The unmet Rehabilitation needs in an Inclusion Health Integrated Care Programme for Homeless Adults in Dublin, Ireland

Abstract

Introduction: Socially excluded individuals have higher morbidity and mortality, use a disproportionate amount of healthcare resources and generate a large volume of potentially preventable healthcare and other costs compared to more privileged individuals. Through a person-centred, whole-system and multi-disciplinary approach to care delivery, integrated care improves care for people with complex needs who are likely to have poor outcomes. Homeless and other socially excluded individuals frequently need the input of multiple health and social care providers. The rehabilitation needs of these individuals have not been explored previously and this projects aim was to establish a baseline of need for this cohort. Design, subjects and setting: A prospective cohort study of cases presenting for discussion at an inclusion health multidisciplinary team meeting in an urban homeless service. Methods: All cases discussed at the inclusion health MDT were studied to identify demographics, inclusion health and rehabilitative needs over a 4 month period. Results: 97 cases were studied over the 4-month period. 66 (68%) were male and 31 (32%) were female. 15 (15%) were over 60 and 82 (85%) were under 60 (age range 18-80). The inclusion health needs of this population are diverse and complex. 50% of cases discussed were considered to have rehabilitation needs. 37% had a physical impairment the most common causes of which were fractures and chronic leg ulcers mainly in intravenous drug users and chronic alcoholics. 42% were considered to have a cognitive impairment. The aetiology of cognitive impairment was uncertain due to significant comorbidity and increased prevalence of mental health conditions. A history of learning disability was proposed in a number of cases. 20% of cases had both physical and cognitive impairments. 76% of individuals were currently addicted to alcohol or drugs. 63% had mental health needs including severe and enduring mental illnesses, and 71% had a chronic medical condition. Discussion: The inclusion health needs of this population are diverse and complex. A traditional rehabilitation programme would not suit the chaotic lifestyles of these individuals and often access requires a fixed address which none of these individuals have. Conclusion: The results of this study show that the rehabilitative needs of this cohort are significant and are not being met through traditional rehabilitation medicine models of care. Limitations: A detailed analysis of the specifics of the rehabilitative needs was not possible at this stage of the project and efforts are underway to identify a biopsychosocial needs assessment tool that can identify all the needs of individuals. We were also not able to assess if individuals had access to community based general rehabilitation services but it was the view of the MDT that a traditional rehabilitation programme would not suit the chaotic lifestyles of these individuals. Suggestions for future research: Development of innovative ways to assess and provide appropriate services to these individuals.

Keywords

• homelessness
• social inclusion
• integrated care
• rehabilitation