ANMJ Featured Story

Nurses lead way in caring for homeless

Saturday 22nd July, 2017

Community Health Nurse Claire Dowling was drawn to working with the disadvantaged after witnessing first-hand the impact of poverty and health disparities in her hometown of Glasgow in Scotland.

“I have this strong belief in social justice and equity and the fact that some people in society do not have the assistance of someone with health knowledge to help their capacity to be able to change in order for them to have self-determination and work on their own goals,” Ms Dowling said.

Ms Dowling moved to Australia in 2005 and soon began working for the Royal District Nursing Service (RDNS) Homeless Persons’ Program (HPP), an outreach service involving a team of community health nurses who offer holistic primary healthcare to people experiencing homelessness.

Most clients have fallen through the cracks, either unable to navigate the health system due to not having a roof over their head or assessed as too difficult by services.

“Within our program we talk about homelessness making people sick,” Ms Dowling said. “Clients actually have quite complex morbidities like liver cirrhosis, respiratory disease, diabetes, Hepatitis C, mental illness and substance use disorders, all of which are potentially not managed in any way.”

Ms Dowling is based at SalvoCare Eastern Homelessness and Support Services and covers Victoria’s entire Mornington Peninsula in delivering healthcare to the homeless.

According to Homelessness Australia, on any given night one in 200 people are homeless across the country.

In 2014-15, 255,657 people received support and almost seven million nights of accommodation were provided by specialist homelessness services.

Ms Dowling is shedding light on the problematic issue as part of Homelessness Week 2017, which runs from 7-13 August, an annual event used to raise awareness of people experiencing homelessness and the issues they face.

“Nurses in particular are at the forefront because we are the ones who are seeing the clients who are most at risk of presenting to emergency departments and at most risk of death from their illness.

“Nurses are pivotal in being able to assess what their immediate needs are and what the short-term to long-term goals for the person are and then linking them into the most appropriate services because quite often we find that the navigation within the service isn’t there.”

Illustrating the impact nurses can make, Ms Dowling revealed recently working with a 51-year-old client named Alan (not his real name) who she encountered while conducting outreach across Rosebud’s private rooming houses.

Through engagement, Ms Dowling uncovered that Alan had been homeless for 20 years and had returned to Rosebud in a bid to reconnect with family.

Diagnosed with schizophrenia at 18, Alan worked as a mechanic until his condition became unmanageable.

He lost his job, then his private rental accommodation, and spiralled into decades of transient homelessness after losing the social supports most people take for granted.

Ms Dowling recounts assessing Alan as both mentally and physically unwell, triggered in part by numerous hospital admissions that didn’t deliver follow-up healthcare.

Alan was suffering cirrhosis of the liver, a bladder tumour, an acquired brain injury due to alcohol dependence and exacerbation of his mental illness.

Through the support of Ms Dowling’s nursing care and collaboration with other services, Alan was able to get back on track by accessing crisis services and then being allocated a home care package via an aged care assessment service which led to independent living.

His bladder tumour has now been treated, his liver cirrhosis is stable and he is taking steps to minimise his drinking.

“He’s achieved his goals and his goal was to achieve housing and be independent but I don’t think that would have happened had we not worked with him,” Ms Dowling said. “It gives you motivation to continue to assist the clients to achieve their personal goals and to try and build capacity for their own personal change because quite often the clients don’t believe. They have no sense of self-esteem and don’t believe in themselves. But by informing them and empowering them you can assist them to have that capacity.”

Homelessness Week 2017 runs from 7-13 August. For more information visit

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