Exploring the experience of patients who have ‘no fixed address’

Ms Azzopardi Elysia2, Ms Sarah Booth1

1Western Health, St Albans, Australia, 2Western Health, St Albans, Australia

Poor health outcomes and homelessness are inextricably linked. Homelessness is associated with higher hospital presentations and longer admissions. Evidence suggests that targeted housing support for patients who are homeless, can reduce future hospital presentations and improve health outcomes.

At a public hospital in Melbourne’s West, we sought to better understand how people with ‘no fixed address’ (NFA) accessed services during their hospital stay, their psycho-social needs and identify service improvement opportunities. To do this, a retrospective audit reviewed the medical records of 483 patients with NFA, collating qualitative and quantitative data using a bespoke audit tool. The health social work research team data mined and conducted content analysis.

Findings suggest the majority of patients were not referred to social work or allied health emergency department clinicians during their hospital contact. A small percentage of patients were referred to specialised housing services during their stay in hospital; those admitted were more likely to receive targeted housing support compared to those who presented to the emergency department only. Key psycho-social stressors were evident for patients including drug and alcohol misuse, mental health concerns, trauma, family violence and isolation. A significant minority of the patients were minors with minimal detail recorded regarding their discharge location.

This project has identified significant gaps in the support provided to patients with NFA. With this knowledge, social work and the health service can target improvements in the identification and response to patients who are homeless, including timely provision of targeted housing support and psycho-social care.


Elysia started her career as a social worker at Western Health and has worked across the Acute, Subacute, Maternity and Paediatric spaces. While working in Acute Services, amidst COVID lockdowns and restrictions in Melbourne, Elysia noticed an increasing trend of patients experiencing homelessness. She wanted to understand how the support social workers and other hospital staff provided to this group of patients could be improved and this project was born. Elysia has actively contributed to other key research initiatives at Western Health, including ‘Exploring the impact of a partnership between Centrelink & Western Health’.

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