( /j.1365Nursing ( -2702Nursing ( .2006 specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice. It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient.