Abstract:Homeless healthcare: raising the standards Over the past 3 years the number of homeless people in the UK has increased by 34%. Most will die young, largely due to treatable conditions. Secondary care can, and must, do more for the silent killer that homelessness is.
“…In an early feasibility study, Lane () noted that a particular advantage of intermediate care was its focus on person‐centred care rather than disease management, and that this could benefit people experiencing homelessness, who are often familiar with and respond well to individually tailored care, as in supported housing. Poor outcomes, such as “self‐discharge”, are a significant problem where there is a failure to tailor care and support to the specific needs of people experiencing homelessness (Albanese, Hurcome, & Mathie, ; Bauer, Moughaian, Viloria, & Schneidermann, ; Dorney‐Smith & Hewett, ; Hewett et al., ; Doran, Ragins, Iacomacci, et al, ; Medcalf & Russell, ).…”
Section: Resultsmentioning
confidence: 99%
“…However, the grey literature suggests that this learning quickly evaporates without a “continuous and consistent presence” (Hochron & Brown, ; Charles, Hobson, Hardwick, & Anderson, ). A particular challenge seems to be ensuring that pockets of good practice extend to all areas (Medcalf & Russell, p353).While there is an understanding of the holistic perspective for elderly people, the attitude for complex homelessness cases… was often reported to be “They walked in here ‐ why can't they walk out.”…”
Section: Resultsmentioning
confidence: 99%
“…A small number of additional articles was included which considered homeless health or hospital discharge more generally, but only where they raised issues about the need for intermediate care (see e.g. Medcalf & Russell, 2014;Parker-Radford, 2015).…”
Section: Selection and Appraisal Of Documentsmentioning
Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements.First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episodeends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital. schemes and empirical research on these is emerging.
| INTRODUCTIONThe paper begins with an overview of these recent developments in intermediate care for people who are homeless. We then outline the search strategy and the methods used to synthesise the literature on homelessness, before discussing how this additional evidence "speaks" to the conceptual framework for intermediate care proposed by Pearson et al. (2013Pearson et al. ( , 2015. In the final section, we draw out the implications for service development and future research, and also make recommendations about possible refinements to the original conceptual framework. This review is reported in accordance with the RAMESES publication standards for realist reviews (Wong, Greenhalgh, Westhorp, Buckingham, & Pawson, 2013). Long-term homelessness is characterised by "tri-morbidity", the combination of mental ill-health, physical ill-health, and drug and alcohol misuse (Hewett, Halligan, & Boyce, 2012). People who are home-
| INTERMEDIATE CARE AND HOMELESSNESS
What is known about this topic• Long-term homelessness is characterised by "tri-morbidity" (the combination of mental ill-health, physical illhealth, and drug and alcohol misuse).• Hospital discharge is often problematic for people who are homeless with high rates of readmission.• Much is known about the design and delivery of intermediate care services for older people, but less is known about how to meet the transitional care needs of people who are homeless. • A reconceptualisation of the intermediate care concept which is designed to prevent these short-term services from becoming "blocked".
What this paper adds
| e347CORNES Et al. housing legislation and local housing options. Staffing roles include addressing broader health and well-being outcomes by means of advocating for and supporting people who are homeless to engage with the full range of local primary care, mental health, drug and alcohol and social care services.
Clinically led Schemes:These are...
“…In an early feasibility study, Lane () noted that a particular advantage of intermediate care was its focus on person‐centred care rather than disease management, and that this could benefit people experiencing homelessness, who are often familiar with and respond well to individually tailored care, as in supported housing. Poor outcomes, such as “self‐discharge”, are a significant problem where there is a failure to tailor care and support to the specific needs of people experiencing homelessness (Albanese, Hurcome, & Mathie, ; Bauer, Moughaian, Viloria, & Schneidermann, ; Dorney‐Smith & Hewett, ; Hewett et al., ; Doran, Ragins, Iacomacci, et al, ; Medcalf & Russell, ).…”
Section: Resultsmentioning
confidence: 99%
“…However, the grey literature suggests that this learning quickly evaporates without a “continuous and consistent presence” (Hochron & Brown, ; Charles, Hobson, Hardwick, & Anderson, ). A particular challenge seems to be ensuring that pockets of good practice extend to all areas (Medcalf & Russell, p353).While there is an understanding of the holistic perspective for elderly people, the attitude for complex homelessness cases… was often reported to be “They walked in here ‐ why can't they walk out.”…”
Section: Resultsmentioning
confidence: 99%
“…A small number of additional articles was included which considered homeless health or hospital discharge more generally, but only where they raised issues about the need for intermediate care (see e.g. Medcalf & Russell, 2014;Parker-Radford, 2015).…”
Section: Selection and Appraisal Of Documentsmentioning
Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements.First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episodeends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital. schemes and empirical research on these is emerging.
| INTRODUCTIONThe paper begins with an overview of these recent developments in intermediate care for people who are homeless. We then outline the search strategy and the methods used to synthesise the literature on homelessness, before discussing how this additional evidence "speaks" to the conceptual framework for intermediate care proposed by Pearson et al. (2013Pearson et al. ( , 2015. In the final section, we draw out the implications for service development and future research, and also make recommendations about possible refinements to the original conceptual framework. This review is reported in accordance with the RAMESES publication standards for realist reviews (Wong, Greenhalgh, Westhorp, Buckingham, & Pawson, 2013). Long-term homelessness is characterised by "tri-morbidity", the combination of mental ill-health, physical ill-health, and drug and alcohol misuse (Hewett, Halligan, & Boyce, 2012). People who are home-
| INTERMEDIATE CARE AND HOMELESSNESS
What is known about this topic• Long-term homelessness is characterised by "tri-morbidity" (the combination of mental ill-health, physical illhealth, and drug and alcohol misuse).• Hospital discharge is often problematic for people who are homeless with high rates of readmission.• Much is known about the design and delivery of intermediate care services for older people, but less is known about how to meet the transitional care needs of people who are homeless. • A reconceptualisation of the intermediate care concept which is designed to prevent these short-term services from becoming "blocked".
What this paper adds
| e347CORNES Et al. housing legislation and local housing options. Staffing roles include addressing broader health and well-being outcomes by means of advocating for and supporting people who are homeless to engage with the full range of local primary care, mental health, drug and alcohol and social care services.
Clinically led Schemes:These are...
“…We cannot exclude the possibility of other confounding factors for length of stay in this cohort. For example, the seasonal variation may impact on length of stay [15]. Therefore, whilst acknowledging that "practice based evidence" will often influence, complement and inform formulation of "evidence based policy" we would recommend a prospective study design to definitively answer the research question [16].…”
Primary Objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury.Research Design: A retrospective case note review assessed total rehabilitation unit admission. Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort.
Methods4
“…3,[6][7][8] A more recent focus of reform, driven by the distinct morbidities and pre-and post-treatment circumstances of homeless patients, is the redesign of hospital services to offer cost-effective patient pathways that better address the needs of the homeless. Pioneering initiatives such as the Boston Health Care for the Homeless Program 9 and Pathway 10,11 signal international recognition of the patient value and cost savings that might result from more informed hospital service planning, including specialist staff and partnership with a range of external health and non-health services.…”
The national picture of the comparative costs and diagnoses of hospitalised homeless patients are examined using the 'no fixed abode' flag in English hospital statistics. Comparable studies sample patients in single cities, eg New York and Toronto. The most common diagnosis is substance misuse; the share of homeless NHS patients with this diagnosis is rising, and now equals that found in North American cities. About half of the cost of homeless patients relates to diagnoses of mental illness, although these comprise a much smaller share of homeless patients than in North America. Hospital costs for homeless patients -both total and per admissionhave fallen significantly in recent years, primarily because of fewer admissions and shorter lengths of stay for mentally ill patients. Aims to reduce NHS costs at the level of individual institutions have often shaped policy. Broader policy to prevent and reduce homelessness offers substantial long-term reductions in the cost of chronic care.
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