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Homelessness Services
In 2023-24 Central and Eastern Sydney PHN continued to support primary health care for vulnerable homeless or at risk of homelessness populations after hours in the inner city region. The programs are aimed at helping rough sleepers, people with a history of IV drug use, Aboriginal and Torres Strait Islander people, sex workers and young people who are at risk of homelessness.
The programs include Kirketon Road Centre inner-city after hours outreach team and St Vincents Homelessness Health after hours program which provides effective coverage of inner-city regions on foot and from fully operational mobile clinic vehicles and primary health care clinics.
The Kirketon Road Centre inner-city after hours outreach team consists of a nurse CNC, a counsellor, health education officer, peer support outreach workers and a medical registrar. In 2023-24, the service provided comprehensive assessment and treatment in the after-hours periods to over 750 vulnerable clients, which exceeded 3,000 occasions of service.
The St Vincents Homelessness Health after hours team provided assertive outreach support to over 1,200 individual clients, totalling more than 2,000 occasions of service. Much of this service provision occurred through regular in-reach primary health care clinics to existing homelessness service providers including drop-in-centers and crisis accommodation shelters.
Case study on The Station
“Mr K.S is a male in his 60s who has been sleeping rough for many years. He had recently been discharged from the acute care unit of the local hospital with two days of temporary accommodation set up for him. He has a history of trauma, homelessness, severe mental illness and chronic health problems that include, dental pain, asthma, and diabetes.
Mr K.S came to The Station for assistance as he wanted support to change his circumstances. When he spoke about his goals, he said he wanted assistance to find a place to live and to access health and mental health services. He expressed interest in making a medical appointment with a dentist and GP. He also requested support to address his use of alcohol by referring to detox and rehab programs.
Mr K.S was supported with a referral to the Housing Support Workers at The Station. The Housing Support Workers assisted him in submitting an application for public housing. He was also referred to St Vincents Hospital Network’s Homeless Health team where he was able to consult with a GP, nurse, mental health clinician and psychiatrist. In addition, he was also referred to a detox and rehab program that would address his use of alcohol and assist with managing withdrawal symptoms.
As a result of The Station’s supportm Mr K.S now lives in accommodation for single men. He has since completed a detox and rehab program where he was able to get help for long term use of alcohol. He has since been referred to a dentist who treated the reoccurring pain. At present he is linked in with the local mental health team, attending his medical appointments on a regular basis. He regularly comes to the service for a meal. He also attends counselling sessions with The Station AOD workers.”
After Hours
In 2023-24 Central and Eastern Sydney PHN continued to contribute to after-hours clinical support services for residents in the 148 residential aged care homes (RACH) in our catchment. This funding enables extension of local geriatric outreach services into the after-hours periods to reduce pressure on public hospital emergency departments (ED) and ensures residents receive the right care in the right place at the right time.
In many cases the treatment received by residents is often identical to hospital care, and it is able to be delivered in the RACH, without the need for transferring the resident into an ED environment and introducing the potential complications of hospitalisation.
The geriatric outreach services, provided through SESLHD, War Memorial Hospital and SLHD provide integrated and specialised aged care through multi-disciplinary teams made up of a mixture of medical, nursing and allied health specialists.
In 2023-24, RACH ED presentations in the after hours periods in SESLHD and SLHD regions accounted for approximately 1.5% of all ED presentations, with almost half of these presentations requiring hospital admission. The program has seen a continual decline in low acuity (category 4 and 5) ED presentations from RACH ED presentations over the last 5 years.
The programs have been pivotal in strengthening collaborative working between Central and Eastern Sydney PHN, Local Health Districts and RACHs to progress both in-hours and after hours quality care options for residents. The work complements a range of other initiatives to support local RACHs, including assistance in developing and implementing telehealth and after-hours action plans for residents, and the development of education and learning opportunities for RACH staff such as:
- management of the deteriorating patients,
- advanced care planning,
- wound care,
- managing COVID and infection prevention control,
- and palliative care measures which guide decision making in the after hours periods.