Challenges for Homeless Patients

Barriers to the provision of holistic care to marginalised patients in the ED include (16,17):

• The episodic nature of the care
• Difficulty addressing medical needs while social needs are unmet
• Failure to recognise the patients housing situation
• Lack of timely involvement of the appropriate ancillary staff
• Staff attitudes toward homeless patients
• Lack of staff time and/or competency in working with people who have experienced complex psychological trauma

Homeless people, and those in other marginalised groups, also face a number of barriers to primary healthcare including (18):

• Stigma (both social stigma and self-stigma)
• Low literacy levels
• Cognitive deficits (including intellectual disability, acquired cognitive impairment, ADHD and autism spectrum disorders)
• Competing priorities (e.g. sourcing food, shelter, money, substances to prevent withdrawal)
• Language and/or cultural barriers
• Mental health problems
• Substance use disorders
• Practical issues including transience, inability to register with a GP and having pets to take care of
• Not being aware that primary care is free of charge
• Long waits for appointments
• Being unable to afford to call the surgery to make an appointment
• Lack of trust in health and social care professionals (may be due to experiences of institutional care in childhood, prison or having children removed in to institutional care)

Learning bite

Homeless people face many obstacles to accessing healthcare, not least of all the stigma associated with their housing status.