{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:28:08Z","timestamp":1792006088931,"version":"4.4.0"},"reference-count":31,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,17]],"date-time":"2021-10-17T00:00:00Z","timestamp":1634428800000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001275","name":"Oak Foundation","doi-asserted-by":"publisher","award":["OCAY-14-574"],"award-info":[{"award-number":["OCAY-14-574"]}],"id":[{"id":"10.13039\/100001275","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,27]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The number of people living in homeless hostels in the UK has steadily increased over the past decade. Despite people experiencing homelessness often having considerable health problems and a range of complex needs frequently in association with addictions, the experiences of hostel staff and residents especially in relation to accessing health and social care support have seldom been explored. The aim of this paper is to identify the barriers and facilitators to accessing health and social care services for people living in homeless hostels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Exploratory qualitative baseline data were collected as part of an intervention to facilitate palliative care in-reach into hostels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/participants<\/jats:title>\n                    <jats:p>Interviews were conducted with 33 participants; 18 homeless hostel managers\/support staff and 15 people experiencing homelessness, from six homeless hostels in London and Kent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes were identified (1) internal and external service barriers to health and social care access due to stigma, lack of communication and information sharing from services and assumptions around capacity and the role of the hostel, (2) the impact of lack of health and social care support on hostel staff leading to burnout, staff going beyond their job role and continuous support given to residents, (3) potential facilitators to health and social care access such in-reach and support from those who understand this population and hostel staff training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Residents have multiple complex needs yet both hostel staff and residents face stigma and barriers accessing support from external services. Positive relationships were described between hostel residents and staff, which can be an essential step in engaging with other services. People experiencing homelessness urgently need better access to person-centred, trauma-informed support ideally via in-reach from people who understand the needs of the population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-053185","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:11:59Z","timestamp":1634602319000},"page":"e053185","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6773-9393","authenticated-orcid":false,"given":"Megan","family":"Armstrong","sequence":"first","affiliation":[{"name":"Marie Curie Palliative Care Research Department, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Shulman","sequence":"additional","affiliation":[{"name":"Marie Curie Palliative Care Research Department, University College London, London, UK"},{"name":"Pathway Charity, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briony","family":"Hudson","sequence":"additional","affiliation":[{"name":"Marie Curie, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Stone","sequence":"additional","affiliation":[{"name":"Marie Curie Palliative Care Research Department, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Hewett","sequence":"additional","affiliation":[{"name":"Pathway Charity, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"2025120619161139000_11.10.e053185.1","unstructured":"Bramley G . Homelessness projections: core homelessness in Great Britain, summary report. crisis, 2017. Available: https:\/\/www. crisis. org. uk\/media\/237582\/crisis_homelessness_projections_2017. pdf"},{"key":"2025120619161139000_11.10.e053185.2","unstructured":"Jacobs K , Kemeny J , Manzi T . The struggle to define homelessness: a constructivist approach. homelessness: public policies and private troubles, 1999: 11\u201328."},{"key":"2025120619161139000_11.10.e053185.3","unstructured":"Link H . The future hostel: the role of hostels in helping to end homelessness. London: Homeless Link, 2018."},{"key":"2025120619161139000_11.10.e053185.4","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1108\/HCS-05-2020-0007","article-title":"Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel","volume":"23","author":"Rogans-Watson","year":"2020","journal-title":"Housing, Care and Support"},{"key":"2025120619161139000_11.10.e053185.5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0075133"},{"key":"2025120619161139000_11.10.e053185.6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.12688\/wellcomeopenres.15151.1","article-title":"Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England","volume":"4","author":"Aldridge","year":"2019","journal-title":"Wellcome Open Res"},{"key":"2025120619161139000_11.10.e053185.7","unstructured":"Busch-Geertsema V , Sahlin I . The role of hostels and temporary accommodation. European Journal of Homelessness 2007;1."},{"key":"2025120619161139000_11.10.e053185.8","first-page":"306","volume-title":"Homelessness is a healthcare issue","volume":"103","author":"Hewett","year":"2010"},{"key":"2025120619161139000_11.10.e053185.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.soscij.2008.03.001"},{"key":"2025120619161139000_11.10.e053185.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2020.08.001"},{"key":"2025120619161139000_11.10.e053185.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-016-0168-6","article-title":"Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research","volume":"15","author":"Hudson","year":"2016","journal-title":"BMC Palliat Care"},{"key":"2025120619161139000_11.10.e053185.12","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317717101"},{"key":"2025120619161139000_11.10.e053185.13","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1108\/14608791211254207","article-title":"The (dis) stressing effects of working in (dis) stressed homelessness organisations","volume":"15","author":"Johnson","year":"2012","journal-title":"Housing, Care and Support"},{"key":"2025120619161139000_11.10.e053185.14","doi-asserted-by":"crossref","first-page":"236","DOI":"10.12968\/ijpn.2015.21.5.236","article-title":"When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people","volume":"21","author":"Webb","year":"2015","journal-title":"Int J Palliat Nurs"},{"key":"2025120619161139000_11.10.e053185.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-020161"},{"key":"2025120619161139000_11.10.e053185.16","doi-asserted-by":"crossref","first-page":"134","DOI":"10.3109\/14659891.2012.754508","article-title":"A qualitative exploration of relations and interactions between people who are homeless and use drugs and staff in homeless hostel accommodation","volume":"19","author":"Stevenson","year":"2014","journal-title":"J Subst Use"},{"key":"2025120619161139000_11.10.e053185.17","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1177\/02692163211006318","article-title":"The benefits and challenges of embedding specialist palliative care teams within homeless hostels to enhance support and learning: perspectives from palliative care teams and hostel staff","volume":"35","author":"Armstrong","year":"2021","journal-title":"Palliat Med"},{"key":"2025120619161139000_11.10.e053185.18","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025120619161139000_11.10.e053185.19","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025120619161139000_11.10.e053185.20","doi-asserted-by":"crossref","DOI":"10.5688\/ajpe78125","article-title":"NVivo 10 [software program]. Version 10. QSR International; 2012","volume":"78","author":"Castleberry","year":"2014","journal-title":"Am J Pharm Educ"},{"key":"2025120619161139000_11.10.e053185.21","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph15020309","article-title":"Improving health care management in primary care for homeless people: a literature review","volume":"15","author":"Jego","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"2025120619161139000_11.10.e053185.22","doi-asserted-by":"publisher","DOI":"10.2174\/1874924001003020080"},{"key":"2025120619161139000_11.10.e053185.23","unstructured":"Sanders B , Brown B . I was all on my own\u2019: experiences of loneliness and isolation amongst homeless people. London: Crisis, 2015: 1\u20139."},{"key":"2025120619161139000_11.10.e053185.24","doi-asserted-by":"publisher","DOI":"10.1007\/S10597-018-00364-7\/TABLES\/3"},{"key":"2025120619161139000_11.10.e053185.25","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.nedt.2018.09.022","article-title":"Evaluation of training on palliative care for staff working within a homeless hostel","volume":"71","author":"Shulman","year":"2018","journal-title":"Nurse Educ Today"},{"key":"2025120619161139000_11.10.e053185.26","doi-asserted-by":"publisher","DOI":"10.1108\/14608791211238412"},{"key":"2025120619161139000_11.10.e053185.27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1108\/HCS-10-2016-0012","article-title":"Psychologically informed environments for homeless people: resident and staff experiences","volume":"20","author":"Phipps","year":"2017","journal-title":"Housing, Care and Support"},{"key":"2025120619161139000_11.10.e053185.28","unstructured":"Groundswell . 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