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Trends in Emergency in-Patient Hospitalisations among those with No Fixed Abode (Homeless): What lessons Can be Learnt

Anne O'Farrell

Estimates show that homelessness is increasing in Ireland. The impact on emergency in-patient hospital admissions is unclear. This study analysed emergency hospitalisations among those experiencing homelessness from 2005-2014. There were 2,051 in-patient emergency admissions of people classified as homeless during the study period, an increase of 406% since 2005 (78 in 2005 vs. 395 in 2014). The mean age was 40.6 (S.D. 13.2). Males were five times more likely to be admitted than women. This reflects the larger proportion of men that are homeless compared to women (40% as opposed to 60% overall) but also that men are more likely to be ‘roofless’ while women are more likely to reside in ‘hidden homeless’ situations (friends, family etc.) where they are more likely to give an address and thus not be classified as homeless. Because of the hidden nature of women’s homelessness caution is needed in interpreting the gender differences in the study. The majority of the patients (1,176/2,051) 57% had a mental/behavioural diagnosis. Over one in ten (280; 13.7%) were admitted for ambulatory care conditions including convulsions/epilepsy (N=92/280; 32.9%) and cellulitis (62/280; 22.1%). With over half experiencing mental health disorders; a third experiencing alcohol and substance misuse, it is clear that pathways to care need to be established as such health issues will have a significant impact on the cycle of homelessness if not addressed.. Access to, and use of, community and preventative services is needed to reduce utilisation of emergency hospital services by those who are homeless.