How Common Is Homelessness in Emergency Departments?

Homeless people have higher rates of hospital and emergency department use than the general population and often suffer from serious conditions upon admittance, resulting in high medical costs and potentially long stays. These people are not always easily identifiable because of a lack of or improper documentation and recognition bias by emergency medicine professionals, which can result in improper care. This study sought to determine how prevalent homelessness is in emergency department settings and whether it varied by season and day of the week. The authors administered a survey, using a five-question screening tool created from the US Departments of Housing and Urban Development, Health and Human Services, and Veterans Affairs to define homelessness in three emergency departments in northeastern Pennsylvania. They included an inner-city hospital, a suburban trauma center with 100,000 visits per year, and a suburban hospital with 45,000 visits per year. The analysis included 4,395 people. Based on answers to survey questions, patients were categorized as homeless or at risk for homelessness. The authors used a chi-square to compare the distribution of homelessness or risk of homelessness by other study variables and then used logistic regression to explore the association between survey questions, clinical enrollment site, weekday-versus-weekend survey administration, and seasonality.

Key findings

• The prevalence of homelessness or risk of homelessness varied from 7.5 to 18.8 percent based on site. The urban site had the highest prevalence, but the trauma center (7.5 percent) and suburban (9.1 percent) sites had a higher homelessness presence than the authors anticipated, dispelling the stereotype that homelessness is only present in inner-city facilities.
• The authors did not observe a significant difference in the distribution of survey responses between weekday and weekend administration.
• 8 percent of the surveys were administered in the winter, and 47.2 percent were administered in the summer. Among the 5.8 percent who reported being concerned about losing their housing, the authors did not observe a significant difference by season. This dispels the common conception that homelessness is only an issue during colder months when patients don’t have warm shelters.
• This study shows that homelessness is a year-round concern, regardless of season, day of the week, or site. Further research on screening protocols for homelessness is necessary. Patient outcomes and potential money saved to the health care system should be factored into the cost of screening. Ultimately, a universal screening for homelessness in emergency departments should be implemented.