18 Simon Communities of Ireland the necessity of prioritisation of needs by people who are homeless, given the limited resources at their disposal46. A Study of Homeless Adults in Los Angeles found ‘for example’ that 31% of the survey respondents had gone without needing medical care in the previous 12 months because other needs were prioritised above access to health services. In this study, authors argued that the high rates of hospitalisation among adults who are homeless are often as a result of neglected illnesses that could have been “prevented or treated in ambulatory care settings if identified earlier.” They also noted that “Any attempt to address the healthcare needs of the homeless must take into consideration their unmet needs for food, clothing, shelter and bathroom facilities. Locating walk-in clinics where the homeless congregate to receive subsistence services would help to reduce the role of time and scheduling constraints as barriers to care.” Other barriers to people who are homeless accessing the primary health care in particular include47: • Stigma: people who are homeless report encountering negative reactions when they try to access healthcare services. They identify trying to deal with administrative personnel as particularly difficult; • Discrimination: people who are homeless find it harder to register with a General Practitioner than members of the general public. Requests for a permanent address and other details can constitute a real or a psychological barrier; • No continuity of care: the lifestyle of people who are homeless tends to be a mobile one, but there is frequently no flexibility in the healthcare system in this regard. A move from one area to another may mean that a person who is homeless finds himself or herself outside the system again; • Difficulty accessing drug and alcohol services: services may be insufficient and often have very long waiting times, but they are crucial for the health of people who are homeless. • Lack of knowledge about entitlements: some people who are homeless don’t know what they are entitled to in the line of healthcare and services. If they were better informed they would be more confident about trying to access them; • Financial obstacles: in many countries there may be costs associated to accessing healthcare that makes it inaccessible to people who are homeless. O’Carroll and O’Reilly found that over 40% of people who are homeless (44% in 2008 and 45% in 1997) did not have a medical card despite the introduction of a range of initiatives to increase uptake of free entitlements to primary care. Added to this list as barriers to accessing Irish health services must be the absence of a medical card and previous negative experience of accessing health services.48 Recent changes49 in the way the medical card scheme has been administered have posed challenges but strategies have now been put in place by the HSE to prioritise the processing of medical cards for people who are homeless50. The findings of a recent study51 on the survivors of abuse are also very relevant in this context, suggesting that experience of abuse has contributed to an anxiety regarding the possibility of receiving nursing care later in life. It is not clear exactly how many people who are homeless have experience of abuse. Given that time in care is generally accepted as a route into homelessness and that a charity, consulted52 by the Commission to Inquire into Child Abuse, providing accommodation to people with experience of 46 M. Kushel, R. Gupta, L. Gee, J. Saas: “Housing Instability and Food Insecurity as Barriers to Health Care Among Low-Income Americans.” Populations at Risk, JGIM 2005, pg 76 47 “Listening to Homeless People: Involving Homeless people in Evaluating the Health Services” Groundswell UK, Healthlink, 2003 http://www.health-link.org.uk/publications/fileupload/index2.php 48 Simon Communities of Ireland (2011) Simon Health Snapshot 2011 49 The system has recently been centralised, leading to long delays in processing applications. Although communication with the HSE suggest that it is still possible to ‘fast track’ certain categories of applicants (including people who are homeless) through contact with a dedicated person in the central office. 50 Personal Communication Maurice Hoare (HSE) 5th April 2012 51 Higgins , M (2010) Developing a profile of survivors of abuse in Irish religious institutions. St. Stephens Green Trust 52 Commission to Inquire into Child Abuse (2009). Report of the Commission to Inquire into Child Abuse: Dublin
Homelessness, Ageing and Dying
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