Homeless people are being discharged from hospital to go back onto the streets despite needing ongoing care, according to nurses surveyed for a new report.
The report by the Queen’s Nursing Institute (QNI) highlights gaps and shortcomings in services for this vulnerable group especially when it comes to being discharged from acute settings.
More than 180 nurses and other health professionals from the QNI’s Homeless Health Network took part in a national survey, which also found people with complex health needs were bouncing in and out of hospital because of a lack of holistic care.
While the majority of nurses rated the overall quality of their homeless health service highly, the poll revealed concerns about the consistency of health screening, treatment and aftercare.
Problems identified by respondents included lack of communication and co-ordination between services.
Some said hospital staff did not have enough training on discharging homeless patients and primary care and housing teams were not always informed when a homeless person was being discharged.
Other issues included a lack of forward planning when a homeless person was first admitted and a lack of appropriate accommodation meaning some “had no place to go back to”.
“A patient can present at an A&E department experiencing suicidal ideas triggered by accommodation problems,” said one respondent.
“They are admitted and that trigger is reduced. They are then discharged with no fixed arrangements in place and so the same problem arises.”
In addition, some homeless patients are discharged after being treated for a routine medical issue with no attempt to address underlying mental health conditions or addictions, which “makes re-admittance more likely”, says the report.
The survey also highlighted wide variation in health screening and assessments for this group with 67 different methods of assessing patients in use.
Most services either did not use any form of assessment or one they had designed themselves.
The QNI said there were some “excellent examples” of community nurses working with hospitals, the voluntary sector and housing providers to deliver all-round care to homeless people.
It highlighted the need to share this best practice and improve the collection of data and said it was working with nurses to develop a comprehensive health screening tool.
Nurses involved in work with homeless people also need the right support, stressed QNI chief executive Crystal Oldman.
“Nurses work with patients who are misusing substances, seeking asylum and living with severe mental health conditions and many do not speak English as a first language,” she said.
“This requires an extremely complex set of knowledge and skills and a flexible, compassionate approach. So it is vital they can access regular peer and managerial support, supervision, training and development opportunities.”