Physiotherapy access for homeless patients

Homeless people can present with challenging behaviour – perhaps turning up unkempt or drunk. They may not show up at all. They can, however, be very rewarding patients to work with and are often the ones who need you most. Physiotherapy can make a huge difference and yet they are often excluded from our services.

A national study of more than 3,355 homeless people found musculoskeletal and respiratory problems were rife. So why aren’t we seeing them? 

Little is known about homeless people’s access to physiotherapy. But we know some GPs might not register a person without an address. Unless self-referral to physiotherapy is available, having no GP can mean no referral. Some homeless people who are referred don’t attend, don’t understand what physiotherapy is, don’t have the money to travel, leave the address where the referral letter was sent, or forget about the appointment. However, if you have no home you clearly have bigger problems on your mind.

When homeless people do attend, I’ve found simple interventions can radically improve their health. Teaching someone how to use their inhaler properly might mean their asthma won’t land them in hospital so often – a cost saving for the NHS. 

Bearing in mind the difficulties homeless people face, and the differences treatment can make, perhaps it’s time our profession reconsidered barriers to care.

Let’s ask ourselves why so few homeless people are referred or miss appointments. Let’s stop blaming individuals for ‘not engaging’ or ‘failing to attend’, and focus on making our services more accessible to ‘easy to ignore’ populations.

Homelessness is rising – last year more than 54,000 people were accepted as homeless, a rise of a third since 2009-10. People are sleeping on streets, in hostels, in break and breakfasts, on sofas and floors. Many are fleeing violence or have a physical health, mental health and addiction problems. We can’t end the UK housing crisis, but we can make some lives better.

Organisations that can help

• Crisis runs ‘Crisis at Christmas’, which over a designated week offers homeless people shelter, food, support and health services. Last year, the London service provided 194 physiotherapy sessions in six days. 
• the Faculty for Homeless and Inclusion Health brings together 700 professionals working with multiply-excluded people.
• Pathway’s hospital-based teams work with homeless people to maximise the clinical benefit of admission and improve options at discharge. 
• Groundswell offers peer advocacy, helping homeless people attend outpatient appointments. Currently only available in London, the service is expanding elsewhere

Jo Dawes is a senior lecturer in physiotherapy at Kingston University and St George’s, University of London and on Twitter @DawesJo

Cat Whitehouse is a communication and administration officer at Pathway

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