Abstract
BackgroundPeople experiencing homelessness are known to suffer from poor health and can be reluctant to seek healthcare except in crisis. Foot and ankle problems are a concern; as well as causing discomfort and pain, they may escalate from a minor problem to a very serious one without timely and appropriate treatment. Little is known about the foot and ankle problems of people experiencing homelessness.This paper describes a podiatric service specifically for people experiencing homelessness, which includes a fixed site as well as outreach services. The service operates as part of the Homelessness Team program at Cohealth, a large community health service in Melbourne.MethodsThe study used routinely collected data. Every person who was seen by the podiatrist in the Cohealth Homelessness Team in 2019, whether on site or on outreach, was included in the study (n = 295). Of these, 156 were attending for the first time and 139 were returning clients. People who used the service were predominantly rough sleeping (45.2%), with 32.2% in unstable or insecure housing and 22.6% recently housed.ResultsSkin and nail pathologies (68.1%), inadequate footwear (51.9%) and biomechanical issues (44.1%) were the most common presentations. People sleeping rough were particularly likely to present with biomechanical issues (50.8%), acute wound care needs (17.4%) or traumatic injury (10.6%). Most people presented with more than one issue (mean = 2.4), and new clients (mean = 2.53) and those rough sleeping (mean = 2.69) had more issues than others.Outreach was the most effective way to reach clients in the most difficult circumstances (48.9% of those in unstable housing, 34.8% of rough sleepers). Most of the clients (81.4%) had connections with other services offered by Cohealth, such as social work or physiotherapy.ConclusionsThis study demonstrated that reaching and intervening on foot and ankle problems of people experiencing homelessness who may not seek care on their own could be achieved through a publicly funded health service, using simplified pathways to care including outreach. In addition to the long- and short- term benefits of the immediate podiatric treatment, building trust and connections through footcare may provide an entry point into accepting other health and welfare services.
Highlights
People experiencing homelessness are known to suffer from poor health and can be reluctant to seek healthcare except in crisis
Homelessness and health It is well established that experiencing homelessness is associated with poor physical health, even in affluent countries with universal health care such as Australia [1]
In this paper we look at a podiatry service which aims to overcome barriers to improve the foot and ankle health of people experiencing homelessness in Melbourne, Australia
Summary
People experiencing homelessness are known to suffer from poor health and can be reluctant to seek healthcare except in crisis. In this paper we look at a podiatry service which aims to overcome barriers to improve the foot and ankle health of people experiencing homelessness in Melbourne, Australia. In 2012, the Australian Bureau of Statistics (ABS) adopted a statistical definition of six categories of homelessness ranging from “improvised dwellings, tents or sleeping out” (sleeping rough) through to severely overcrowded dwellings [3]. Based on this definition, 2016 Census data identified nearly 25,000 people experiencing homelessness, including 1123 who were sleeping rough [4]
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