Early Detection and Intervention Could Improve Health Outcomes for Homeless Families

More than a third of homeless people are part of a family, most of which are headed by women with at least one child. Homeless families are different from single homeless people, and their needs differ. But limited research focuses on these families. This study aims to fill the gap by exploring longitudinal health service use and expenditures for homeless family members before and after entering an emergency shelter.

Using administrative data from Massachusetts, this study analyzes the health care use and Medicaid expenditures of families who experienced one or more homeless episodes between 2008 and 2015 to investigate how health care use is related to emergency housing experiences. Of the study group, 55.9 percent were children and 44.1 percent were adults. Nearly 8 in 10 adults were women with a mean age slightly younger than 30, and children averaged younger than 6. Eighty-eight percent experienced only one episode of homelessness during the study period. Findings suggest that increased emergency department (ED) use and health expenditure begins in the months leading up to a family’s homeless episode.

Key findings

• ED use, hospital admissions, and expenditures increased in the month before the start of a homeless episode.
• Thirty-five percent of children and 53 percent of adults had at least one ED visit in the 12 months leading up to an emergency housing assistance episode.
• Younger children had significantly higher rates of ED use, hospital admissions, and expenditures than older children.
• Adults and children with no previous shelter episodes had lower odds of an ED visit than those with previous homeless episodes.
• Placing families in shelters outside their home community increased ED use because their regular sources of care were too far away.
• Pregnancy and childbirth were most often (40 percent) the reason for adult hospital admission, followed by alcohol or drug use, depression, asthma, and anxiety disorders.
• Upper respiratory infection, lower respiratory disease, otitis media, asthma, and allergic reactions were the most common reasons for ED visits by children.

Policy implications

• After entering emergency shelters, health expenditures decreased, indicating that assistance can lower health care costs.
• Early detection of families at risk of becoming homeless and intervention could save money and improve family health.

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