Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues

Abstract

PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

The effect of a non‐congregate, integrated care shelter on health: A qualitative study

“…Homelessness has well‐documented negative impacts on health and is associated with high levels of chronic and acute disease, mortality, and cyclical acute care hospital utilization (Gryczynski et al., 2020; Morrison, 2009). Integrating healthcare delivery at shelters has been shown to improve both access to healthcare and clinical outcomes for people experiencing homelessness through directly addressing physical and mental health needs with on‐site medical assistance and coordinated referral to outside services (Clark et al., 2021; Cornes et al., 2018). People with integrated care and permanent housing use emergency departments less often and experience shorter hospital stays (Sadowski et al., 2009; Salhi et al., 2018).…”

Using a meta-ethnographic approach to explore the role of interprofessional education in inclusion health for health and care staff

“…Previous research identified that IH education is needed to address inequalities and manage the multiple needs of IH groups (Clark et al, 2022;Davis and Lovegrove, 2015). However, there has been little progress or research to understand what educational interventions should look like or how they can promote interprofessional care.…”

“…Previous research identified that IH education is needed to address inequalities and manage the multiple needs of IH groups (Clark et al. , 2022; Davis and Lovegrove, 2015).…”