HOME

Homeless individuals are among the most disadvantaged groups globally and largely absent from dementia policies. The older homeless population with memory problems is increasing, yet their complex care needs remain unmet. Staff in homelessness services are an overlooked dementia care workforce and some hostels may be inadvertent ‘dementia communities’. 

What is the aim of the HOME study?

The HOME study is a five-year research project (starting in March 2021 for 60 months) funded by the NIHR. During these five years we aim to identify and test ways to support people with memory problems in homelessness hostels in South England, facilitating their transition to suitable and settled homes.

Why is this important?

The older homeless population with memory problems is growing, and people who are homeless are likely to have one or more additional vulnerability, such as longstanding physical and mental health problems, drug and alcohol addictions and a history of head injury. Therefore they are more likely, than those who have not been homeless, to have memory loss and other problems in functioning similar to those of people diagnosed with dementia.

We have consulted widely with people experiencing memory problems and homelessness, charities, statutory services, hostel workers and managers. They tell us that people experiencing homelessness and memory problems find it more difficult to accomplish moving from temporary hostels to permanent accommodation than other homeless people, and use more health and social services than those with secure accommodation.

There is little known about how to support this group. We do not know how homeless people with memory problems experience homelessness and how frontline staff support them. It remains unclear how best to support both these groups, so this is what we hope to address in this project.

What have we done so far?

The project is split into different streams carried out in stages:

1.We started by interviewing a total of 49 people, including homeless people with memory problems, hostel staff and managers; and practitioners working in support services. This study identified four overarching themes: (i) The population is not taken seriously; (ii) you ‘can’t see the wood for the trees’; (iii) risk of exploitation and vulnerability; and (iv) (dis)connection and social isolation. You can read about the study in this blog.

We also directly observed staff in hostels supporting older people with memory problems, learning about what currently works and what the challenges are.

2. We then brought together a team of experts by experience (people who have experienced homelessness and memory problems), researchers and people working in related areas to help design the intervention, learning from interviews and observations and what we know already.

This helped develop a six-session intervention to be delivered to groups staff members, such as support workers, in homelessness hostels. Intervention topics focus on practical, individualised strategies, supporting staff to recognise, assess and deliver the help residents aged ≥50 years with memory problems require to move on successfully and manage the challenges that memory problems bring.

The topics covered in the intervention include:

• improving communication,
• supporting functioning and minimising harm,
• mental capacity and safeguarding,
• and managing distress behaviours and unmet need.

3. We have made changes to the intervention based on feedback from trying out the intervention in one hostel.

What are we currently doing?

At the beginning of 2024, we started the process of carrying a study with 40 hostel staff and residents across multiple hostels in different organisations. This study aims to see if the intervention is feasible (if hostel staff and residents agree to take part and if we can collect necessary information) and acceptable (if people completed and liked the intervention).

This study will consider what would be the best outcome measure for a full trial and how to measure how people use services and the intervention cost.

We will collect information about how the intervention was delivered, how it was received and what people feel should be changed and how, if it was useful, it could be rolled out.

What impact will we have?

This research will potentially help those who are homeless, the workforce supporting them, and those delivering and commissioning services. If the intervention is feasible and acceptable, we will use the results to design a full randomised controlled trial testing whether it works and is financially feasible to deliver. The study will also help increase understanding of how research can be done in homelessness settings.

We will continue to work with people experiencing homelessness and memory problems in designing the intervention and to guide us in running the project as promised in an ethical and efficient way.

Funding, awards and further study details

More details about the study methods can be found here on the ISRCTN registry. A link the study protocol can be found near the page end. A link to our NIHR funding page can be found here.