Bridging Healthcare Expertise with the Experience of Homelessness: How Do We Integrate Peer Support in Post-Acute Cardiac Care Transitions?

Background: There are many barriers for navigating care, and these are compounded for individuals who are marginalized and then facing a reality that has been altered by an acute health condition. This study aimed to co-develop and test the concept of a transition or ‘step-down’ process, which included assistance from a peer-support worker to support individuals who are homeless and discharged from hospital following an acute cardiac event.

 

Approach: A participatory action research approach aligns with developing a program suited to a vulnerable group by centring community voice and experience. Health care personnel from acute and community care were consulted, based on an interview guide created with individuals who have expertise and experience with homelessness and aware of the challenges that need to be overcome among this population during discharge from the hospital. The findings were analyzed using an inductive thematic analysis approach.

 

Results: While healthcare facilities offer various follow-up services including cardiac rehab programs, outreach teams, or advocacy for additional supports, there was an awareness that homeless patients face significant barriers accessing resources. Critical obstacles include lack of stable phone access and addresses for appointment communication, transportation challenges, and limited family support systems. Long waitlists for mental health, addiction services, and housing further compound these issues, often contributing to patient relapse.

Healthcare providers attempt to bridge these gaps through transportation assistance (taxi vouchers, bus passes), advocacy letters for shelter accommodations, culturally specific support workers, and assistance securing phone benefits through Employment and Income Assistance. When the role of a peer support worker was explored, a number of specific recommendations emerged: 1) understanding both healthcare and shelter systems based on lived experience, 2) possessing trauma-informed care knowledge, 3) assisting recovery according to a defined healthcare discharge process and 4) effectively advocating for patients while helping them navigate community resources. In essence, the peer support worker was expected to have a breadth of expertise beyond their lived experience, suggesting a greater comfort level with credentialed expertise and needed to feel a high degree of trust in the individual taking on this role. Short of this, there was some reluctance of whether and how to engage with a peer support worker.

 

Implications:

Findings: highlight that the needs of IEH are unique and multifactorial requiring an equally multifactorial, robust approach to health and social support. Strategies to better connect IEHs with a peer support worker and service providers leverages a responsive, sensitive approach for individuals with complex and unique health needs. However, our findings raise important questions concerning peer workforce integration, and ways to build relational and operational connections between the community and the health and social care systems.