About Homeless Healthcare

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 Centers, and since then the demand has continued to rise. In 2014/15, Homeless Healthcare provided 12,922 medical consultations at 11 clinic locations across the metropolitan area.

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 preventative health services is much lower than the general population [1]. They also have very high rates of smoking, which has a profound effect on their short and long term health. In 2016, of the Homeless Healthcare patients who had their smoking status recorded, the vast majority were daily smokers (81%), with 9% having previously smoked [1].

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.

“Smoking is a huge part of the lives of most people experiencing homelessness. However, with access to best practice quit smoking support they can successfully reduce and quit smoking” says Andrew Davies, Director of Homeless Healthcare.

In 2016, Cancer Council WA research of WA community services in collaboration with Homeless Healthcare and WA Cancer Prevention Research Unit showed that 59-70% of people, regardless of their circumstances, want to reduce and/or quit smoking[2]. The study was conducted with staff and clients from five community services in WA and found that health was the most commonly reported motivation for quitting (57%), followed by the cost of tobacco (36%) and family (27%). However, the main barrier to successfully quitting was that few receive best practice quit smoking support.

Hotels With Heart pilot project

During the COVID-19 pandemic, Cancer Council WA sponsored $5000 worth of nicotine replacement therapy (NRT) to assist homeless VIP guests who smoke during their stay at Pan Pacific Perth. The initiative, in conjunction with Homeless Healthcare and the Hotels With Heart pilot project, ensured guests were getting support and the best health care possible during the unprecedented and challenging time.

Research shows that one of the most effective ways to encourage people to quit smoking is by health professionals giving advice, with one in every 33 conversations resulting in a patient successfully quitting smoking [3]. Due to their clinical expertise and regular contact, staff at Homeless Healthcare is best placed to have conversations with guests about smoking, administer the NRT and follow-up on an ongoing basis. One of the success stories is Barry, who was able to get support to quit through the Hotels With Heart project:

Barry was a long term smoker in his early sixties who was homeless for seven years.  He has several cardio-vascular disease risk factors, and a range of long-term health issues, including depression and anxiety, osteoarthritis and alcohol dependence. Barry had been attempting to quit smoking in the past, but has struggled to remain quit. While accommodated through Hotels with Heart, Barry was able to get support to address his smoking. A Homeless Healthcare GP engaged in motivational interviewing with Barry and supporting him to develop a quitting plan. With the support of Cancer Council WA, he was able to access a wide range of NRT products at no cost. When Barry developed a rash from his NRT patch, the Homeless Healthcare GPs were able to switch him to the inhalator and gum and try a different dose patch. At the conclusion of the Hotels With Heart project, Barry was offered a unit to live in, and has been happily living there for nearly four months. He admits that it is hard to stay off the smokes when it has been part of your life for so long, and has had some relapses in his quitting journey but is determined to be an ex-smoker in the near future. “I really need to quit as it is not  good for my lungs and I have this terrible cough.  I feel really self-conscious when on a bus and I cough,as feel I have to explain it is not a COVID cough, it’s a smokers cough” Barry says. He continues to see Homeless Healthcare for cessation support, and greatly appreciates the NRT support provided to him, saying “it definitely helps when trying to quit having access to the NRT.”

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Working together with Make Smoking History

Since the completion of the pilot project, the remaining funds are being used to continue supporting people experiencing homelessness through homelessness services and drop-in centres across Perth metropolitan area. Providing financial support through access to free NRT removes one of the main barriers to quitting. 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 support into routine care; and
• refer patients to appropriate behavioural support, such as Quitline.

This project is currently being evaluated by UWA School of Population and Global Health.

Read about Tobacco and COVID-19 here or find out more about Homeless Healthcare at homelesshealthcare.org.au.

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References

[1] Wood L, Gazey A, Vallesi S, Cumming C, Chapple N.Tackling Health Disparities among People Experiencing Homelessness – The Impact of Homeless Healthcare. School of Population and Global Health, The University of Western Australia, Perth Western Australia. 2018.

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

[3] Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2013(5):CD000165.