Improving patient health.
The underlying philosophy of Homeless Healthcare is one where the patient is respected regardless of background. While addressing the health needs of a patient is a priority, Homeless Healthcare aims to provide holistic and wide reaching support to address a number of interconnected issues to improve patient health.
See the below case studies on the ways Homeless Healthcare works to improve patient health.
Case Study: Shane and Street Health
Shane is a 20 year old young man, sleeping rough since a relationship breakdown 18 months ago. Diagnosed with Type I Diabetes 3 months ago. After a 3 day admission to hospital, Shane is discharged with some education that is not really clear to him, 2 different types of Insulin to administer, a glucometre with limited test strips and a follow up appointment for 1 week.
Being homeless he has no fridge to keep his Insulin in; a diet that is limited to Soup Vans and drop in centres; often high in sugar and carbohydrates; and a diagnosis that is extremely difficult to come to terms with for any young person. When we met Shane he was fortunate enough to be staying at Tom Fisher House for 2 nights. He had run out of one of his insulin’s, had no test strips and very little knowledge of his disease – and no intention of doing anything about his situation, it all appeared too daunting. His blood sugar level (BSL) was 30 (normal range 4-6). We were able to provide immediate education, in small doses, set up an appointment for the next morning at the RUAH centre where Shane was given scripts for Insulin, strips and introduced to the Street to Home (S2H) programme co-ordinator.
We see Shane on a weekly basis now and as of last week he has been put into Foundation Housing in Fremantle.
Case Study: Transitions
Background
Walter is a man in his mid-fifties who has a long history of post-traumatic stress disorder after witnessing an accidental shooting. He has alcohol dependency, and this was exacerbated when he began rough sleeping.
Role of HHC
Walter initially saw HHC at one of the drop-in centre mobile clinics and now regularly comes to the Transitions Clinic. His engagement with HHC has enabled numerous health issues to be addressed, including treatment for alcohol dependency and commencement of medication for his PTSD and depression.
Current Health and Housing Situation
Walter was housed through 50 Lives and, though he still experiences multiple health issues, continues to engage with HHC for treatment of these.
Case Study: Street Health
Background
Chris is in his late forties and has been homeless for nearly a decade. In 2014, he scored 10 on the VI-SPDAT survey and reported having comorbidities of mental health and AOD issues. During 2017, Chris had multiple ED presentations relating to a cyst on his hip that was repeatedly infected over a two-month period. Chris initially approached Street Health who transported him to RPH for abscess draining and dressing. He returned to ED on four occasions for dressing changes in the days following the initial drainage at the hospital. The average ED visit in a Perth public hospital is costed at $765, equating to an estimated cost of $3,060 for dressing changes in the ED setting.
Role of HHC
He subsequently saw the Street Health nurses nine times over the next month to have his abscess wound dressed. As observed by Dr Amanda Stafford of the RPH Homeless Team, “It has taken 6 weeks of dressings by Street Health and the wound has now completely healed”. Having his wound re-dressed by Street Health cost substantially less, with an average consult with the Street Health team costing $37 (compared with the cost of $765 for an ED presentation). Hence, nine visits with the Street Health nurse for his dressing changes totalled only $333, compared with a cost of $6,885 to the health system if he had presented at ED on these nine occasions.
Case Study: After-Hours Support Service
Background
Cathy is an Aboriginal woman in her mid-forties with a complex history of homelessness, domestic violence, troubled family circumstances, and numerous health issues including cancer, lower limb amputation and alcohol/drug use; as well as anxiety and depression.
Role of HHC
HHC supported Cathy to address her multiple health issues, linked her with 50 Lives, and continued supporting her through the AHSS after she was housed. Over the last year, among varying health concerns such as her amputated leg, Cathy’s custody case regarding her child has been the cause of considerable worry. Through AHSS, the HHC nurse has provided a steady combination of weekly home visits and telephone calls that proved extremely beneficial for her. Her anxiety has often been calmed, and her problems and burdens talked over with the help of the AHSS. One of Cathy’s concerns was keeping it all together, both health and housing wise, and this AHSS support has been the mainsail for keeping everything on track.
Current Health and Housing
Recently, Cathy has described herself as doing “really well”. The steps towards this outcome were maintaining the positive trajectory of her mental health, continuing her sobriety and improving positive relationships with family. She has been supported to increasingly self-manage her conditions and has now transitioned from weekly contact to calling HHC only when she requires additional support.
Case Study: Importance of Trauma-Informed Care
Background
Kylie had been homeless for the six months prior to entering transitional accommodation. At 50 years old, Kylie has a complex history of life stressors experiencing miscarriage, family suicides, an abusive partner, four-year methamphetamine addiction and separation from her children. When Kylie first attended the HHC clinic, she was in need of a review for sleep disturbances and iron deficiency.
I was anaemic before I came in here and I had to have an iron infusion because I was slowly basically just trying to - I was killing myself because I didn't want to deal with all these things.
Role of HHC
Between mid-2017 and early-2018, Kylie was seen by HHC 14 times. She was treated for a range of conditions including, depression, panic disorder, anxiety, anaemia, sleep disturbance and heavy periods. HHC helped her to develop a mental healthcare plan, and this was one of the first opportunities Kylie had ever had to talk about her trauma and anxiety. A referral was eventually made to a psychologist, while she was also assisted with medication management and organising counselling sessions.
..you can be a doctor, you can be a psychiatrist, you can be all these sort of people, and you can have the degrees on the wall, but unless you've got that empathy for people you're not going to get through to a lot of people, especially a lot of the people that [my partner] and I have met.
Current Health and Housing Situation
Kylie and her partner have since moved into a unit with the Community Living Program and are well. She is case-managed by the Salvation Army outreach team, and she has been coming to The Beacon for counselling sessions regularly.