Health Implications: People experiencing homelessness (PEH) often face significant health challenges, including a higher risk of frailty at an earlier age, both physically and cognitively NICE CKS. They are also at increased risk of premature death, particularly those with mental health conditions who miss appointments NICE CKS. Common health issues encountered in PEH include respiratory conditions (asthma, COPD, chest infections, tuberculosis), cardiovascular issues (heart failure, post-MI secondary prevention, stroke), anaemia, chronic pain, obesity, dental problems, skin conditions (scabies, head lice), smoking, alcohol and opioid dependence, and various mental health conditions such as depression, anxiety, bipolar disorder, and PTSD NICE CKS. Missed appointments are a significant risk marker for all-cause mortality in this population NICE CKS.
Management Strategies:
- Access to Services: PEH have a right to health and social care services of the same standard as the general population NICE CKS. GPs should ensure PEH can register without an address and consider offering longer appointments, appointment cards, and text reminders NICE CKS. Practices can appoint a 'homelessness lead' and ensure staff are trained to manage PEH NICE CKS.
- Assessment: A comprehensive assessment is crucial, including health screening (e.g., using the QNI Health Assessment tool), mental health, substance use, and social care needs NICE CKS. It's important to reassess needs regularly, especially when circumstances change NICE CKS. Consider psychologically informed environments and trauma-informed care NICE CKS.
- Integrated Care: Commissioners should plan and fund integrated multidisciplinary health and social care services for PEH, involving other sectors as needed NICE NG214. Local needs assessments should inform service planning NICE NG214.
- Outreach: Multidisciplinary outreach services should be provided in non-traditional settings to identify health problems earlier, promote health, and support engagement with care NICE NG214. This includes support for primary healthcare, drug and alcohol, and mental healthcare needs, especially for those who fear engaging with services NICE NG214.
- Support and Navigation: Care navigation is essential to help PEH overcome barriers to accessing services NICE NG214. Support should be provided for transitions between settings (e.g., hospital to community) NICE NG214. Voluntary and charity sector services are also vital resources NICE CKS.
- Prevention and Screening: Encourage PEH to participate in national screening and routine vaccination programmes NICE CKS.
- Specific Considerations: Recognize that PEH may require tailored long-term care due to potential frailty NICE CKS. For those nearing the end of life, discuss and provide coordinated palliative care NICE CKS.
- Referrals: GPs should consider referring PEH to specialist primary healthcare centres for homeless people or homelessness multidisciplinary teams if available and preferred by the patient NICE CKS.
- Record Keeping: Improve the recording of housing status to better meet needs and improve services NICE NG214.
- Inclusion: Ensure PEH are treated with dignity and do not face discrimination NICE NG214.