Homeless in Hospital: Kettering’s Health and Housing Partnership
Posted on 09/09/19
Bed Blocking, DTOC, Discharge Delays, Frequent Flyers, these are all phrases used to describe the impact of homelessness in hospitals. Pathways, PDNA, Discharge Tracking are all used to describe solutions but ultimately the outcome remains the same … “Refer to Karen in Housing”
I am a Housing Options Advisor and have been working within the discharge teams across the acute and community hospitals in North Northamptonshire now for over 2 years, I often look back at myself and smile due to my naivety and expectations as to how “easy” I thought this job would be. “Ah that’s okay I will just assess as to whether or not we owe a duty and if we do, we can just put somebody in temporary accommodation and if we don’t, I will find a night shelter for them to go to job done” I would say to myself. Never in a million years would I have pictured myself running around Kettering town centre in order to find an available wheelchair for an elderly patient just so I could take him to his bank. Never did I picture myself at someone’s property until 9pm putting a bed together so he would have something to sleep on that night and never, did I ever, picture myself blocking in an ambulance driver and begging them not to take my patient back to hospital for the sake of a light bulb! But the reality is that “Housing Delays” aren’t black and white, they aren’t an assessment of priority need, or what duty is owed by what local authority, they are complex issues just like people’s lives and every scenario and every person requires a different solution.
Some days are tougher than others and sometimes I just have to go home in the evening to some peace and quiet and reflect on my day. My partner works in an office and sometimes he will come home and tell me all about his stressful day and about how his computer was running ridiculously slow or how he was running five minutes late in the morning. I’m not trivialising his worries as they are equally as important as mine, but it can make for an awkward atmosphere when I try to compare the stresses of my day to his. “Well darling did you know that today I had to tell a man who has a diagnosis of terminal cancer that his wife no longer wants him to return home, he is now homeless and I’ve got to try and find a solution, and quick, because he’s now medically fit to leave” Safe to say my day at work can be an instant mood changer so I find it’s often best I keep it to myself.
I always knew that our hospitals were placed under immense pressure, but I had no idea of the complications surrounding someone’s discharge and what health staff have to deal with. I think the majority of the public assume everyone goes in to hospital, receives their treatment and is discharged home, but what if that patient doesn’t have a home? Or what if their home is no longer accessible? What if someone needs more than just independent living? Where does the patient go then?
Surprisingly a high percentage of my referrals are as a result of relationship breakdowns during a patient’s admission. On almost a weekly basis I receive a telephone call from a ward panicking that Mr Blog’s wife won’t allow him to return home, or that his children have decided to sell his home and refuse him access. It’s fair to say I have been involved in some truly shocking situations where I have seen the extreme lengths family members go to, in order to prevent their loved ones from returning home. Sometimes I can offer a quick solution such as a lock change (Yes, I really have had family members refuse to give over a patients house keys), or even some generic housing advice and support, but other times I am left with no alternative but to look for emergency accommodation which in an era of a “Housing Crisis” can be extremely difficult and can take time to find something appropriate and suitable which, unfortunately, means a longer stay in hospital. I know from collecting what feels like endless amounts of data that my role does dramatically reduce this delay, but this does cause some frustration because, at the end of the day, this isn’t what our NHS was designed for, and with such limited options available in a crisis, it can sometimes feel like an impossible challenge to try and resolve. Despite this, I can sympathise with families as gaining access to appropriate housing and/or care and support is becoming more and more difficult and often it’s those family members who must bridge those gaps. At least in hospital you have access to not just medical staff but several services; Social care, Mental Health, Occupational Therapist, Voluntary and community sector organisations, and now housing. In what other setting would you find all those services sitting under the same roof?
I’m not saying we have it completely right and I feel, in a perfect world, we would have less criteria and processes in order to access services and more common sense and forward thinking around solutions. I have however, been fortunate enough to work with some fantastic colleagues across all sectors whilst doing this role and some of our most successful cases to date have been those where all of us have worked together to achieve the same outcome for that patient. You can’t help but think, if we had more of this in the community the chances are, we would reduce these types of scenarios.
Just to finish off with some stats, to date I have seen over 250 patients in 2 years and of those referrals approximately 69% have managed to return home or secure permanent accommodation, 23% of referrals have gone in to some level of temporary accommodation and just 8% had a change in circumstances which no longer required my involvement.
Two years ago, I was inundated with case studies of patients who had been medically fit to leave but faced a discharge delay of 6 months plus before a housing solution was found. Since my role has been in post the number of days has dramatically reduced and the majority of patients referred are discharged on the same day as becoming medically fit. For more complex cases the delay can take longer but the more we can discuss these issues and come up with initiatives and solutions to these issues early on the more likely we are to reduce housing delays in hospital once and for all!
Kettering’s Health and Housing Partnership consists of colleagues from Kettering Borough Council, Northamptonshire Healthcare NHS Foundation Trust and Kettering General Hospital. We are already trying to discuss the possibility of future projects to improve the health and wellbeing of residents in our borough so watch this space…
By Karen Clarke, Housing Options Adviser at Kettering Borough Council
Karen presented at the NPSS conference earlier this year, read the full presentation ‘Working in partnership: health and homelessness’ here.