The aim of this study was to explore homeless people's health perspectives and experiences of a 2-week medical respite care programme following acute hospitalisation. There is a high level of health inequality when comparing the health status of homeless people to the general population, including increased mortality and morbidity. Homelessness predisposes an increased risk of infectious disease, cancer and chronic illness, such as diabetes and cardiovascular disease. Moreover, homeless people have a higher frequency of acute hospitalisation than general population estimates. In order to facilitate the transition from hospitalisation back to life on the streets, homeless people who were acutely hospitalised in the Capital Region of Denmark were offered 2 weeks of medical respite care from the day of discharge by a non-governmental organisation. This is a qualitative study with a phenomenological hermeneutical approach based on narrative interviews of 12 homeless people who received medical respite care from 1 March 2016 to 30 September 2016. Data were collected through individual semi-structured interviews and analysed according to Lindseth and Norberg's presentation of Paul Ricoeur's theory of interpretation. The analysis identified four themes: (i) basic needs are of highest priority; (ii) a safe environment provides security and comfort; (ii) social support is just as important as healthcare; and (iv) restitution facilitates reflection. The findings indicated that the medical respite care centre provided a place of rest and restitution following hospitalisation, which made room for self-reflection among the homeless people regarding their past and present life, and also their wishes for a better future. This study also indicates that a medical respite care stay can contribute to the creation of a temporary condition in which the basic needs of the homeless people are met, enabling them to be more hopeful and to think more positively about the future.

Background:In the meeting between socially marginalised patients and somatic hospitals, healthcare systems often encounter complex challenges related to health inequalities that are difficult to resolve. To help reduce these challenges, a nursing approach employing a nurse (RN) with in-depth knowledge of socially marginalised patients and competences in rehabilitation ("social nurse") has contributed to diminish health inequalities. However, further insight into the potential benefits of social nursing is required. Aim:To examine how social nurses describe and experience the social nursing approach situated at somatic hospitals. Methods:A qualitative study of social nurses' descriptions and experiences with a social nurse approach included eight Danish hospitals. One male and 12 female nurses (n=13) employed as social nurses at somatic hospitals participated. Thirteen semi structured interviews were conducted using the methodological frameworks of phenomenology and hermeneutics. The interviews were analysed employing a method inspired by the French philosopher Paul Ricoeur's theory of interpretation. Results:Four themes emerged from the analysis: 1) A unique expertise encompassing experience and evidence-based knowledge 2) coordination towards a common goal to reduce patients' vulnerability, 3) to see and understand patients as whole persons, thereby assuring successful treatment and 4) working with the system to avoid losing the patients.The themes describe a unique expertise emerging from focusing healthcare efforts on the socially marginalised patients and the system in charge. Conclusion:The study indicated that the social nurse approach is a holistic nursing approach. Applying this approach allows for optimised treatment that fosters a more equal outcome across the spectrum of socially marginalised patients. The social nurse approach may contribute to diminishing health inequalities.

Background: Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This leads to more frequent and expensive use of health care services. Medical respite care enables an opportunity to recuperate after a hospitalization and has shown a positive effect on readmissions, but little is known about the cost-effectiveness of medical respite care for homeless people discharged from acute hospitalization. Therefore, the aim of the present study was to investigate the cost-effectiveness of a 2-week stay in post-hospital medical respite care. Methods: A randomized controlled trial and cost-utility analysis, from a societal perspective, was conducted between April 2014 and March 2016. Homeless people aged > 18 years with an acute admission were included from 10 different hospitals in the Capital Region of Denmark. The intervention group (n = 53) was offered a 2-week medical respite care stay at a Red Cross facility and the control group (n = 43) was discharged without any extra help (usual care), but with the opportunity to seek help in shelters and from street nurses and doctors in the municipalities. The primary outcome was the difference in health care costs 3 months following inclusion in the study. Secondary outcomes were change in health-related quality of life and health care costs 6 months following inclusion in the study. Data were collected through Danish registries, financial management systems in the municipalities and at the Red Cross, and by using the EQ-5D questionnaire. Results: After 3 and 6 months, the intervention group had €4761 (p = 0.10) and €8515 (p = 0.04) lower costs than the control group, respectively. Crude costs at 3 months were €8448 and €13,553 for the intervention and control group respectively. The higher costs in the control group were mainly related to acute admissions. Both groups had minor quality-adjusted life year gains. Conclusions: This is the first randomized controlled trial to investigate the cost-effectiveness of a 2-week medical respite care stay for homeless people after hospitalization. The study showed that the intervention is cost-effective. Furthermore, this study illustrates that it is possible to perform research with satisfying follow-up with a target group that is hard to reach. Trial registration: ClinicalTrials.gov Identifier: NCT02649595.