“I didn’t want to be known”: finding healthcare when you are homeless
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6511 (Published 08 December 2016) Cite this as: BMJ 2016;355:i6511
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Dear Editors
While I wholeheartedly agree that homelessness presents a challenge not just in presentation (the fear of being found delaying seeking healthcare) and discharge/followup planning (ensuring people return or go to a safe environment with the ability to participate in the treatment they needed), I feel that the need to ask about the home situation goes beyond these group of people.
Patients may also live in unsafe environment (domestic violence, unhealthy conditions, unsupervised or lack of safety equipment), or lack social support (lives alone, carer for dependents or disabled partner or has a working housemate/relative not around for most part of the day).
These can often be elicited honestly from patients; I do that routinely within the first 5 minutes of any new consultation.
Not only it affects home care planning, often it may even influence treatment of patients, from non-operative to operative intervention and vice versa. Some patients may not cope with cumbersome plasters while others may be at higher risk of surgical complications.
I am sure this issue is similar to other specialties and I urge all clinicians to keep in mind patient's home situation and current working status during clinical interviewing.
Competing interests: No competing interests
Re: “I didn’t want to be known”: finding healthcare when you are homeless
Anne Gulland sets out several strategies for tackling the ebb and flow of homeless patients between health establishments and the street, which can help break the recycling of homeless patients between the streets and hospitals [1]. Homeless patients commonly do not voluntarily make contact with health institutions, such contacts are commonly enforced by an acute health issue. Such contacts should prompt efforts to explore the provision of housing, as the provision of adequate housing can be a powerful driver in helping homeless people to escape the quagmire of homelessness.
The provision of social housing is however the responsibility of Local Authorities, who have sought to avoid this responsibility at every opportunity. Between April 2014 and March 2015 there were 54,430 applications for housing to Local Authorities in England on grounds of statutory homelessness, but less than 50% of these were accepted; leaving an awful lot of people homeless. [2] It has taken the might of the Supreme Court to force Local Authorities to live up to their responsibilities as regards the provision of social housing, by closing some of the loop holes Councils had traditionally used to deny deserving applicants accommodation. In Hotak, Kanu and Johnson [2015], [3] it spelt out who was "vulnerable" and hence eligible for housing support and in Hale v London Borough of Waltham Forest [2015], [4] it redefined "intentional homelessness"., again tilting the scales in favour of homeless people regarding their eligibility for social housing
Healthcare institutions have an important role to place when homeless patients come in, or as more likely to happen, are brought in, by exploring opportunities for housing such that they are not discharged back to the streets. Local Councils have perhaps the more important role in providing accommodation especially post treatment in healthcare facilities to which these patients can go to on discharge. The solution to this problem lies in largely with Local Authorities.
References.
1. Gulland A. How to end the endless recycling of patients between the streets and the hospital. BMJ 2016;355:i6511
2. Department for Communities and Local Government (DCLG), Statutory homelessness live tables, 2016 .Table 770: decisions.
3. Hotak , Kanu and Johnson v London borough of Southwark and Anor [2015] UKSC 30
4. Haile v London Borough of Waltham Forest [2015] UKSC 34
Competing interests: No competing interests