Contacts
Contact:
Samantha Dorney-Smith
Project Lead
Organisation:
Three Boroughs Homeless Team
Nurse Practitioner United Kingdom
Email:
Case study:
06 December 2010
Homeless Intermediate Care Project
Key points
- The Homeless Intermediate Care Project has helped reduce deaths and cut hospital admissions from the St Mungo’s Cedars Road hostel in Clapham, London
- The team offers intensive support to up to 10 clients at a time for six to 12 weeks
- During its initial year hospital admissions dropped by 77%, A&E admissions by 52% and the number of ambulance calls fell by 67%.
The Homeless Intermediate Care Project has provided care and support to a group of clients with life-threatening conditions at the St Mungo’s Cedars Road hostel in Clapham, London over the last 18 months, reducing deaths and cutting hospital admissions.
The main purpose of the project, which began in January 2009, was to reduce mortality and morbidity while also cutting secondary care usage. In 2008 there were seven deaths with an average age among those who died of 38. Since then there have been only three deaths.
The project team consists of a band 7 nurse, a health worker and a sessional GP and offer intensive support to up to 10 clients at a time for six to 12 weeks. Its main activities include outreach, clinical interventions, liaison and referrals, screening and advocacy.
The level of illness and disease among the 34 clients cared for over the first pilot year was extremely high. Twenty four per cent had had a diagnosis of HIV, 34% had past Hepatitis B and 84% active or past Hepatitis C. 83% had been intravenous drug users, 74% alcohol dependent and 88% had had mental health problems. Many suffered from serious conditions such as end stage liver failure, acute syphilis and pulmonary TB.
During that year the project has cut London Ambulance Service calls by 67%, hospital admissions by 77% and A&E admissions by 52%. Repeat attendances are also down. The length of admission has increased slightly, reflecting a reduction in inappropriate and self-discharges.
Nearly four out of five clients have undergone pre-detoxification. In addition 90% of women received cervical and sexual health screening, 96% of all clients had a comprehensive health assessment and 87% had a full blood screen.
Key workers say they now feel better equipped to deal with health emergencies and have more knowledge about the conditions suffered by their most unwell clients.
The plan is to move towards residents dying in the place of their choice, usually the hostel. However, because deaths are often sudden this has not always been possible. “We do attempt to ensure death is as dignified as possible and to re-engage people with their families at the end,” says Project Lead Samantha Dorney-Smith.
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