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BMC Geriatrics
Published in: BMC Geriatrics 1/2023

Open Access 01-12-2023 | Care | Research

An Australian aged care home for people subject to homelessness: health, wellbeing and cost–benefit

Authors: Claire M. C. O’Connor, Roslyn G. Poulos, Anurag Sharma, Costanza Preti, Najwa L. Reynolds, Allison C. Rowlands, Kyall Flakelar, Angela Raguz, Peter Valpiani, Steven G. Faux, Michael Boyer, Jacqueline C. T. Close, Leena Gupta, Christopher J. Poulos

Published in: BMC Geriatrics | Issue 1/2023

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Abstract

Background

Older people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited.

Methods

This study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents’ physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived.

Results

Thirty-five residents enrolled in the study between March 2020 – April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission.

Conclusion

While this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness.
Appendix
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Literature
1.
Brown RT, Kiely DK, Bahrel M, Mitchell SL. Geriatric syndromes in older homeless adults. J Gen Intern Med. 2012;27(1):16–22.PubMedCrossRef
2.
Rowlands A, Poulos R, Agaliotis M, Faux S, Raguz A, Poulos C. Designing residential aged care for people at risk of, or experiencing, homelessness: An exploratory Australian study. Health Soc Care Community. 2020;28(5):1743–53.PubMedCrossRef
3.
Crane M, Warnes A. Responding to the needs of older homeless people. Innovation Eur J Soc Sci Res. 2005;18(2):137–52.
4.
Gelberg L, Linn LS, Mayer-Oakes A. Differences in health status between older and younger homeless adults. J Am Geriatr Soc. 1990;38(11):1220–9.PubMedCrossRef
5.
Kellogg FR, Bocker V. The aged homeless: a study comparing older and younger homeless persons. Parity. 2008;21(7):18–9.
6.
Australian Bureau of Statistics. Census of Population and Housing: Estimating Homelessness, 2016. Canberra; 2018. Contract No.: Cat. No. 2049.0.
7.
Australian Institute of Health and Welfare. Older Australia at a glance. 2018.
8.
Brown RT, Hemati K, Riley ED, Lee CT, Ponath C, Tieu L, et al. Geriatric conditions in a population-based sample of older homeless adults. Gerontologist. 2017;57(4):757–66.PubMed
9.
NSW Government. NSW Homelessness Strategy 2018–2023. 2018.
10.
NSW Department of Communities and Justice. Pathways to homelessness: Final report. 2021.
11.
Suh K, Beck J, Katzman W, Allen DD. Homelessness and rates of physical dysfunctions characteristic of premature geriatric syndromes: systematic review and meta-analysis. Physiother Theory Pract. 2020;38(7):858–67.PubMedCrossRef
12.
13.
Crane M, Joly L. Older homeless people: increasing numbers and changing needs. Rev Clin Gerontol. 2014;24:255–68
14.
Crane M, Warnes T. Older homeless people with complex problems and needs: the British experience. Parity. 2008;21(7):20–1.
15.
Kushel M. Homelessness among older adults: an emerging crisis. Generations. 2020;44(2):1–7.
16.
Dyer SM, Liu E, Gnanamanickam ES, Milte R, Easton T, Harrison SL, et al. Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life. Med J Aust. 2018;208(10):433–8.PubMedCrossRef
17.
Davies A, Wood LJ. Homeless health care: meeting the challenges of providing primary care. MJA. 2018;209(5):230–4.PubMed
18.
Hopper E, Bassuk E, Olivet J. Shelter from the Storm: Trauma-Informed Care in homelessness services settings. The Open Health Services and Policy Journal. 2010;3(2):80–100.CrossRef
19.
Song MJ, Nikoo M, Choi F, Schutz CG, Jang K, Krausz RM. Childhood Trauma and Lifetime Traumatic Brain Injury Among Individuals Who Are Homeless. J Head Trauma Rehabil. 2018;33(3):185–90.PubMedCrossRef
20.
Rota-Bartelink A. The Wicking Project II (2015–2016). The provision of skilled specialist consultancy services to people living with highly complex needs and their caregivers. Final report. Final Report published by Wintringham, Flemington Victoria. 2016.
21.
Petersen M, Jones A. Addressing later life homelessness. Brisbane: Institute for Social Science Research, The University of Queensland; 2013.
22.
Rogoz A, Burke D, Price P, Hickie I. Cognitive impairment in the elderly homeless in the inner-city of Sydney: a preliminary report on a study in progress. Parity. 2008;21(7):22–3.
23.
Mills M, City of Knox, Johnston P, City of Darebin, Incerti K, City of Port Phillip, et al. Local Government program and policy partnership responses to older people at risk of homelessness. Parity. 2008;21(7):9–10.
24.
Eagar K, McNamee JP, Gordon R, Snoek M, Duncan C, Samsa P, et al. The Australian National Aged Care Classification (AN-ACC). The Resource Utilisation and Classification Study: Report 1. Wollongong; 2019.
25.
Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6–18.PubMed
26.
Storey JE, Rowland JTJ, Basic D, Conforti DA, Dickson HG. The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr. 2004;16(1):13–31.PubMedCrossRef
27.
Rowland JT, Basic D, Storey JE, Conforti DA. The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons. Int Psychogeriatr. 2006;18(1):111–20.PubMedCrossRef
28.
Basic D, Khoo A, Conforti D, Rowland J, Vrantsidis F, Logiudice D, et al. Rowland Universal Dementia Assessment Scale, Mini-Mental State Examination and General Practitioner Assessment of Cognition in a multicultural cohort of community-dwelling older persons with early dementia. Aust Psychol. 2009;44(1):40–53.CrossRef
29.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan BD, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173(5):489–95.CrossRef
30.
31.
Flaatten H, Guidet B, Andersen FH, Artigas A, Cecconi M, Boumendil A, et al. Reliability of the Clinical Frailty Scale in very elderly ICU patients: a prospective European study. Ann Intensive Care. 2021;11(1):22.PubMedPubMedCentralCrossRef
32.
Struble-Fitzsimmons D, Zipp GP, DeLuca D, Zhang N. Exploring the relationship between Timed Up and Go Test times and fall history in an inpatient geriatric psychiatry unit: a retrospective case-control study. Journal of Geriatric Physical Therapy. 2020;43(3):E25–30.PubMedCrossRef
33.
Nordin E, Rosendahl E, Lundin-Olsson L. Timed, “Up&Go” test: reliability in older people dependent in activities of daily living—Focus on cognitive state. Phys Ther. 2006;86:646–55.PubMedCrossRef
34.
Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol J Ageing Mental Health. 1986;5(1–2):165–73.
35.
Pocklington C, Gilbody S, Manea L, McMillan D. The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2016;31(8):837–57.PubMedCrossRef
36.
Friedman B, Heisel MJ, Delavan RL. Psychometric properties of the 15-item Geriatric Depression Scale in functionally impaired, cognitively intact, community-dwelling elderly primary care patients. J Am Geriatr Soc. 2005;53(9):1570–6.PubMedCrossRef
37.
Ayano G, Soloman M, Tsegay L, Yohannes K, Abraha M. A systematic review and meta-analysis of the prevalence of post-traumatic stress disorder among homeless people. Psychiatr Q. 2020;91:949–63.PubMedCrossRef
38.
Weathers FW, Litz BT, Huska JA, Keane TM. PTSD Checklist—Civilian version. Boston: National Center for PTSD - Behavioral Science Division; 1994.
39.
Weathers F, Litz B, Herman DS, Huska JA, Keane TM, editors. The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. San Antonio: Annual Convention of the International Society for Traumatic Stress Studies; 1993.
40.
Ruggiero KJ, Del Ben K, Scotti JR, Rabalais AE. Psychometric properties of the PTSD Checklist-Civilian Version. J Trauma Stress. 2003;16(5):495–502.PubMedCrossRef
41.
International Wellbeing Group. Personal Wellbeing Index - Adult (PWI-A). Melbourne: Australian Centre on Quality of Life, Deakin University; 2013.
42.
Mission Australia. Impact measurement and client wellbeing 2015 [Available from: Impact-measurement-and-client-wellbeing-report-2015.pdf.
43.
Capic T, Fuller-Tyszkiewicz M, Cummins RA, Khor S, Richardson B, Greenwood C, et al. Australian Unity Wellbeing Index: Report 35.0, Financial Control. Geelong: Australian Centre on Quality of Life, School of Psychology, Deakin University; 2018.
44.
McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. Health-related quality of life measured using the EQ-5D–5L: South Australian population norms. Health Qual Life Outcomes. 2016;14(1):133.PubMedPubMedCentralCrossRef
45.
Cheng LJ, Tan RLY, Luo N. Measurement properties of the EQ VAS around the globe: a systematic review and meta-regression analysis. Value in Health. 2021;24(8):1223–33.PubMedCrossRef
46.
Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.PubMedPubMedCentralCrossRef
47.
Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res. 2021;30(3):647–73.PubMedCrossRef
48.
Granger CV, Hamilton BB, Keith RA, Zielezny M, Sherwin FS. Advances in functional assessment for medical rehabilitation. Topics in Geriatric Rehabilitation. 1986;1(3):59–74.CrossRef
49.
Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.PubMedCrossRef
50.
Lin DY, Cheok TS, Samson AJ, Kaambwa B, Brown B, Wilson C, et al. A longitudinal validation of the EQ-5D-5L and EQ-VAS stand-alone component utilising the Oxford Hip Score in the Australian hip arthroplasty population. Journal of Patient-Reported Outcomes. 2022;6(1):71.PubMedPubMedCentralCrossRef
51.
Nord E. EuroQol: health-related quality of life measurement. Valuations of health states by the general public in Norway. Health Policy. 1991;18:25–36.
52.
53.
Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: An EQ-5D-5L value set for England. Health Econ. 2018;27(1):7–22.PubMedCrossRef
54.
Salem BE, Nyamathi A, Phillips LR, Mentes JC, Sarkisian C, Brecht ML. Development of a frailty framework among vulnerable populations. Adv Nurs Sci. 2014;37(1):70–81.CrossRef
55.
Theou O, Sluggett JK, Bell JS, Lalic S, Cooper T, Robson L, et al. Frailty, hospitalization, and mortality in residential aged care. Journal of Gerontology: Series A, Biological Sciences and Medical Sciences. 2018;73(8):1090–6.
56.
Cheung A, Haas B, Ringer TJ, McFarlan A, Wong CL. Canadian Study of Health and Aging Clinical Frailty Scale: does it predict adverse outcomes among geriatric trauma patients? J Am Coll Surg. 2017;225(5):658-65.e3.PubMedCrossRef
57.
Kim HY. Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restorative Dentistry and Endodontics. 2017;42(2):152–5.PubMedPubMedCentralCrossRef
58.
Cnaan A, Laird NM, Slasor P. Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Stat Med. 1997;16(20):2349–80.PubMedCrossRef
59.
60.
61.
Australian Government Productivity Commission. Report on Government Services 2021. Supporting material: Housing data tables. 2021.
62.
63.
Gilbert L, Lilly A. Independent Review: COVID-19 outbreaks in Australian residential aged care facilities – no time for complacency. 2021.
64.
Zanini A, Aiello M, Adamo D, Casale S, Cherubino F, Patrona SD, et al. Estimation of minimal clinically important difference in EQ-5D visual analog scale score after pulmonary rehabilitation in subjects with COPD. Respir Care. 2015;60(1):88–95.PubMedCrossRef
65.
Crane M, Warnes A. The outcomes of rehousing older homeless people: a longitudinal study. Ageing Soc. 2007;27:891–918.CrossRef
66.
Thredgold C, Beer A, Zufferey C, Peters A, Spinney A. An effective homelessness services system for older Australians. Melbourne: Australian Housing and Urban Research Institute; 2019.
67.
Jeskie W. Meeting the needs of the elderly homeless: a residential aged care perspective. Parity. 2008;21(7):33.
68.
Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12–9.PubMedCrossRef
69.
Belanger HG, Lange RT, Bailie J, Iverson GL, Arrieux JP, Ivins BJ, et al. Interpreting change on the neurobehavioral symptom inventory and the PTSD checklist in military personnel. Clinical Neuropsychologist. 2016;30(7):1063–73.PubMedCrossRef
70.
Gadermann AM, Hubley AM, Russell LB, Thompson KC, Norena M, Rossa-Roccor V, et al. Understanding subjective quality of life in homeless and vulnerably housed individuals: the role of housing, health, substance use, and social support. SSM - Mental Health. 2021(100021).
71.
Brown RT, Kiely DK, Bahrel M, Mitchell SL. Factors associated with geriatric syndromes in older homeless adults. J Health Care Poor Underserved. 2013;4(2):456–68.CrossRef
72.
Forder P, Byles J, Vo K, Curryer C, Loxton D. Cumulative incidence of admission to permanent residential aged care for Australian women – A competing risk analysis. Aust N Z J Public Health. 2018;42(2):166–71.PubMedCrossRef
73.
Canham SL, Custodio K, Mauboules C, Good C, Bosma H. Health and psychosocial needs of older adults who are experiencing homelessness following hospital discharge. Gerontologist. 2020;60(4):715–24.PubMedCrossRef
74.
Salem BE, Ma-Pham J, Chen S, Brecht ML, Antonio AL, Ames M. Impact of a community-based frailty intervention among middle-aged and older prefrail and frail homeless women: a pilot randomized controlled trial. Community Ment Health J. 2017;53:688–94.PubMedPubMedCentralCrossRef
75.
Rogans-Watson R, Shulman C, Lewer D, Armstrong M, Hudson B. Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel. Housing Care and Support. 2020;23(3/4):77–91.CrossRef
76.
Age UK. The impact of COVID-19 to date on older people's mental and physical health. London: Age UK; 2020.
77.
Public Health England. Wider impacts of COVID-19 on physical activity, deconditioning and falls in older adults. UK; 2021.
78.
Taylor AM, Page D, Okely JA, Corley J, Welstead M, Skarabela B. Impact of COVID-19 lockdown on psychosocial factors, health, and lifestyle in Scottish octogenarians: the Lothian Birth Cohort 1936 study. PLoS ONE. 2021;16(6): e0253153.PubMedPubMedCentralCrossRef
79.
Netten A. Overview of outcome measurement for adults using social care services and support. London: NIHR School for Social Care Research; 2011.
80.
Fleming SA, Blake H, Gladman JRF, Hart E, Lymbery M, Dewey ME, et al. A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people. Age Ageing. 2004;33(4):384–90.PubMedCrossRef
81.
Young J. The development of intermediate care services in England. Arch Gerontol Geriatr. 2009;49(Suppl 2):S21–5.PubMedCrossRef
82.
Ni Lochlainn M, Cox NJ, Wilson T, Hayhoe RPG, Ramsay SE, Granic A, et al. Nutrition and frailty: opportunities for prevention and treatment. Nutrients. 2021;13:2349.PubMedPubMedCentralCrossRef
83.
Rota-Bartelink A. Supporting older people living with alcohol-related brain injury: the Wicking Project outcomes. Care Manag J. 2011;12(4):186–93.PubMedCrossRef
84.
Rota-Bartelink A, Lipmann B. Supporting the long-term residential care needs of older homeless people with severe alcohol-related brain injury in Australia: the Wicking Project. Care Manag J. 2007;8(3):141–8.PubMedCrossRef
85.
Tanaka N, Nakatsuka M, Ishii H, Nakayama R, Hosaka R, Meguro K. Clinical utility of the Functional Independence Measure for assessment of patients with Alzheimer’s disease and vascular dementia. Psychogeriatrics. 2013;13(4):199–205.PubMedCrossRef
86.
Depp CA, Vella L, Orff HJ, Twamley EW. A quantitative review of cognitive functioning in homeless adults. Journal of Nervous and Mental Disease. 2015;203(2):126–32.PubMedCrossRef
87.
Horan WP, Wynn JK, Gabrielian S, Glynn SM, Hellemann GS, Kern RS, et al. Motivational and cognitive correlates of community integration in homeless veterans entering a permanent supported housing program. Am J Orthopsychiatry. 2020;90(2):181–92.PubMedCrossRef
88.
Mahtani K, Spencer EA, Brassey J, Heneghan C. Catalogue of bias: observer bias. BMJ Evidence-Based Medicine. 2018;23:23–4.PubMedCrossRef
89.
Kelly C, Hulme C, Graham L, Ellwood A, Patel I, Cundill B, et al. Inter-rater reliability of care home staff’s proxy judgements with residents’ assessments of their own health-related quality of life: an analysis of the PATCH trial EQ-5D data. Age Ageing. 2021;50(4):1314–20.PubMedPubMedCentralCrossRef
90.
Macháčová K, Vaňková H, Holmerová I, Čábelková I, Volicer L. Ratings of activities of daily living in nursing home residents: comparison of self- and proxy ratings with actual performance and the impact of cognitive status. Eur J Ageing. 2018;15(4):349–58.PubMedPubMedCentralCrossRef
91.
Poss JW, Jutan NM, Hirdes JP, Fries BE, Morris JN, Teare GF, et al. A review of evidence on the reliability and validity of Minimum Data Set data. Healthc Manage Forum. 2008;21(1):33–9.PubMedCrossRef
92.
Ly A, Latimer E. Housing first impact on costs and associated cost offsets: a review of the literature. Can J Psychiat. 2015;60(11):475–87.CrossRef
Metadata
Title
An Australian aged care home for people subject to homelessness: health, wellbeing and cost–benefit
Authors
Claire M. C. O’Connor
Roslyn G. Poulos
Anurag Sharma
Costanza Preti
Najwa L. Reynolds
Allison C. Rowlands
Kyall Flakelar
Angela Raguz
Peter Valpiani
Steven G. Faux
Michael Boyer
Jacqueline C. T. Close
Leena Gupta
Christopher J. Poulos
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Care
Published in
BMC Geriatrics / Issue 1/2023
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-023-03920-3

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