When you’re homeless, you’re more likely than most to have health issues. But where do you go for medical treatment when you’ve nowhere to sleep? Last year, staff at St James’ Hospital in Dublin noticed a marked increase in the number of homeless people presenting for treatment. These patients had complex needs, but also quite often a distrust of the health system. This led to many of them falling through the cracks. Dr Clíona Ní Cheallaigh, a consultant in general medicine and infectious diseases at St James’s Hospital, joined Seán O’Rourke on Tuesday to talk about her pilot programme to tackle the problem.
“Homeless people have complex needs in a lot of ways. The majority of homeless people would have experienced severe trauma in childhood.”
Homeless patients come with a lot of psychological baggage and usually quite a few chronic diseases, so immediately diagnosis and treatment can be challenging. Dr Ní Cheallaigh told Seán that homeless people tend to use the services of the Emergency Department about twenty times more than the general population and at any one time, as the homeless population in Dublin has risen, homeless people now represent in the region of 10% of the hospital’s general medical inpatients. And discharging a homeless patient is more complicated too:
“If you’re homeless… you have to be well enough to go back out to homelessness.”
Dr Ní Cheallaigh drew up a plan to address the various challenges the hospital was facing with homeless patients. She secured funding for a nurse for a year and together they set about trying to make it easier and more efficient to treat homeless patients coming into the hospital. All homeless patients entering the hospital were flagged, so Dr Ní Cheallaigh and her specialist nurse were alerted when a patient presented at the Emergency Department. Contacts were established with many people and agencies dealing with the homeless, from key workers to nurses based in Merchants Quay Homeless and Drugs Services, to hostel staff. So not only were patients presenting looked at by Dr Ní Cheallaigh, but people who hadn’t yet made it to hospital could be flagged:
“We also get a lot of phone calls from our partners in the community saying so and so was really sick, we’re really worried about them, we’re trying to get them in, can you keep an eye out?”
This approach has led to the number of homeless people needing to be seen going down, even as the number of homeless in Dublin continues to rise.
“On a personal level, I have to say, it’s been the most rewarding job I’ve ever done.”
The pilot programme runs for a year and a business plan has gone into the hospital, with the hope that the service can be made permanent. Dr Ní Cheallaigh also hopes to set up a training programme for other hospitals around the country who are experiencing high numbers of homeless patients presenting, so they can share their knowledge and experience from the successful pilot programme.
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