Almost 5,000 hospital bed days were lost last year due to the delayed discharge of 154 patients who were homeless, according to the Health Service Executive.
An average of 31.6 such days were lost per patient recorded by the health service as being homeless, figures released under the Freedom of Information Act show.
Most patients (85) were discharged to emergency shelters, with delays in making arrangements resulting in 1,835 bed days being lost.
A further 38 patients were escalated to local authorities or voluntary agencies, with 947 bed days lost.
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Some 28 homeless patients were awaiting suitable accommodation from local authorities, such as wheelchair-accessible shelters, according to the HSE, resulting in 2,046 bed days being lost.
A further three patients were recorded as “foreign nationals” and “not entitled to accommodation within the Republic”, with these cases resulting in 49 bed days being lost.
The HSE said it continuously monitors the number of bed days lost due to homelessness and has developed “targeted responses” to address the issue. These include having dedicated teams and staff to facilitate “timely discharges” from acute hospitals for complex patients.
In Dublin, it has developed a protocol which aims to improve the health and social outcomes of homeless people and those at risk of destitution.
“This is achieved through planned, co-ordinated, and timely discharges from acute hospitals, along with appropriate onward referral,” said the HSE. “Prevention of homelessness is critical, and this protocol ... addresses standard discharges for patients experiencing or at risk of homelessness, ensuring a structured transition with housing and follow-up supports in place. It does not cover delayed transfers of care, where patients, though medically fit, remain in hospital due to unresolved issues such as housing or support availability.”
While the protocol does not specifically address delayed discharges, the HSE said “it plays a role in preventing certain delayed transfers by facilitating well-planned hospital discharges”.
Although hospital discharges can be delayed while accommodation arrangements are sought, the services to which they are discharged are often already stretched for space and support due to the rise in homelessness and the increasing complexity of cases.
Dublin Simon Community’s 51-bed Usher’s Island health and addiction care facility, the first of its kind in the State, aims to reduce the demand for hospital beds, shorten stays, and free up outpatient appointment slots.
Naomi Nicholson, director of clinical governance and therapeutic services, said the facility is receiving about 120 referrals each month, about 55 per cent of which are from acute hospitals.
“The pressure is big. We’re getting about 30 referrals a week and we only have 51 beds and I’m sure we would get a hell of a lot more if we had more beds open,” she said.
Most referrals from acute hospitals come from St James’s in Dublin, followed by the city’s Mater hospital, she said, while the remaining 45 per cent or so come from primary care or other NGOs, preventing admissions to acute hospitals.
While the charity has been providing step-up and step-down intermediate care for several years, Ms Nicholson said referrals have “shot up” since the facility opened in October.
“We get the bottleneck on our end as well, so our length of stay is really increasing because the hospitals may discharge to us. But then we may find it really difficult to move somebody on to suitable accommodation,” she said.
Once fully operational, the facility, which also provides detox care and blood-borne virus treatment, will be able to support between 1,200 and 1,400 patients annually, according to the charity.
