Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles.

Improving health outcomes requires understanding the complex role of structural determinants of homelessness, such as the availability of secure housing and employment, gender equality, racism, in addition to the funding and structure of health and social services.3 The requirement for health service responses that are tailored to people experiencing homelessness has been highlighted by the COVID-19 pandemic. People experiencing homelessness have few resources with which to support prevention measures from COVID-19, such as accommodation that enables social distancing and self-isolation or hygiene facilities, compounding the risk from higher rates of diseases such as chronic respiratory conditions.4 These factors require an integrated service response from health and housing in order to successfully protect health and reduce transmission risk. Individuals who can provide an address and people who do not appear ‘typically homeless’ may not be asked about their housing status.6 Better recognition of homelessness in healthcare services requires the development of screening tools and processes, as well as systems that support healthcare workers in understanding and responding to homelessness.7 Though issues exist with the use of administrative health service data for research purposes (eg, ‘no fixed address’ being shown to be a poor indicator of homelessness),6 there is potential for such data to better characterise the composition and the needs of this population. In Australia, implementing the healthcare component of such wraparound support is complicated by a complex health system with differing state, federal and ‘out-of-pocket’ funding mechanisms and a blended public and private service delivery model.