Homelessness, Ageing and Dying 45 needed. The HSE are committed to more accurate health needs assessment and have begun to pilot a scheme in Dublin, it is hoped that this scheme will identify both the barriers and the solutions to the barriers. On a positive note the HSE is committed to ensuring that the healthcare needs of people who are homeless and elderly people who are homeless are clearly identified and met in a holistic manner using a care and case management approach and this is a very welcome development. Health Care Recommendations 1. Recognition of the particular health needs of people who are homeless and particularly the health needs of individuals aged 50 and over who are homeless There is a clear need for recognition and advocacy within the health services and within the application of the care and case management approach that people who are homeless (similar to the Traveller community) have particular health needs.92 Specifically there is a need for a recognition a) that individuals who are homeless have a reduced life expectancy and b) that individuals aged 50 and over who are/have a long history of homelessness have health needs more associated with the over 65 population and a mechanism needs to be found to support individuals who fall into the “older homeless” category access health and support services more generally designed for older people. 2. Hospital Discharge Policies/Establishment of a Pathways Model Hospital discharge policies vary from location to location. It is important that the system is standardised to ensure that people who are homeless are not discharged into homelessness. In the short term the 2012 HSE Service Plan contains a commitment to review the effectiveness of current discharge protocols. This review of integrated discharge planning protocols will be undertaken by the National Review Group and will include consideration of all discharges including people who are homeless. This is a welcome development, important to ensuring that a) the needs of people who are homeless are taken into account and b) that organisations working with people who are homeless ‘such as Simon’ are consulted. The London Pathway project ‘based at University College Hospital in London’ has proved (with dedicated supports) it is possible to offer people who are homeless access to enhanced levels of healthcare within the hospital system and save money (approx. €300,000 a year).93 In the longer term this is a model that could be adapted and applied in an Irish context, targeted at all aged groups of people who are homeless with a range of health needs. 3. The Provision of Appropriate Accommodation with Healthcare Support’ The case for the establishment of an intermediate care centre targeting individuals who are too sick for hostels and not sick enough for hospital, ideally with a number of beds dedicated to people who are terminally ill (proposed by Dublin based GP Austin O’Carroll in 2006) is one which requires further exploration in an Irish context particularly given that this model has demonstrated excellent results in other locations (e.g. St. Mungos in London). 92 Traveller health needs are for example addressed at national level by the National Traveller health Advisory Group, no similar national structure exists for homelessness. 93 Personal communication with Dr. Nigel Hewitt clinical lead for the homeless team at UCLH and Medical Director of the London Pathway on 15th February 2012
Homelessness, Ageing and Dying
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