Discharge into homelessness. A qualitative analysis of the discharge conditions of homeless people in Austrian healthcare facilities

Background. Homelessness has been on the rise in Austria and the European Union for the past decade-with inconsistent measurement systems and data reinforcing the problem. People who are homeless are also confronted with a high hospitalization and readmission rate. The aim is to identify factors influencing the readmission rate of homeless patients in Austrian healthcare facilities and to derive recommendations for optimizing discharge management. Methods. Discharge conditions from healthcare facilities represent a research gap in this respect, which was investigated in this study. In order to be able to comprehensively map the research project, data were collected from people who were homeless and from social work experts using semi-structured, guided interviews and grounded theory methodology, presented in a theoretical model based on Strauss and Corbin's coding paradigm. A group of five homeless people and five social work professionals were included in the study, taking theoretical sampling into account. Results. The present study was able to analyze the interdependency of inadequate discharge conditions and increased readmission rates among homeless people, which are characterized by a relationship between causes, context, intervening conditions, action strategies, and consequences. The core issues here are addiction and psychiatric illnesses, reinforced by the problem of the care gap for uninsured and immobile people, and inadequate care services. In this respect, it is very important to preventively address these illnesses and to expand low-threshold care services for homeless people. Conclusions. The results support the need for structural changes to the Austrian care landscape for homeless people. In order to ensure a sustainable reduction in the readmission rate and enable those affected to reintegrate into society, addictions and lack of insurance must also be addressed. Further research into the mechanisms of action of such measures is therefore essential.