Inadequate public services are causing “preventable harm and suffering” to homeless people after they are discharged from hospital, exacerbating their ill-health and causing early death, a healthcare expert has warned.
Prof Clíona Ní Cheallaigh, consultant in general medicine and infectious diseases at St James’s Hospital in Dublin, was speaking as a scheme to better meet the needs of socially vulnerable patients, pioneered at St James’s and the Mater hospital, was extended nationwide.
The Inclusion Health scheme, thought to be the first of its kind globally, was initially piloted in the Dublin hospitals from 2016 and is now mainstreamed. The Health Service Executive has committed funding its expansion, on an 18-month pilot basis, to Tallaght, Cork, Limerick and Galway university hospitals.
Described by Prof Ní Cheallaigh as a “bespoke scheme” for the most marginalised patients, Inclusion Health has a dedicated team of a senior medical social worker, a clinical nurse specialist in chronic illnesses, a psychiatric nurse and case manager. They see about 600 patients a year, as inpatients and at outpatient clinics, the vast majority of them homeless.
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Its genesis, says Prof Ní Cheallaigh, came from the city-centre hospitals noting in 2015 that 10 per cent of those presenting at emergency departments were homeless and many individuals were returning repeatedly, as their health deteriorated so badly on discharge.
“Homelessness is really, really bad for anybody’s health but particularly for anyone with severe health needs,” she said.
Death among homeless people in Ireland happens at a mean age of 38 for women and 44 for men.
“We are looking at people who are very complex, who are living very difficult, hard lives. They tend to have a lot of multimorbidity and may have more than one chronic disease at a time. They often have mobility needs. They may have cognitive impairment, early dementia, addiction,” continued Prof Ní Cheallaigh.
“Any homeless person who comes into James’s now, they come under our team and we look after them. People may come in feeling really stigmatised and the aim is take that out of the equation.”
As well as basics such as clean clothes, pyjamas, toiletries, standard medical care and methadone in some cases, the patient is assessed and the team links in with housing, mental health and social protection services in the community to try to optimise outcomes post hospital discharge, she said.
Their greatest challenges, she said, are a lack of housing and emergency accommodation, and a lack drug and alcohol rehab services, particularly those without a religious ethos.
“It is heartbreaking,” she said. “You see people trying so hard to get their lives where they want them, like so hard, and the system really beating it out of them at every turn. Our aim then is harm-reduction, to do the very best we can within those challenges.”
Among the most recent patients on the scheme is Anthony Burns (48), originally from Ballyfermot. He was homeless from February 2021 when he lost his apartment after being unable to pay his rent due to being laid off during the pandemic. He has chronic obstructive pulmonary disease (COPD) and experiences a rare, recurrent infection called actinomycosis, which can be fatal.
A recovering drug and alcohol user, Mr Burns relapsed after losing his home and slept rough for months. He got into a Dublin Simon detox programme in September 2021 and stayed in a series of temporary emergency accommodations until late last year, when he felt he needed to sleep in a tent again to avoid drug use in the hostel he was in.
“The most important thing for me is my recovery. I have to protect that at all time,” he said.
A severe swelling on his groin – a recurrence of the actinomycosis – resulted in a referral from Dublin Simon into the Inclusion Health team in St James’s in late May. He was admitted and discharged in mid-June to step-down care in St Luke’s Hospital, Rathgar.
With a discharge date from there of June 29th, it was unclear whether he would return to sleeping in his tent. On June 28th, he was offered an emergency bed in a centre known to have active drug users, which would risk his recovery from addiction.
“They came back to me at the last minute with [a hotel]. It’s grand. It’s safe. I have my own room,” he says.
Mr Burns has a daughter and she, her partner and their children live in a two-bed council flat. He says she “would get in trouble” if he stayed with her.
“I am not looking for a palace or a brand new apartment. I don’t care what condition or size it is ... I just want to have a normal life, to have neighbours, see my grandkids visiting me,” he says.
“Going to hospital was literally a lifesaver. I’d have been found dead within a year if I was still in the tent. I am still homeless though, and I have a long, long road ahead of me. My hope is I could get back to college and finish my studies in social care.”
