W3 – Holistic care for people experiencing homelessness

Link to EAHP Statements
Section 4 – Clinical Pharmacy: Statements – 4.5, 4.6, 4.7, 4.8
Section 5 – Patient Safety and Quality Assurance: Statements – 5.5

Abstract
The term “homelessness” extends beyond merely rough sleeping, encompassing those living in derelict buildings, temporary shelters, squats or sofa surfing. In 2023-2024, almost 325,000 households in the UK were assessed as homeless, or at risk of homelessness, an increase of 8.9% from 2022-2023, with over a third of these households being families with children.  The number of rough sleepers in urban areas has doubled in the last 6 years.  People experiencing homelessness face up to 12 times higher mortality rates compared to the general population, dying at an average age of 43 to 45 years.
Homelessness confers an increased risk of dying from drug misuse, circulatory and respiratory disorders, infections, and external factors.  Part of the excess mortality may be explained by exposure to co-existing risk factors e.g. alcohol and co-morbidities including mental illness. Multimorbidity develops earlier, levels of multimorbidity are higher: with a mean age of 40 years, numbers of health conditions are comparable to persons over 85 years in the general population.  The impact of co-morbidities is more severe with a negative impact on functional status, increased and poorly co-ordinated use of health services, and increased healthcare costs. One reason for increased healthcare costs in people experiencing homelessness, is the increased attendance at emergency services (emergency departments via ambulance, hospitalisations, and missed specialist out-patient appointments). Lacking adequate support, safety and recovery-oriented places to stay, people experiencing homelessness become overwhelmed by their multiple, untreated health conditions. Repeat admissions to hospital are a particular problem; while in hospital receiving care, some people experiencing homelessness who arrived in hospital from a room in a hostel or other temporary accommodation, may have their room closed. Others may have been rough sleeping and return there after hospital discharge. Without safe accommodation and adequate support, obtaining and taking medicines as prescribed, is often de-prioritised. Nonadherence leads to lowered chances of recovery and increases the risk of readmission.
Evidence is emerging from ongoing randomised controlled trials, to suggest pharmacist and third sector homelessness worker holistic intervention may precent readmission, delay timne to admission, overdose, and emergency department attendance.
This facilitated, interactive, case-based workshop will consider evidence for pharmacist led support and for dedicated hospital homeless discharge teams. Using case studies, participants will explore how pharmacist-led holistic medication management in people who are homeless, might improve outcomes and reduce costs. The session will also allow for and include brief discussions around decision making and communication with multi-agency health, social care and third sector teams because all are needed to reduce the risks of people experiencing homelessness returning to hospital. The experiences of participants who have cared for people experiencing homelessness will be set alongside reports of stigma faced by people experiencing homelessness while on wards. Also covering challenges in the management of drug use in hospital, and introducing the concept of ‘treatment burden‘, the session will discuss how hospital teams can take a more trauma informed approach to care for patients experiencing homelessness, and understand the benefits of early involvement of key third sector and social care workers in the discharge process.

Learning objectives
After the session, the participant should be able to:
– Improve understanding of the wide-ranging health and social care challenges facing people experiencing homelessness in the community, in hospital and on discharge.
– Learn why and how to adopt a different approach and better support people experiencing homelessness as in-patients.
– Recognise, anticipate and prevent triggers for readmission, irregular discharge and prolonged hospital stays.

Educational need addressed
This session will address any lack of understanding of the health and wider needs of people experiencing homelessness, update participants on best practice in terms of hospital discharge schemes for this vulnerable group and cover some common areas of therapeutics worth attention and intervention.

Keywords
Homelessness, health inequalities, multimorbidity, health services research, courtesy and humanity.