Homeless Healthcare has been collaborating with researchers from The University of W.A since 2016 to demonstrate how our work is improving the health and wellbeing of people who are homeless and contributing to reductions in costly hospital admissions.
Through this collaboration, HHC has also been able to strengthen evidence to advocate for services that address gaps in the system for people who are homeless such as a much needed Medical Respite Centre.
Royal Perth Homeless Hospital Team (RPH HT)
In mid 2016, Homeless Healthcare established its first in-reach program in collaboration with Royal Perth Hospital. The inreach program is modelled on the internationally renowned and evidence based Pathway program that operates in 11 hospitals in the UK. The aim of RPH HT is to improve outcomes for homeless patients by providing support, improved discharge planning and continuity of care. GPs and nurses from Homeless Healthcare work alongside RPH Homeless Team staff.
The second UWA evaluation report on the work of the RPH Homeless Team was released this week and documents the work and impact of the team since it commenced in June 2016. In its first two and a half years of service delivery, the Team provided support to 1,014 patients, many with multiple complex health issues exacerbated by surviving on the streets. Comparing patient hospital use before and after contact with the RPH Homeless Team, fewer people were presenting to ED and there were significant reductions in inpatient admissions at EMHS Hospitals, equating to a cost saving of around $4,600,000. The addition of a full-time caseworker (albeit temporarily funded only) to the team has strengthened its capacity to connect patients to accommodation and other community supports, reducing the likelihood of re-admission. As reflected in this report, there has been growing recognition of the RPH Homeless Team nationally and internationally over the last year, and a number of interstate organisations have recently visited Perth to see the work of the Team in action, with a view to adapting the Homeless Healthcare model for their own jurisdiction. With the ever-escalating strain on hospitals and health systems around Australia, the commendation from the Australian Academy of Emergency Medicine is particularly powerful:
EDs are increasingly strained across Australia and there is an urgent need for innovative ways to address the high rates of ED presentations among people who are homeless. Over two and a half years, Royal Perth Hospital’s Homeless Team has demonstrated how a hospital can break the cycle of homeless people presenting to emergency departments. Most EDs are only resourced to respond to immediate medical issues, with homeless people then discharged back to the streets. The UWA evaluation shows that tailored care and linkages with GPs and follow up care in the community is reducing ED re-presentations and lengthy inpatient admissions. The homeless team has been proactive in connecting rough sleepers with stable housing and support, and once housed, other health and social issues can be addressed. This is a program that needs recurrent funding and should be rolled out across Australia
- Australasian College for Emergency Medicine, February 2019.
The project's first report provides a baseline profile of the health issues affecting RPH HT patients, and the patterns of hospital use (ED presentations and inpatient admissions) for this vulnerable population group. The report describes the unique way in which the team provides joined-up care for people who often end up in a revolving door between homelessness and poor health. Although in it's early stages, patient case studies included in the report illustrate the impact that the Homeless Team is already having.
International expert visits project
The Homeless Team at Royal Perth Hospital is modelled on the Pathway UK initiative, which had developed an effective model of enhanced care coordination for homeless people admitted to hospital. There are now 11 UK hospitals with Pathway teams, and Perth is the first Australian hospital to establish something similar.
In a visit to Perth late 2017, Dr Nigel Hewett (OBE) from Pathway visited Perth to see the work of Homeless Healthcare in action. He shares here an observation from a ward round with the RPH Homeless Team.
Published Journal Article
Published in late 2017, this paper describes the raft of socially determined factors that contribute to the frequent hospital attendance of people experiencing homelessness. Three case histories of homeless patients seen by the Royal Perth Hospital Homeless Team (Western Australia) are presented. The cumulative healthcare costs for the three individuals over a 33 months period were substantial, but significant also is the potential to reduce hospital use when housing and tailored support are provided – View Article.
Published Journal Article
Stable housing together with tailored health care services are vital in addressing homelessness. In this paper, UWA’s Associate Professor Lisa Wood and founder and Medical Director of Homeless Healthcare Dr Andrew Davies outline key recommendations for tackling the poor health of the homeless who have a life expectancy of up to 30 years lower than the general population. – Read Article
Homeless Healthcare Evaluation
People experiencing homelessness are less likely to attend primary healthcare and are far more likely to engage with the acute and more costly end of the health service spectrum.
This study evaluated changes in health service use, health outcomes and housing and social support outcomes among HHC clients, assessed the cost effectiveness of the HHC service and it's model of care and mapped barriers and enablers to improving the health, social and housing circumstances of people who are homeless.