title: Shelter-based convalescence for homeless adults in Amsterdam: a descriptive study.
abstract: BACKGROUND
  Adequate support for homeless populations includes shelter and care to recuperate from illness and/or injury. This is a descriptive analysis of diagnoses and use of shelter-based convalescence in a cohort of homeless adults in Amsterdam.
  
  
  METHODS
  Demographics of ill homeless adults, diagnoses, referral pattern, length of stay, discharge locations, and mortality, were collected by treating physicians during outreach care provision in a shelter-based convalescence care facility in Amsterdam, from January 2001 through October 2007.
  
  
  RESULTS
  629 individuals accounted for 889 admissions to the convalescence care facility. 83% were male and 53% were born in the Netherlands. The mean age was 45 years (SD 10 years). The primary physical problems were skin disorders (37%), respiratory disorders (33%), digestive disorders (24%) and musculoskeletal disorders (21%). Common chronic conditions included addictions 78%, mental health disorders 20%, HIV/AIDS 11% and liver cirrhosis 5%. Referral sources were self-referred (18%), general hospitals (21%) and drug clinics (27%). The median length of stay was 20 days. After (self)discharge, 63% went back to the previous circumstances, 10% obtained housing, and 23% went to a medical or nursing setting. By March 2008, one in seven users (n = 83; 13%) were known to have died, the Standard Mortality Ratio was 7.5 (95% CI: 4.1-13.5). Over the years, fewer men were admitted, with significantly more self neglect, personality disorders and cocaine use. Lengths of stay increased significantly during the study period.
  
  
  CONCLUSIONS
  Over the last years, the shelter-based convalescence care facility users were mainly homeless single males, around 45 years of age, with chronic problems due to substance use, mental health disorders and a frail physical condition, many of whom died a premature death. The facility has been flexible and responsive to the needs of the users and services available.
authors.affiliation: Dr Valckenier Outreach Practice for Homeless People, GGD Municipal Public Health Service, Amsterdam, The Netherlands. ivlaere@ggd.amsterdam.nl
authors.forename: Igor
authors.initials: I
authors.lastname: van Laere
authors.forename: Matty
authors.initials: M
authors.lastname: de Wit
authors.forename: Niek
authors.initials: N
authors.lastname: Klazinga
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000379:methods*; D003289:Convalescence; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands