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FEATURE


Jo Fitzpatrick Project Manager Opening Doors, Queens Nursing Institute


Nursing the homeless


The invisibility and instability of the homeless population can make this patient group diffi cult to reach and treat


T


he term ‘homeless’ can be used to describe anyone who is not securely housed. This can range from people sleeping on the streets (rough sleepers), ‘sofa surfers,’ and squatters, to families in temporary accommodation and people in hostels. The health issues amongst homeless


people are well documented. They tend to be less healthy and more likely to suffer from long-term conditions as well as acute illness. It is also a fact that the average lifespan is considerably lower amongst this group. A Crisis Policy Briefi ng found that homeless men have an average life expectancy of 47 years, and women 43 years; thirty years less than the national average.1


Homelessness has increased in recent years and stories about this problem often appear in the media. It is fairly diffi cult to quantify the numbers accurately as this is a transient population. Recently released govern- ment fi gures state that rough sleeping increased by 23% in one year, from 1,768 in 2010 to 2,181 in 2011. Rough sleeping is most concentrated in London, the South East and South West. The biggest year-on-year increases were in the east Midlands (55%), and the North West (40%).2 These fi gures are likely


to be an underestimate as it is thought that the true numbers are much higher than these studies indicate. The latest fi gures for households living in temporary accommodation numbered 49,100.3 It is estimated that in England alone there are more than 40,000 people in hostels, and that around 100,000 people cycle in and out of hostels every year.4


Health issues can be both a cause and a consequence of homelessness. For people who are long-term homeless, the health issues can be profound. A high proportion of these people will also have issues with substance misuse (drugs and alcohol) and a signifi cant amount will also have developed mental health issues. This leads to an often complicated medical situation and can make treatment challenging. Physical health issues are not a high priority for them and so these issues can become serious and acute before treatment is sought. Many do not have access to a GP and so tend to use A&E as their source of primary care. For the more entrenched rough sleepers, they will often self-discharge or exclude themselves from treatment, therefore not completing courses of medication or follow-up appointments, exacerbating the


initial problem. Drug and alcohol dependence can cause a variety of conditions, both physical and psychological. Complications can arise from injecting drugs, such as septicaemia, abscesses and deep vein thrombosis. Research by St Mungos


found that half of their residents have mental health issues, 32%


had an alcohol dependency and 63% had a drug misuse issue.5 Substance misuse accounts for around a third of deaths in the homeless population.1 Common medical conditions related to rough sleeping are


respiratory conditions, such as bronchitis pneumonia and TB, foot problems, such as frostbite and trenchfoot, and also skin conditions such as wound infections and abscesses. In a study by St Mungos in 2008, it was found that nearly one in three people had at least one of these conditions. They also found that 83% of the people


20 Nursing in Practice March/April 2012


www.nursinginpractice.com


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