Academic journal article Care Management Journals

Supporting the Long-Term Residential Care Needs of Older Homeless People with Severe Alcohol-Related Brain Injury in Australia: The Wicking Project

Academic journal article Care Management Journals

Supporting the Long-Term Residential Care Needs of Older Homeless People with Severe Alcohol-Related Brain Injury in Australia: The Wicking Project

Article excerpt

For years, community service providers have been frustrated with the lack in availability of long-term, specialized supported accommodation for older people, particularly older homeless people, with severe acquired brain injury (ABI) and challenging behaviors. Although the incidence of ABI (particularly alcoholrelated brain injury) is far wider than being confined to the homeless population, it is frequently misdiagnosed and very often misunderstood. Wintringham is an independent welfare company in Melbourne, Australia, that provides secure, affordable, longterm accommodation and high quality services to older homeless people. The high incidence of alcohol abuse among the resident population has led us to adapt our model of care to accommodate a complexity of need. However, there are some individuals with severely affected behaviors that continue to challenge Wintringham's capacity to provide adequate support. The deficiency in highly specialized, long-term supported accommodation for older people with severe alcohol-related brain injury (ARBI) is the driving force behind this project. We aim to further develop and improve the current Wintringham model of residential care to better support people with these complex care needs. We will report on the synthesis of this project, which aims to test a specialized model that can be reproduced or adapted by other service providers to improve the life circumstances of these frequently forgotten people.

Keywords: older people; alcohol-related brain injury; residential care model; challenging behavior; complex needs

In Australia, up until the mid-to late 1980s, frail elderly homeless men and women lived and died in homeless person's night shelters. Three large homeless persons' night shelters operated in Melbourne at that time and all had large numbers of frail elderly residents in need of hostel or nursing home care. For a variety of prejudicial reasons, workers at these homeless service centers found it extremely difficult to place frail elderly homeless residents in mainstream aged care residential services. As a result aged men and women were forced to live in environments that were frequently violent, intimidating, and totally ill equipped to provide appropriate aged care services.

The Supported Accommodation Assistance Program (SAAP), established in 1985, was Australian's programmatic response to homelessness. Almost 1,200 SAAP agencies across Australia receive joint state and federal funding to provide housing and support services. More than 180 organizations throughout the state of Victoria receive SAAP funding (Commonwealth Department of Family and Community Service [FACS], 2002). Services included crisis accommodation, transition support services, support centers, and a telephone information and referral service (Department of Human Services [DHS], 2000). Originally intended to provide transitional support and housing, it soon became apparent that there was a chronic shortage of stable long-term housing solutions. Many homeless people continued to live and die in the dilapidated, crowded conditions of night shelters and halfway houses.

The night shelters have since closed down following the redevelopment of Melbourne's Homeless Accommodation services in the mid- to late 1980s (Victorian Government, 1988). Today, in addition to SAAP services, there are a number of federal- or statefunded programs available to homeless people. The Assistance with Care and Housing for the Aged (ACHA) program is an outreach program designed to assertively seek out the elderly homeless and reestablish a tenancy with appropriate supports. The Community Connection Program (CCP) is an assertive state-funded outreach program, similar to the ACHA program, designed to identify homeless people and link them back into the community. The Homeless Persons Psychiatric Service targets homeless people with mental health illness. And the Royal District Nursing Services Homeless Persons Program provides direct health care and support to homeless people (DHS, 2000; FACS, 2002). …

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