24 Simon Communities of Ireland 2.15.2 Internationally The introduction in the US of the Pathway Housing First Model (PHF)78, linked to a housing and case management program (Larimer, et. al, 2009) (which facilitated the participant’s housing placement and co-ordinated appropriate medical care, with substance abuse and mental health treatment referrals as needed), for chronically ill adults who are homeless had the effect of reducing hospitalisation and emergency department visits. While it led to an improvement in physical functioning and mental health of the men it did not ‘ultimately’ improve their mortality rates. Another interesting health initiative is the London Pathway Integrated Healthcare initiative79 for hospitalised rough sleepers and single people who are homeless and attending hospital. The initiative seeks to engage with and treat all aspects of the health of people who are homeless, including their long- term underlying problems as well as the immediate problems that led them to be in/to attend hospital. For the most unwell and chronically sick patients, Pathways staff convene weekly paper-based ward rounds which bring together people from a range of professional disciplines to coordinate and integrate the patients’ care plans. This makes sure that the sickest patients get the most attention. London Pathway medical staff follow a strict discharge protocol to ensure that the patient who is homeless moves on/is moved to the most appropriate location in a coordinated and supported way.80 2.16 In Summary The CSO Special Report on Homelessness identified 3,808 individuals (67% male and 33% female) as located in either accommodation providing shelter for people who are homeless or sleeping rough. 62.4% of these individuals were located in the Dublin Region. The causes of homelessness vary. They can be structural (e.g. related to poverty, unemployment and housing), institutional (as a result of leaving institutions including foster care, prison, mental health institutions and the armed forces), related to relationships (including abusive relationships and family breakdown (death or separation), and for personal reasons (including mental illness, learning difficulties and drug and/or alcohol use). Average Irish life expectancy is currently 76.8 for men and 81.6 for women. According to the UK research, the average age of death of a person who is homeless is 47 for men and 43 for women. This is because people who have a long term history of homelessness have higher levels of physical and mental illness, problematic drug and/or alcohol use and higher death rates than the general population. Anyone over 50 who has had a prolonged experience/s of homelessness is generally thought to be vulnerable to many of the physical health problems associated with older age which also often present with high levels of cognitive impairment and mental illness. For this reason individuals who are aged 50 and homeless are included in the “older homeless” category. Individuals who are homeless often have ‘complex needs’ which may include physical and mental health issues, combined with problematic drug and/or alcohol use, and learning disability. Experience of trauma (sexual and/or physical abuse) is also often very high among people who are homeless, while alcohol use is the single most prevalent health problem. 78 Housing First is a housing model developed in the US as a response to chronic homelessness. Housing First programs provide direct access to housing. Unlike housing programs that have specific conditions that need to be met in order to become a tenant, the goal is to re-house the person regardless of past or current behaviours. In Housing First projects, we don’t, for example, require mental health treatment plans, addiction recovery, or other forms of compliancy prior to moving in. Once a person is housed, staff support and work with the tenants to solve any issues that create problems in housing. This approach can greatly reduce the amount of time people spend homeless. http://heretohelp.bc.ca/publications/visions/housing-homelessness/alt/4 79 See Standards for Commissioners and Service Providers, The Faculty for Homeless Health (May, 2011) http://www.londonpathway.org.uk/uploads/homeless_health_standards.pdf 80 www.londonpathway.org.uk
Homelessness, Ageing and Dying
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