No Place to Call their Own: Addressing Homelessness and Housing in the ED

Patients who are homeless visit the ED more often than the general population, yet we get minimal formal education about homelessness and the impact of housing on health. We'll talk with 3 physicians about their experience around homelessness and housing and how we can best support our patients struggling with housing issues.

No Place to Call their Own: Addressing Homelessness and Housing in the ED

Overview
Patients who are homeless visit the ED more often than the general population, yet we get minimal formal education about homelessness and the impact of housing on health. In this episode, we talk with three physicians about their experience around homelessness and housing and how we can best support our patients struggling with housing issues.

Key Resources:

• State of Homelessness: 2020 Edition https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/
• Point in Time Volunteer/Homeless Census Training 
  https://www.hudexchange.info/resource/5864/pit-count-volunteer-training-toolkit/

Dr. Chen's Recent Publication

• Chen KL, Wisk LE, Nuckols TK, Elmore JG, Steers WN, Zimmerman FJ. Unmet Medical Needs Among Adults Who Move due to Unaffordable Housing: California Health Interview Survey, 2011–2017. J Gen Intern Med. 2020; Dec 28;1-8.

Organizations mentioned in this episode:

• Housing First: https://endhomelessness.org/resource/housing-first/
• Neighborhood Service Organization: https://www.nso-mi.org/
• Covenant Community Care: https://covenantcommunitycare.org/
• Operation Safety Net (Pittsburgh, Pennsylvania): https://www.pittsburghmercy.org/homeless-services/pittsburgh-mercys-operation-safety-net/
• Vanderbilt Street Medicine Project: "How Street Medicine Saved One Hospital $3.7M in ED Costs"  & recent Health Affairs article: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.00998?journalCode=hlthaff
• Bon Secours (Baltimore, Maryland): https://www.bonsecours.com/
• National Health Care for the Homeless Council: https://nhchc.org/
• Boston Health Care for the Homeless: https://www.bhchp.org/
• Homeless Action Network of Detroit: https://www.handetroit.org/
• Covenant House: https://covenanthousemi.org/
• Street Medicine Detroit: http://streetmedicinedetroit.org/
• National Clinician Scholars Program: https://nationalcsp.org/

Books on how housing has created a stratified society and policies/programs to improve housing (& health!) equity

• Affordable City - Shane Phillips
• The Color of Law - Richard Rothstein
• Evicted - Matthew Desmond
• Stories from the Shadows: Reflections of a Street Doctor - Dr. Jim J O'Connell

Articles on what health systems are doing about housing

• Affordable Housing Investment: A Guide for Nonprofit Hospitals and Health Systems - Urban Institute
• Housing and Health: A Roadmap for the Future - American Hospital Association

Peer Review

• Brown RT, Steinman MA. Characteristics of emergency department visits by older versus younger homeless adults in the United States. Am J Public Health. 2013;103(6):1046-1051.
• Doran KM, Curry LA, Vashi AA, Platis S, Rowe M, Gang M, Vaca FE. Rewarding and Challenging at the Same Time: Emergency Medicine Residents' Experiences Caring for Patients Who Are Homeless. Acad Emerg Med. 2014;21(6):673-679.
• Ku BS, Fields JM, Santana A, Wasserman D, Borman L, Scott KC. The urban homeless: super-users of the emergency department. Popul Health Manag. 2014;17(6):366-371.
• Lamparter LE, Rech MA, Nguyen TM. Homeless patients tend to have greater psychiatric needs when presenting to the emergency department. Am J Emerg Med. 2020;38(7):1315-1318.
• Lombardi K, Pines JM, Mazer-Amirshahi M, Pourmand A. Findings of a national dataset analysis on the visits of homeless patients to US emergency departments during 2005-2015. Public Health. 2020;178:82-89.
• Salhi BA, White MH, Pitts SR, Wright DW. Homelessness and emergency medicine: a review of the literature. Acad Emerg Med. 2018;25(5):577-593.