400% rise in number of homeless attending A&Es

There has been a four-fold increase in people admitted to hospital emergency departments who classed themselves as “homeless”, research published in the Irish Medical Journal shows.

Dr Anne O’Farrell of the HSE’s Health Intelligence Unit led a team, including a representative of homeless charity Focus Ireland, which looked into in-patient admissions to acute hospitals for people of “no fixed abode” between 2005 and 2014.

Over the study period there were 2,051 in-patient emergency admissions for people in that category. There was a 406% increase between 2005 (78 cases) and 2014 (395 cases). The research also highlighted the extent to which the homeless level is concentrated in the capital — 370 of the 395 cases in 2014 were admissions to Dublin hospitals.

The mean age of the patients was 40.6 years and 57% of them (1,176) had a mental/ behavioural diagnosis. The majority, 83%, were men and 29 died in hospital.

More than one in 10 of the in-patient emergency admissions of homeless people were for, what were classed as “ambulatory care sensitive conditions (ACSCs)” including convulsions/epilepsy (32.9%), cellulitis (22.1%), and COPD (10.4%).

“Many homeless people experience difficulties maintaining good health due to poor access to primary care and have worse health outcomes when compared to the general population. International studies have found individuals who are homeless are more likely to be hospitalised particularly for ACSCs,” the authors said.

The authors said the increase in emergency in-patient admissions among the homeless is likely to be contributing to the overcrowding difficulties in EDs.

“In addition, with an average length of stay of 6.5 days they are also placing demands on acute beds. Compared to emergency admissions generally the average age of the homeless patient is younger than the general population. Although health issues may have contributed to homelessness (e.g. alcohol and drug misuse), this finding does suggest that being homeless itself has a significant impact on health. Indeed, the average age of this cohort that died in hospital was 48.2 years, significantly lower than the current average life expectancy,” they said.

They said homeless services have long identified the discharge of vulnerable people from hospitals as one of the key areas where prevention strategies should be focused but said there has been less strategic focus on the overall interaction between hospital admission, primary health services and homelessness. “Overall, the study suggests that the growing number of admissions of people who are homeless to acute hospitals represents both a serious problem and a real opportunity,” they said.

“The problems reside both in the poor health of the homeless population and the substantial cost to the health service in dealing with these problems in a hospital setting. The opportunities arise in the potential to reconfigure the relationship between homeless services and health services so that the transition between the two systems cease to be places where vulnerable people can become lost and instead become intersections where pathways to appropriate supports can be identified and made available.”