Homeless Research Articles

Exclusion, prejudice and the invisibility of homeless people at odds with the right to health

Objetivou-se discutir a exclusão, o preconceito e a invisibilidade de pessoas em situação de rua em desacordo ao direito à saúde. Trata-se de um estudo delineado pela Teoria Fundamentada nos Dados e Interacionismo Simbólico, com 36 participantes de municípios da região centro-oeste de Minas Gerais, Brasil, que evidencia a exclusão institucional das pessoas em situação de rua e preconceitos de usuários ao estar com essas pessoas no espaço da unidade de saúde. A falta de planejamento das ações da Atenção Primária inviabiliza o cuidado integral e oportuno e mantém a exclusão. A pesquisa também enfatiza a importância das redes de apoio social na superação das invisibilidades dessas pessoas e maior resolutividade com ações intersetoriais. Considera-se, como resultados deste estudo, que a atenção à saúde das pessoas em situação de rua ocorre mediante um agravo ou adoecimento, refutando a relevância das ações intersetoriais e comprometendo a garantia de acesso equânime à saúde, sem preconceitos.

Rua na Rede: um dispositivo para cuidado no âmbito do Consultório na Rua

The aim of this experience report is to present the Rua na Rede (Street in the Network) device, created by the Consultório na Rua (eCR) team in Florianópolis - SC, as a strategy for building integrality and longitudinal care for eCR users during hospitalization and after discharge. The authors’ experience of building the device was analyzed through their field diary, in dialogue with the scientific literature on the subject. The report underlines that Rua na Rede is guided by the Harm Reduction paradigm and faces an important challenge for the Brazilian National Health System: the link between Primary Care and Hospital Care. A nodal point for integrality and longitudinal care for homeless people.

When artistic is altruistic: the power of beauty from P. A. Sorokin's sociology to Building Beauty social project.

The article contributes to the ongoing debates on the social value and sociological relevance of the arts by examining the intuitions of the Russian-American sociologist P. A. Sorokin (1889-1968) on the concept of "beauty" as a force akin to what he calls "Altruistic Creative Love", both potentially catalysing a process of "fraternisation of humanity". Starting from the author's sociological reflections on the relationship between "Altruistic Love" and "beauty" and an analytical model of "altruistic artistic social action," the article proposes the analysis of a specific social project named Building Beauty, promoted in Turin (Italy) by universities, public bodies and the third sector, which aims to foster the social inclusion of homeless people through participatory processes, discovering expressions of beauty with aesthetic and sociological relevance simultaneously, able to move social transformations.

Pharmacist-led trial to assess impact of outreach on homeless people secures government funding

Pharmacist-led trial to assess impact of outreach on homeless people secures government funding

Composing work of art lives: a cartography of homeless people’s care territories

Resumo Este artigo parte da problematização da concepção de cuidado difundida pelo discurso biomédico, para assim pensar a produção de cuidado entre a população de rua, tendo como objetivo principal dar visibilidade à produção de territórios de cuidado nas ruas. O cuidado é um conceito complexo, tendo em vista sua dimensão ontológica, que nos leva a compreendê-lo como uma condição existencial, uma vez que existimos a partir e por meio do cuidado. Assim, para acompanhar os processos de composição de territórios de cuidado entre pessoas em situação de rua, lançou-se mão da cartografia como método de pesquisa. As cenas cartografadas apresentam a delimitação de territórios existenciais nas ruas, territórios que se caracterizam pelo seu nomadismo, não apenas por seu deslocamento no espaço e no tempo, mas também por suas variabilidades e composições de conexões rizomáticas. No processo cartográfico, foi possível observar produção de redes de cuidado no cotidiano da população de rua, um cuidado que se produz a partir das relações estabelecidas com a alteridade. Nesse sentido, há de se estar atento aos sinais que vêm da rua, conhecer e reconhecer suas linhas de fuga, a fim de aprender outros jeitos de se encontrar no mundo e produzir cuidado.

Interactional contributions of homeless people to urban sustainability

Resumo Será que é possível vislumbrar, no socialmente controverso tema do morar nas ruas, qualquer contribuição para a agenda das Nações Unidas (ONU) em prol da sustentabilidade urbana? Enfrentamos tal questão interpretativamente com base em procedimentos investigativos que potencializam o emprego de métodos qualitativos das Ciências Sociais em projetos transdisciplinares – de colaboração entre pesquisadoras/es e agentes da prática profissional –, acerca dos chamados Objetivos de Desenvolvimento Sustentável (ODS’s) da ONU. Argumentamos que as contribuições compreendem padrões de interação face a face por e acerca de pessoas em situação de rua nos espaços públicos urbanos. Em relação particularmente ao ODS 11, isto é, “tornar as cidades e assentamentos humanos mais inclusivos, seguros, resilientes e sustentáveis”, na São Paulo pandêmica (2020-2022), as contribuições abrangem interações de três tipos, aquelas ambientalmente (i) sustentáveis e (ii) inclusivas por pessoas em situação de rua com objetos materiais, animais e plantas em ruas e praças; e aquelas (iii) socialmente inclusivas protagonizadas por profissionais que assistem quem mora nas ruas. Enquanto os dois primeiros tipos interacionais são contribuições já vigentes, atuais de pessoas em situação de rua para as metas 11.6 e 11.7 do ODS 11, o terceiro é possibilidade futura para a Meta 11.1 por parte de profissionais dedicadas/os a essas mesmas pessoas.

The context of homeless people who live with ostomies

The context of homeless people who live with ostomies

노숙인의 정신적 습관 형성에 영향을 미친 경험

Mental habits could be considered a major determinant not only of physical health behaviors and status but also of mental health. However, there has been limited research on the concept of mental habits in Korea and internationally. As homeless people experience mental health issues more frequently than the general population, early detection and management could be crucial for improving their mental health. Therefore, this study aims to conduct a phenomenological study to discover common experiences of the homeless, focusing on the formation process of mental habits. Through the analysis of in-depth interviews with 12 homeless people, 21 themes, 11 theme clusters, and 6 categories were derived. The results suggested that the mental habits of the homeless were formed through experiences including social disconnection, addiction, unethical behavior, economic difficulties, social exclusion, chronic problematic environments, and intrinsic motivations for life. From childhood to the current homeless status, various experiences have led to complicated interactions affecting the interviewees in multiple ways: a single event could lead to multiple mental habits, or a combination of experiences could develop a single mental habit. Therefore, policies for homeless people should not simply aim to provide shelter but should also aim to end homelessness through supports for sustainable living. This should be built on an understanding of their experiences including life before homelessness, the process of becoming homeless, and their experiences as homeless individuals. Based on this, the researchers' policy recommendations are as follows: First, programs for the homeless should proactively aim to eliminate discrimination. Second, interventions for mental habits should incorporate specific and non-specific interventions. Lastly, interventions for the mental health of homeless people should focus on creating intrinsic motivations.

Kalifornijski test uczenia się językowego wśród polskich bezdomnych

IntroductionReports on the low intellectual level of the homeless are quite numerous and independent of the geographical location of the study.AimThe aim is to assess cognitive functions among the homeless as measured by the California verbal learning test (CVLT).Material and methodsIn our study we included 102 homeless people to assess the functioning of verbal memory using the CVLT. The absolute value of the sum of the results in tasks 1–5 amounted only to 36.21 (SD 10.63). Almost 42% of the subjects obtained a sten score of 1 or 2 for this task.Results and discussionIn all tested CVLT parameters the homeless people, who were the respondents of the present study, obtained results that were significantly below standards (low or very low).ConclusionsThese results indicate the presence of large numbers of people with severe verbal memory disorders among the homeless.

Kim są osoby bezdomne i jakie maja problemy? Przegląd literatury

IntroductionThe publications about homeless persons and homelessness are very popular among scientists. Entering the keyword ‘homeless’ returns about 17 thousand hits in the PubMed search engine. What is so interesting about homelessness that so many researchers devote their time and resources to this topic?AimOur paper is an attempt to answer the question about that, and partially about the genesis of homelessness.Material and methodsThe PubMed and Scopus databases have been researched. We selected the articles related to the most common pathologies among the homeless.Results and discussionThe background of the phenomenon of homelessness is described in the context of the most commonly reported shared elements i.e. poverty, social exclusion, high mortality rates, male predominance, alcohol and drug dependence, intellectual deficits, depressive disorders and suicides. We described the differences resulting from geographical location and environmental factors. We are trying to elucidate the reasons for the discrepancies between individual investigators studying similar problems at different places and at different times.ConclusionsHomeless people are not a different species. They are a derivate of societies on the margins of which these people live. They are therefore different in the geographical sense, but in a given area they change with time similarly to the local population.

Social inclusion of homeless people with mental illness: a community-based intervention

Introducción: Experiencia de una comunidad de barrio capitalino (Asunción-Paraguay), movilizada por la grabación de un corto documental a cargo de estudiantes de cinematografía, que inician un proceso de participación para mejorar la calidad de vida de una persona con trastornos mentales y discapacidad psicosocial en situación de calle, logrando su inclusión social. Objetivo: Identificar los elementos claves que favorecieron la participación comunitaria, derivando en el proceso de reinserción social de una persona con trastorno mental y discapacidad psicosocial para contribuir con estrategias innovadoras de modelos de atención basados en la comunidad con enfoque de derechos humanos. Materiales y métodos: Estudio cualitativo de diseño narrativo, utilizando datos de la historia de una persona y la experiencia de una comunidad para describir, analizar e identificar elementos que se consideran claves para los resultados logrados. La experiencia comunitaria fue observada y registrada de cerca durante más de 4 años. Resultado: Participación comunitaria activa en torno a un objetivo colectivo impulsado por un proyecto cinematográfico logrando la reinserción social de una persona con trastorno mental o discapacidad psicosocial que se encontraba en situación de calle. Conclusión: El cine o arte generan un impacto emocional y sensibilizador que acompañados con estrategias sostenibles; facilitación, tecnología, recursos económicos, lugares de residencia o acogida, acompañamiento; permiten aprovechar y movilizar recursos comunitarios, con participación y enfoque de derechos humanos. El resultado en este caso es la inclusión social de una persona con trastornos mentales y discapacidad psicosocial, que se encontraba en el extremo de exclusión social: vida en calle por más de 20 años.

Pathways to Homelessness and Social Exclusion: Research with Rough Sleepers in Croatia

This new study explores pathways into homelessness and identifies ‘turning points’ among persons currently experiencing rooflessness. Besides their explanations, this research also holistically examines individual biographies to see how other issues have permeated their lives. Although the reasons people described for becoming homeless were complex and multi-layered, the study identifies six pathways into homelessness, as well as some turning points. This research shows that pathways into homelessness do not develop in isolation from life circumstances, but rather that life pathways and pathways into homelessness were closely interwoven into a web, making sustainable exits from homelessness more difficult.

Cabrio Teams, Primary Care for Homeless People In Belgium- Limburg

Cabrio aims to prevent homelessness with a cross-sector, multidisciplinary and autonomous team that establishes contact with homeless people in their living environment in an outreach manner, offers customized support and connects to social facilities. The team aims to help homeless people in finding sustainable housing. In the Belgian province of Limburg there are 3 Cabrio teams that serve 5 local authorities. The welfare organisation CAW Limburg coordinates the 3 Cabrio teams.
 Cabrio is active within the framework that is offered by the Flemish Action Plan to combat homelessness 2020-2024.
 https://www.departementwvg.be/welzijn-en-samenleving/welzijnswerk/dak-en-thuisloosheid 
 Objectives: 
 •Making contact in the social environment of homeless people and building a close relationship with homeless people.
 •Offer support in various life domains and realize a connection with services (network). Guarantee continuity in care.
 •Strengthening the personal network of clients.
 •Working on sustainable housing with social and other housing services.
 •Working on connection through small-scale projects with a high level of participation of the target group. This is part of the socialization of care.
 •Signalling structural barriers to local policy makers. 
 Methodical framework: Cabrio works in an outreaching and multidisciplinary way and uses methods from addiction care, counselling for people with psychological vulnerability and welfare work. Cabrio works from a shared vision of homelessness.
 Outreach work: Counsellors contact clients in the public space, at their home or in the semi-public space (e.g. institution, facility) with a participative basic attitude. They focus on making a connection with 'distrustful' clients
 Multidisciplinary work: To aim for care continuity the Cabrio team brings together different disciplines: general social work (CAW Limburg), addiction care (ZorGGroepZin), psychiatric home care (Beschut Wonen, Mobiel Herstelteam Psychiatrie), special youth care (CANO Pieter Simenon), outreach work (straathoekwerk).
 •Expertise of supervisors is shared in the Cabrio team.
 •Different perspectives and different expertise provides customized guidance.
 •The collaboration and sharing of expertise strengthens the communication and trust between the client and the team and improves the follow-up of specific cases.
 •Supervisors acquire new insights and methods in guiding homeless people to their own work setting.
 Special methods: Harm reduction (or harm-limiting work), motivational interviewing, circle of behaviour change Prochaska and Diclemente, making quarters, guideline for dealing with ethical dilemmas, Housing First.
 1.4.Registration by the Local Homeless Consultation
 The local authorities organize a Local Homeless Consultation (LDO) in which various welfare organizations participate that have contacts with homeless people through their daily practice. The LDO has 3 tasks: 
 •Making an inventory of homeless people in the work area.
 •Coordinating which service/counsellor takes care of the specific client.
 •Tackling signals or structural barriers.
 The LDO refers to the Cabrio team if the client:
 •Does not have stable housing (see Ethos).
 •Scores bad on several life domains and struggles with special problems (e.g. addiction, psychological vulnerability, medical problems, ...)
 •Has a disrupted personal network or does not have or has a few contacts with care services (also called care avoiders).

Connecting with Rough Sleepers: Community Volunteer Training and Partnership

Background: A nationwide study on homelessness in 2019 reported high prevalence of poor health among rough sleepers in Singapore. There are rough sleepers supported by volunteers and community partners within Singapore General Hospital service boundary. Community nursing team engaged Ministry of Social and Family Development (MSF) Partners Engaging and Empowering Rough Sleepers (PEERS) Network and Homeless Heart, a volunteer group, to reach out to this vulnerable population and to understand challenges faced by volunteers. The learning needs survey among 39 volunteers was conducted and showed that less than 8% of them were equipped with basic healthcare knowledge and skills. The top three learning needs were i) healthcare resource for homeless (92.1 %), ii) mental Health (68.4%), iii) basic triaging skills (68.4%).
 Interventions: A virtual volunteer training programme was developed based on survey findings and inputs from PEERS Network during COVID-19. It was further extended to shelter operators supporting rough sleepers. The training was conducted by community nurses on alternate weekend from February to March 2022. The mode of delivery included didactic teaching and case discussion. A referral process to community nursing for rough sleepers requiring assistance in chronic disease monitoring was established to ensure care continuity. 
 Outcomes: A total of 46 participants attended training. All found the program content was useful, relevant to their volunteer activities, and easy to understand. Nearly 80% will recommend this program to their peers. Till date, a total of 5 referrals to Community Nurse Posts were made by volunteers. Nurses conducted health coaching and medication re-consolidation to rough sleepers and also guided volunteers for the subsequent follow up.
 Learning Points and Future Plan: It is the first training programme provided by community nurses to volunteers and staff supporting rough sleepers. The programme was tailored to meet participants’ experience and learning needs. Community nursing will further collaborate with PEERS for outreach events and provide onsite training to facilitate effective learning experience. Moving forward, community nurse team will extend the training program to other community service provides and grassroots volunteer, to support the residents’ physical and psychological well-being in the community .

Words to find common ground for action. Bridging social and health services through concertation on accessibility to vulnerable groups in Brussels

Introduction: Linking general primary care, health and social services with non-profit organisations dedicated to vulnerable groups is the aim of an ongoing concertation process hosted by Brusano, the regional organisation aimed at fostering person-centred health and social-integrated services in Brussels.
 In the Belgian Capital, the most vulnerable people are often attended to by non-profit organisations dedicated to a specific target group or problem. These organisations are often overwhelmed, with people not moving towards general services as intended at some point. General primary care and social services remain insufficiently accessible to vulnerable people. Considering the integrated health and social policy reforms currently taking place at national and regional levels, health and social professionals felt the need to better understand each other and build common ground in order to work together and participate in the reform process. 
 Targeted population and stakeholders: The targeted population is care providers from all levels of care, home helpers and social workers in all kinds of settings. End beneficiaries are vulnerable groups - e.g. migrants, sex workers, people with addictions, prisoners and former inmates, isolated persons, homeless people... - and people who are at a high risk of exclusion when facing problems mixing health and social situations – low income, precarious housing, language barriers... The premise is that if services can include such vulnerable groups, they might achieve broader accessibility for all. 
 Participants: The concertation gathers professionals from multiple health sector disciplines- primary care, hospital, mental health - as well as from the social sector and dedicated non-profits. Nearly 150 professionals participate, with a mean attendance of 30 per meeting.
 Description of the initiative: In 2021-2022, the concertation resulted in an online publication, co-written by two partners, reviewed by 5 others, presented and discussed in 3 meetings, then further adjusted accordingly. The paper provides an overview of the organisation of the health and social systems, as well as a set of definitions. It acknowledges that different levels of care operate as first contact and often lack the means and skills to be fully inclusive and accessible to vulnerable groups. 
 Results / Impact: Stakeholders coined a new phrase - “inclusive practices” - to fully capture the expertise of the dedicated non-profits and to bring about inclusivity in different settings through collaborations. The definitions were included in the glossary used as a reference for the upcoming Regional Health and Social Policy Plan.
 
 Learning for the international audience: Building a common language for health and social professionals, while fully recognizing the expertise of non-profits dedicated to vulnerable groups bridges the gap between health and social services. It is a step towards better integration of health and social organisations, which is a major challenge to integrated care.
 Next steps: In the coming months, the concertation process will continue identifying and supporting inclusive practices whatever the service or level of care. It will be fully part of the Regional Health and Social Integrated Plan. 
 It develops as a model where a specific expertise supports services to the general population.

A person-centred approach to help services and commissioners to improve the experience of people who are homeless and secure better sustainability.

Successful implementation of evidence-based services in health and social care depends largely on the fit of the services with the values and priorities of users who are shaping and participating in their delivery and use. When looking at the implementation of innovative specialist hospital discharge schemes for people who are homeless, there is a lack of knowledge on homeless people’s preferences and perspectives on receiving out-of-hospital care.
 In England, the Department of Health and Social Care, Ministry for Housing and Local Government and Ministry of Justice allocated £16 million to further develop and test out hospital care for people experiencing homelessness. The out-of-hospital care model programme is seeking to scale successful hospital discharge models that were shown to be effective and cost-effective in an earlier pilot programme adapting these for new contexts and circumstances post Covid-19. Evaluation of the implementation of the out-of-hospital care model programme is currently underway in 17 local authority test sites across England. A specific component of the larger evaluation is aimed at capturing service users’ preferences for different types of specialist hospital discharge schemes.
 This is done using a flexible health economics tool for measuring choices in health and social care-related settings named discrete choice experiments (DCE). It measures preferences from individual decision-makers over alternative scenarios (or service provisions). Each alternative is described by several attributes (or characteristics) and the choices made between two or more competing scenarios subsequently determine how preferences are influenced by each attribute (eg, which attributes are valued as well as their relative importance). It can also provide a measure of the overall value attached to different alternatives (and identify optimal service provision that meets stakeholder requirements and have the best chance of sustainability in the long term). Hence a DCE survey has been developed to measure people’s preferences for what out-of-hospital care provides in terms of types of location of care, the professional who delivers most of their care, how often they receive care, how long they receive care after hospital discharge and rules about behaviour where they live.
 The attributes (characteristics) and their various levels were informed by our previous research. Webinar discussions regarding what stakeholders value about specialist services were used to validate and refine the attributes and levels. PPI stakeholders were also consulted on the development of the presentation, wording and format of the survey. Efficient experimental design techniques were applied to create the DCE questions. Due to the cognitive load involved in completing the survey, respondents are assisted in the completion of the questionnaire by members of the research team to secure responses from more than 250 people who are homeless. Data will be modelled using logit techniques and results will be ready for presentation in May 2023.
 Information on how service users value specialist hospital discharge schemes for people who are homeless is needed to better inform the implementation and development of the innovative out-of-hospital care model programme currently proposed in England at a national level. Identified learning will be shared at the conference.

CoBUSters: organization and deployment of a mobile Covid-19 test team for large-scale testing in collectivities as a societal outreach from a university hospital.

During the summer of 2020, government agencies in Belgium were hasty to create additional test capacity for the diagnosis of acute infections with SARS-CoV-2. Large-scale initiatives were necessary to absorb the waves of covid-19 infections throughout all levels of society.
 Within the Antwerp University Hospital (UZA) we realized that it would be impossible to perform large-scale testing of schools, universities, companies, or other collectivities if sampling capacity would not be made available within the collectivities themselves. A large number of scholars or students would not be able to move toward test centers. So, we created a mobile testing team that on-call would be sent to the collectivities to perform testing within the schools, universities, and companies. The test team started in October 2020 with a single bus which was transformed to accommodate the administrative handling of the test e-form, the scanning of the eID of the person to be tested, as well as the sampling through a nasopharyngeal itself. The structure of the bus allowed to perform the testing of 12 students every 15 minutes. Within a couple of weeks, the demand for large-scale testing increased to more than 1000 a day. Towards the end of 2020, a second bus was put into operation. During the year 2021, additional vans were put into operation as the daily number of tests further increased.
 The mobile test team remained in operation until the end of May 2022. During this lifespan, more than 200,000 nasopharyngeal samples were collected by the test team. The highest number of tests on a single day was 4,200. The mobile test team operated within three Belgian provinces, serving more than 2,500,000 people. Besides the testing teams, we created a dispatching team which was evaluable 7/7 for calls and registration of demands for new testings. Besides schools, we performed collective testing in colleges, universities, nursing homes, large companies, prisons, and hospices for homeless people. We even performed large-scale tests within municipalities at the hights of the covid waves. TAT for reporting results was less than 24 hours after sampling.
 The mobile test team, CoBUSters, became known throughout the entire country as a truly innovative social project. Many wondered why a hospital developed a service that was well outside of the regular hospital-related activities. We however did this because this aligns with our mission as a community-based hospital with a strong societal-oriented focus. Hospitals should not remain within their walls, but when society needs them they should quickly develop activities to support society as a whole. This project allowed us also to interact on an almost daily basis with healthcare providers on the first line of healthcare (GPs, home care nurses). From the hospital, we provided the services that the first line could have never mobilized like administrative and nursing staff or manipulation of huge numbers of PCR tests. Together we were able to protect our collectivities against massive outbreaks of the SARS-CoV-2 virus. Even tertiary hospitals have a fundamental societal role when called upon. We should never forget this.

Wit-Gele Kruis good practices in outpatient home care

Wit-Gele Kruis is an outpatient home care organization, spread across five Flemish provinces in Belgium. Each has an autonomous organizational structure, but for large-scaled projects forces are joined under an umbrella headquarters, in Brussels.
 Person-centered care, emancipatory methods and interdisciplinary teamwork are among our core methods. Since integrated care is part of our DNA, we present some of our good practices.
 Limburg & West-Flanders 
 In these two provinces, a handful of nurses go onto the streets to try and provide care for homeless persons. Their scope of work ranges from motivating them to go to a shelter for a shower, to wound care treatment, oral hygiene and getting the necessary vaccinations.
 “Wit-Gele Kruis aims to provide warm quality outpatient home care, but what if there’s no roof over one’s head? Then we still make sure those too receive warm care.”
 In Limburg the initiating partner is a city, whereas in West-Flanders organizations specialized in mental health are taking the lead. Other partners include hospitals, police, welfare and well-being city services and an outpatient shelter for drug users.
 Mostly (young) male adults are reached. But in Ostend sex workers also reach out, seeking advice.
 “Street nursing is on the city council’s agenda to ensure that even the most marginalized groups have (health) care access.”
 East-Flanders
 One of our dementia care experts participates in the care network around a chronically ill patient, to guide and refer them and their informal caregivers to the proper channels.
 This care network consists of home care nurses, general practitioners, pharmacists, cities, hospitals, mental health/ welfare themed organizations, patient care organizations. They focus on the patient’s resilience, autonomy and participation in their own healthcare process.
 “I consider this to be an extremely useful and valuable project that enables people diagnosed with dementia e.g., to remain safe in their own home environment as long as possible.” 
 Antwerp
 In 2021 51% of our palliative care patients received end-of life care by a team consisting of our nursing team, the general practitioner and an external palliative care equip. Given the channel trough which patients in care are reported, the hospital social worker may also be added to that care team. 
 Usually when the need for voluntary services arises, and the advanced care planning conversations are on the table or when the informal caregiver obstructs the care setting, nurses can suggest to the general practitioner to have the equip involved.
 “There’s is nothing earth-shattering that we are doing here, but it does provide a quality service to everyone involved in the dying process.”
 Flemisch Brabant
 There is a transitional limited stay arrangement for elderly people above 60 years, whose home situation is no longer suitable and where there is no medical reason for hospitalization. This project is a collaboration between general practitioners, health insurance funds, city care & welfare services, home care organizations and hospitals.
 “This project aims to support elderly people to live safely at home for longer and avoid (re)admission to the hospital.”

Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain.

Since the introduction of direct-acting antivirals, thousands of chronic hepatitis C patients have been successfully treated. However, vulnerable populations have a higher prevalence of hepatitis C virus (HCV) infection and face barriers that impede their access to antivirals. We carried out an HCV microelimination program focused on vulnerable population groups in Malaga. People in drug addiction treatment centers and homeless shelters in Malaga who participated in the program between October 2020 and October 2021 were included. After providing participants with educational information on HCV, a dry drop test (DDT) was used to collect blood for subsequent screening for HCV infection. The participants who were diagnosed with HCV infection were scheduled for comprehensive healthcare assessments, including blood tests, ultrasonography, elastography, and the prescription of antivirals, all conducted in a single hospital visit. Sustained viral response (SVR) was analysed 12 weeks after end of treatment. Of the 417 persons invited to participate, 271 (65%) agreed to participate in the program. These participants were screened for HCV infection and 28 of them were diagnosed with HCV infection (10%). These hepatitis C-infected patients had a mean age of 53 ± 9 years; 86% were males and 93% were or had been drug users. Among 23 patients with HCV infection, HCV genotype 1a predominated (74%). Medical exams showed that 19% (4/21) had advanced fibrosis (F3-4), and 5% (1/21) had portal hypertension. Finally, 23 infected patients received treatment with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir and SVR was confirmed in 22 patients (96%). Drug users and homeless people have a higher prevalence of HCV infection than the general population. The microelimination program with educational activity and screening tools achieved a high participation rate, easy healthcare access, and a high rate of SVR despite the SARS-CoV-2 pandemic.

Homeless people: Images and imaginaries

This article argues that the construction of social imaginaries around homelessness, which usually focus on the individual variables involved in situations of exclusion, have given way to a broader understanding of homelessness as part of a process of residential exclusion of structural scope. However, both imaginaries, that of the individual causes and that of the structural causes of homelessness, struggle in social practice. Thus, we start from the idea that the different social imaginaries around homelessness are related, in a dialectic way, with the images, produced by different media, of situations in which life in public space is susceptible to be scrutinized in its daily life.In this sense, our analysis of the photographs taken by the journalist Rafa Arjones in the city of Alicante (Spain), between 2002 and 2020, has as its main objectives (Meert and et al., 2004) [1] to reveal these relationships (Rubio-Martín, 2017) [2], to describe which imaginaries may be influencing the production of images on homele02222ssness and (Caeiro and y Gonçalves, 2015) [3] to reveal how the photographer reproduces or questions them throughout the period studied. To achieve these objectives, our analysis is based on a comprehensive Weberian sociology and a hermeneutic/interpretative methodology that attempts to reveal the inner meaning of the photographic images from the external ideological discourse.The findings of our study point to a shift in the photographs analysed, from an approach to homelessness that highlights individual situations to one that seeks contradiction and a focus on the structural problem of access to housing. This is in line with wider social changes that may be occurring in imaginaries of homelessness.