About Homeless Healthcare

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Homeless Healthcare is a not-for-profit charity that aims to advance and promote the health of people experiencing or at risk of homelessness. Dr Andrew Davies recognised that the most effective way to address the health needs of people experiencing homelessness was to work collaboratively with social services. He began Homeless Healthcare by holding medical clinics in existing drop-in centres, and since then the demand has continued to rise. In 2023, Homeless Healthcare is providing services in more than 17 different settings, and sees on average 2,500 unique patients a year across all of these settings [1]. In 2021/22 alone, Homeless Healthcare provided 33,000 consultations to people at risk or experiencing homelessness [2].  

Homeless Healthcare aims to address inequities and provide access to high quality healthcare that meets the unique needs of homeless and marginalised people, at no cost to the patient. People experiencing homelessness often have multiple chronic health issues and their access to primary care and preventive health services is much lower than the general population [3]. They also have very high rates of smoking, which has a profound effect on their short and long term health. In 2022, of the Homeless Healthcare patients who had their smoking status recorded, the vast majority reported smoking daily (79%) with 11% having previously smoked [3].

For many people experiencing homelessness, experiences of adversity and trauma often underlie addictions, and it is difficult to address health issues when people remain in the survival mode of rough sleeping. Homeless Healthcare recognises that health problems do not occur independently of social problems, and believes that improving health and wellbeing is essential to breaking the cycle of homelessness.

Australian research has found that a high number of people accessing homelessness services who smoke want to quit. One study found that out of the 82% clients who smoked half reported wanting to quit (52%) and 64% reported trying to quit or reduce their smoking in the previous 3 months [4]. However, only a small number of clients were able to stay quit at 6 months. One of the main barriers to successfully quitting is that few people accessing community services, including homeless services, receive access to best practice quit smoking support [5]. Make Smoking History and Homeless Healthcare are working together to change this.

Working with Make Smoking History

Make Smoking History first partnered with Homeless Healthcare to increase access to nicotine replacement therapy (NRT) for people experiencing homelessness in 2020. The partnership began with the one-month Hotels With Heart pilot project, where people who were rough sleeping were provided with hotel accommodation and support early in the COVID-19 pandemic. Cancer Council WA, through the Make Smoking History program, provided Homeless Healthcare with access to $5,000 worth of NRT that could be provided at no-cost to support people accommodated at the Pan Pacific Hotel, almost all of whom smoked heavily. Access to free NRT removes a significant barrier to quitting for people who are homeless and often living below the poverty line.  

“Smoking is a huge part of the daily lives of most people experiencing homelessness. However, with access to best practice quit smoking support they can successfully reduce and quit smoking. We have definitely seen an increase in patient quit attempts thanks to this NRT availability.”

Dr. Andrew Davies – Homeless Healthcare

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After the completion of the pilot project, the remaining funds were used by Homeless Healthcare to continue to encourage people experiencing homelessness to quit or reduce their smoking.  

Make Smoking History has also been working closely with Homeless Healthcare to:

• develop tailored quit smoking messaging for homelessness services staff;
• adapt clinical pathways to embed brief advice quit smoking support into routine care; and
• refer patients to appropriate behavioural support, such as Quitline.

The impact of the Cancer Council WA NRT funding for Homeless Healthcare was evaluated by the Home2Health research team that is based at the Institute of Health Research at the University of Notre Dame. Click here to see the outcomes of the project.

For more information about the Hotels With Heart pilot project please click here.

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References‍

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[1]. Wood, L., Tuson, M.,Wood, I., & Vallesi, S. The Homeless Healthcare Hub – Evaluation Snapshot August 2022. Home2Health research team, University of Notre Dame Australia, August 2022.
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[2]. Homeless Healthcare. Homeless Healthcare: Our Impact. Accessed July 19, 2023. Available at: https://www.homelesshealthcare.org.au/

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[3]. Wood, L. (2022). Improving Access to Nicotine Replacement Therapy for People Experiencing Homelessness. NRT. Home2Health research team, University of Notre Dame, March 2022.

[4] Maddox, S., & Segan, C. (2017). Underestimation of homeless clients’ interest in quitting smoking: A case for routine tobacco assessment. Health Promotion Journal of Australia, 28(2), 160-164. doi: https://doi.org/10.1071/HE15102

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[5] Biagioni,N. & Pettigrew, S. Smoking behaviours of clients accessing community service organisations: pilot study results. WA Cancer Prevention Research Unit, Curtin University, Perth, 2016.

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Last updated 27 September 2023