Literature reviewHomelessness, health status and emergency department use: An integrated review of the literature
Section snippets
Significance
Homeless people experience difficulties in accessing health services and health service providers have limited resources, flexibility and understanding to help the homeless. As a result of these difficulties, “the homeless have more health impediments and disabilities, and experience higher mortality and morbidity rates than the general population.”3 Individuals who are economically and socially disadvantaged suffer from a range of medical conditions due to increased susceptibility to risk
Methodology
The literature review was conducted by a computerised search on Medline, Proquest, CINHAL, Psych Info and Web of Science between the years of 1980–2005 in English. Key words used in the search were, homeless/homelessness, health, mental illness, drug and alcohol misuse, dual diagnosis, chronic disease, medication non-adherence (non-compliance), malnutrition, violence, social isolation (exclusion), poverty, policy, access, risk screening (assessment) tool, infectious disease and cognition. In
Results
The literature review revealed a number of areas of importance which impacted on homeless people's health and access to health services. Analysis of health policy revealed an increased focus on homelessness due to political interest in ED length of stay and waiting times. Homeless people were shown to be high users of ED and therefore became a focus in policy and program funding to address ED demand.
The definition and prevalence of homelessness was also identified as an issue revealing the
Discussion
Our review of the literature reveals that few attempts have been made to develop a risk assessment tool to identify homeless people and none to identify the risk of re-presentation. In conjunction with identifying key risk factors that impact on homeless people a mechanism in ED to assist clinical staff to implement early identification and referral is needed.
Access to health services for homeless people is influenced by many issues such as health service policies which include: admission
Conclusion
The utilisation of ED by homeless people is not about inappropriate use but about how homeless people manage their health issues and survive a chaotic life style. A life style that does not respond to organised appointments, waiting lists and waiting times with exclusion criteria. The lack of access to adequate finances, transport, and multiple health needs, poor compliance to instructions on medication and treatments reveals a very vulnerable group. Their response is mostly crisis driven,
Competing interests
Dr. Marie Gerdtz is an Associate Editor of AENJ and has had no part in the peer review or editorial process relating to this paper.
Funding
Financial support was provided through the Australian Research Council Linkage Project Scheme, project number: LP0453587. Financial support was also provided by St Vincent's Health.
Acknowledgements
I would like to acknowledge St Vincent's Health, The University of Melbourne and the Australian Research Council for their financial and organisational support making this study possible. I would also like to thank Dr. Andrew Dent, Director of Emergency, St Vincent's Hospital, who has given expert clinical supervision for this project.
This Manuscript has been peer reviewed.
References (66)
- et al.
Health indicators and risks among people experiencing homelessness in Melbourne, 1995–1996
Aust N Z J Public Health
(1998) - et al.
The effects of clinical case management on hospital service use among ED frequent users
Am J Emerg Med
(2000) The epidemiology of dual diagnosis
Biol Psychiatry
(2004)Homeless: policies, strategies, and lives on the street
(1996)Homelessness and human services—a health service response
(2000)It can be done: healthcare for people who are homeless
(1992)- et al.
Pathogenesis of respiratory infection in the disadvantaged
Semin Respir Infect
(1991) Problems faced by homeless men in obtaining health care
Nursing Standard
(2000)- et al.
Counting the homeless
(2001) - et al.
Mortality among homeless people with schizophrenia in Sydney, Australia: a 10-year follow-up
Acta Psychiatrica Scand
(2001)
High users of VA emergency room facilities: are outpatients abusing the system or is the system abusing them?
Inquiry
The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department
Med J Aust
Epidemiologic analysis of an urban, public emergency department's frequent users
Acad Emerg Med
Homelessness and health
Can Med Assoc J
The heaviest repeat users of an inner city emergency department are not general practice patients
Emerg Med
Emergency department use among the homeless and marginally housed: results from a community-based study
Am J Public Health
Health care and public policy: an Australian analysis
To HITH or not to HITH: making a decision about establishing hospital in the home
Aust Health Rev
A multidisciplinary Care Coordination Team improves emergency department discharge planning practice
Med J Aust
Royal District Nursing Service Homeless Person's Program. Taking nursing out there
Parity
The debate about homelessness
Aust J Social Issues
Dimensions of homelessness
Public Health Rep
Estimating homelessness: towards a methodology for counting the homeless in Canada
Understanding contemporary homelessness: issues of definition and meaning
Aust J Social Issues
Picking up the challenge: developing a methodology to enumerate and assess the needs of the street homeless population
Eval Rev
Homelessness in mentally ill people: Understanding the risks and service needs
Mental Health Aust
Towards a definition and taxonomy of integration in primary care
Factors associated with the health care utilization of homeless persons
J Am Med Assoc
Breaking through the barriers: Healthcare for the homeless
J Nursing Admin
Primary health care services for single homeless people: Defects and opportunities
Family Practice
How many homeless in 2001?
Just Policy
Cited by (28)
Perceptions of hospital-based Registered Nurses of care and discharge planning for people who are homeless: A qualitative study
2021, CollegianCitation Excerpt :Registered Nurses feel disempowered by the lack of community services and accommodation referral options. Links among homelessness, disproportionate utilisation of health services, and poor health outcomes have been well established by a range of national and international studies (Forchuk, Reiss, Mitchell, Ewen, & Meier, 2015; Hewett, Halligan, & Boyce, 2012; Moore, Gerdtz, & Manias, 2007). In spite of this, there has been little research focused on the experiences of Registered Nurses who provide care to people experiencing homelessness when they are in hospitals.
Experiences of hospitalised homeless adults and their health care providers in OECD nations: A literature review
2019, CollegianCitation Excerpt :This literature review added to the body of knowledge regarding nursing considerations and discharge planning required to meet the needs of hospitalised homeless adults. Given the heterogeneous nature of homelessness, one gap is the lack of research regarding specific groups that exist within local homeless populations (Moore et al., 2007). Despite a broad definition of homelessness adopted by the studies included in this review much of the research continued to focus on those experiencing roofless (or primary) homelessness (Moore et al., 2007).
Homeless health care: Meeting the challenges of providing primary care
2018, Medical Journal of AustraliaCitation Excerpt :The transient nature of homelessness makes comprehensive medical care difficult.34 Referrals and effective follow-up are often impossible under traditional models of primary health care, with this population lost to follow-up when moving from one part of the system to another.10,34,35 Fragmented and discontinuous care can be reduced by a specialist homeless service with trained staff working across as much of the system as possible.33,36-39
Counting homelessness: Working creatively to generate complex descriptive profiles of the health and demographics of people experiencing homelessness in Adelaide
2023, Australian Journal of Social IssuesOptimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments
2023, International Journal of Environmental Research and Public Health