住所不定でもリハビリは必要:ホームレス状態にある人々のための入院リハビリテーションの調整:症例シリーズ
Jean-Luc Banks1, Julia Lam2, Maria Twitchell1
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Abstract:
Homelessness significantly hinders access to inpatient rehabilitation (IPR) services, particularly for individuals with complex medical and functional needs. This case series presents three persons experiencing homelessness (PEH) with disabilities-due to amputation, functional neurological disorder, and stroke-who require coordinated rehabilitation care. Each case illustrates the compounded barriers PEH face, including lack of stable housing, limited access to follow-up care, and fragmented healthcare and social service systems. Through interdisciplinary collaboration involving physiatrists, outreach occupational therapists, and social workers, each patient successfully accessed IPR and continued rehabilitation post-discharge despite persistent challenges. The cases underscore the importance of low-barrier, community-based care models and policy changes that view housing as a critical component of healthcare. Recommendations include adopting an expanded Housing First (+) model, improving medical respite programs, and integrating social services into rehabilitation planning. These strategies can improve health outcomes and community reintegration for PEH, highlighting the need for systemic reform to ensure equitable access to rehabilitation services.
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