**Background:** Older people experiencing homelessness face disproportionately high rates of chronic illness, geriatric syndromes (frailty, falls, cognitive impairment), depression, and trauma, yet specialised aged care services for this group are scarce in Australia. This study evaluated a new purpose-built aged care home in Sydney designed for older people with high care needs who are homeless or at risk of homelessness, incorporating a trauma-informed model of care with private rooms, domestic-style communal spaces, and a multi-skilled care worker-led staffing approach.
**Methods:** A longitudinal evaluation was conducted with residents recruited between March 2020 and April 2021. Health and wellbeing measures were collected at baseline (within the first month), 6 months, and 12 months post-admission. Instruments included: the Australian Functional Measure (AFM) for motor and cognitive functional independence; Rowland Universal Dementia Assessment (RUDAS) for global cognition; Clinical Frailty Scale (CFS); Timed Up and Go test (TUG) for mobility; Geriatric Depression Scale (GDS); PTSD Checklist–Civilian (PTSD-C); Personal Wellbeing Index-Adult (PWI-A); and EuroQol-5 Dimension Visual Analogue Scale (EQ-5D VAS) for overall health-related quality of life. Cost-utilisation data for 12 months pre- and post-admission were collected via self-report surveys, contact with service providers, and hospital records from three Local Health Districts. A cost-utility analysis using the EQ-5D-5L was conducted for the 13 residents with complete cost data. Linear mixed-effect models were used for longitudinal analyses, and frailty-based subgroup comparisons (not frail [CFS 0–5] vs frail [CFS 6–9]) were performed using non-parametric tests.
**Key Results:** Thirty-five residents enrolled (median age 75.6 years; 65.7% male; 37.1% with homelessness history; 62.9% referred from hospital). At baseline, 46% scored below the RUDAS cut-off for dementia/cognitive impairment, the majority were moderately frail (median CFS=6), at high risk for falls (median TUG=30 seconds), and had scores indicative of depression (median GDS=6). Median PWI (60) and EQ-5D VAS (50) were well below Australian norms. Over 12 months, linear mixed-effect models showed: significant improvement in personal wellbeing (PWI; F₁,₃₆.₁₈=5.16, p<0.05), with modelled scores rising above the Australian index; a trend toward improvement in health-related quality of life (EQ-5D VAS; F₁,₄₂.₇₀=3.01, p=0.09), with a mean increase of 16.8 points (more than double the minimal clinically important difference of 8 points); and a trend toward improvement in PTSD (F₁,₃₃.₅₈=4.06, p=0.052), with a mean reduction of 14.6 points. Motor functional independence, frailty, mobility, global cognition, and depression scores remained stable. Cognitive functional independence (AFM-Cognitive) declined significantly (F₁,₅₃.₀₇=7.08, p=0.01). In the frail group (n=21), 42.9% died within 12 months versus 0% in the not-frail group (n=14) (χ²=8.077, p<0.005). For the 13 residents with complete cost-utility data, average per-capita government costs decreased from AU$153,068 (12 months pre-admission) to AU$121,101 (12 months post-admission), a saving of ~AU$32,000 per resident, driven largely by reductions in inpatient hospital episodes (from AU$22,300 to AU$10,400) and ED visits (from AU$4,600 to AU$1,600). EQ-5D-5L utility scores remained stable (p=0.6).
**Clinical Implications:** This study provides preliminary evidence that a purpose-designed, trauma-informed aged care home can improve mental wellbeing and maintain physical function in older people subject to homelessness, while potentially reducing government healthcare costs. The clinically meaningful improvements in health-related quality of life and PTSD symptoms—despite the confounding effects of COVID-19 lockdowns—suggest that the supportive environment and specialised model of care were beneficial. The high mortality rate (42.9%) in frail residents underscores the vulnerability of this population and the need for early intervention. The stable EQ-5D-5L scores alongside cost savings indicate improved cost-effectiveness. However, the small sample, lack of a control group, potential survivor bias (given high mortality in the frail group), and reliance on a single site limit generalisability. These findings align with prior Australian research (the Wicking Project) and support calls for dedicated, holistic services that integrate trauma-informed care, stable housing, and multidisciplinary support for older people experiencing or at risk of homelessness.