Integrating healthcare and housing to improve patient outcomes

Members of St Vincent's Hospital Melbourne's Better Health and Housing team

Breaking the cycle of chronic homelessness and poor health

St Vincent’s Hospital Melbourne’s (SVHM) Better Health and Housing Program (BHHP), funded by the Department of Families Fairness and Housing (DFFH) and operated in partnership with Launch Housing and the Brotherhood of St Laurence, commenced in August 2022, integrating healthcare and housing service models under the one roof.

The BHHP aims to break the cycle of chronic homelessness, poor health, hospitalisation and return to homelessness by providing people exiting hospital and those who are referred from other community and housing agencies, who are homeless, or at risk of homelessness, with an integrated housing-led healthcare response.

The BHHP is a residential-based service for people who have experienced chronic homelessness and poor health. Residents are supported for three to six months, during which they are expected to experience a significant improvement to their quality-of-life, engagement in care, management of health issues and housing stability.

Residents experience an environment where they are able to rest, stabilise and recover so they can, with the support of staff, identify and work on their own longer-term goals, enabling them to better manage their health and transition to stable housing. Improved resident wellbeing, through achieving better health and housing outcomes, leads to reduced demand on a number of service sectors including specialist homelessness, healthcare and welfare systems.

The BHHP is delivered by a multidisciplinary team including St Vincent’s care coordinators and lived experience workers alongside Launch Housing support workers and case managers. The SVHM Aboriginal Health team supports the delivery of culturally safe care.

Residents are provided up to three months of support following exit from the facility, to support the high-risk time of transition to their new health and housing arrangements to assist in ensuring gains made are sustained. 

The BHHP was expanded to 20 beds in early 2023 and has received further funding from the DFFH to continue through to June 2024.

Results and outcomes

Built on evidence that shows improved outcomes for people experiencing homelessness when their healthcare and housing are addressed simultaneously, the BHHP focuses on capability building, genuine opportunities and resident goal-directed care planning driven by the resident and what matters most to them.

Improved outcomes are expected to continue occurring over an extended period of time as participants move away from unplanned healthcare to planned and coordinated care.

In the program’s first year, all residents entered with unmanaged health conditions. On exit, residents who completed the program experienced an improvement in the management or resolution of health issues related to physical health, mental health or substance dependence.

In addition, 78% of residents who exited the program were linked with a GP or ongoing primary care service.

Residents also reported improvement during their time in the program across wellbeing domains, with the domains of ‘achieving in life’, ‘future security’ and ‘community connectedness’ reporting the greatest average increase. 

Of residents who had a planned exit from the program, 100% have secured and maintained to date secure housing.

The BHHP is also supporting a reduction in presentations to SVHM’s emergency department (ED) and an increase in planned community mental health engagement.

A commitment to caring for Victoria’s most vulnerable people

SVHM is the leading provider of healthcare for people experiencing homelessness in Victoria.

Homelessness is associated with significant health disparities, including a higher prevalence of chronic conditions, acute illness and injury, and a three-decade gap in life expectancy.  

Despite significant health needs, people experiencing homelessness can face many barriers to accessing health services and preventive healthcare and are more likely to seek emergency or unplanned care. This is often at a later stage of ill health, leading to poorer health outcomes, and longer and costlier hospital admissions.  

Delivering excellent healthcare to people experiencing homelessness is at the heart of SVHM’s mission and commitment to serving those who are marginalised or vulnerable.

The BHHP builds on existing SVHM programs and seeks to address a gap in the system where people experiencing homelessness are discharged to the street, lost to follow-up care and then return to the ED with more acute illness and subsequently poorer health outcomes.