Teresa Davis, Margaret K. Hogg, David Marshall, Alan Petersen and Tanja Schneider
Lisa Wood, Nicholas J.R. Wood, Shannen Vallesi, Amanda Stafford, Andrew Davies and Craig Cumming
Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting…
Abstract
Purpose
Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues.
Design/methodology/approach
This mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia’s inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice.
Findings
This collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed.
Research limitations/implications
While the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort.
Practical implications
This model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health.
Originality/value
Coordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness.
Details
Keywords
Andreja Siliunas, Mario L. Small and Joseph Wallerstein
Today, low-income people seeking resources from the federal government must often work through non-profit organizations. The purpose of this paper is to examine the constraints…
Abstract
Purpose
Today, low-income people seeking resources from the federal government must often work through non-profit organizations. The purpose of this paper is to examine the constraints that the poor must face today to secure resources through non-profit organizations.
Design/methodology/approach
This is a conceptual paper. The authors review cases of non-profit organizations providing federally supported resources to the poor across multiple sectors.
Findings
The authors find that to accept government contracts serving the poor, nonprofit organizations must often engage in one or several practices: reject clients normally consistent with their mission, select clients based on likely outcomes, ignore problems in clients’ lives relevant to their predicament, or undermine client progress to manage funding requirements. To secure government-supported resources from nonprofits, the poor must often acquiesce to intrusions into one or more of the following: their privacy (disclosing sensitive information), their self-protection (renouncing legal rights), their identity (avowing a particular self-understanding) or their self-mastery (relinquishing authority over daily routines).
Originality/value
The authors show that the nonprofits’ dual role as brokers, both liaisons transferring resources and representatives of the state, can complicate their relation to their clients and the predicament of the poor themselves; the authors suggest that two larger trends, toward increasing administrative accountability and demonstrating deservingness, are having both intended and unintended consequences for the ability of low-income individuals to gain access to publicly funded resources.