A qualitative study exploring how health and social care professionals can support frailty and holistic needs among people experiencing homelessness

Abstract

Purpose – The Frailty, and Holistic Care Needs Assessment (FHCNA) questionnaire was designed for use by non-clinical staff to assess the health and social care needs among people residing in homeless hostels. This study aims to refine the FHCNA to enable use in practice. The authors explored the views of mainstream health and social care professionals (HSCPs) regarding necessary questions, formatting and potential utility and then modified the questionnaire so it can be used to respond to identified needs in line with health reviews and Care Act assessments. Design/methodology/approach – Semi-structured interviews with HSCPs practising in mainstream services were carried out and analysed thematically to explore their views of how they could be supported to respond to the frailty needs of people experiencing homelessness (PEH). Modifications to the FHCNA were made, and focus groups were carried out to check for usability with hostel staff and people with lived experience of homelessness. Findings – Multiple uses of the modified FHCNA were identified including guiding consultations, supporting multi-disciplinary decision making and education/advocacy for both mainstream professionals and homelessness services. To optimise its utility in the face of systemic barriers, adaptations were suggested, including a shift towards the social care paradigm to support professionals’ understanding of identified needs within the context of the Care Act, the addition of information to combat the normalisation of frailty in PEH and prompts to streamline responses from GPs. Feedback from PEH and hostel staff was positive, and acceptability of the questionnaire remained following adaptations. Practical implications – Multiple uses of the modified FHCNA were identified, including guiding consultations, supporting multidisciplinary decision-making and education/advocacy for both mainstream professionals and homelessness services. Social implications – Findings supported adaptations of the FHCNA to combat the normalisation of frailty in PEH and prompts to streamline responses from GPs. Originality/value – To the best of the authors’ knowledge, this is the first study to explore how information regarding the health and care needs of PEH can be gathered in a way that facilitates a timely and individualised response from mainstream HSCPs.