Regions Hospital: Caring For The Homeless

Homeless people have specific healthcare needs that are often more advanced and complex than those of their low-income peers. They are more susceptible to certain diseases, have greater difficulty accessing healthcare, and are harder to treat. As a result, they frequently rely on emergency rooms, clinics, hospitals, and other facilities that serve the poor. However, homeless people often face barriers to accessing healthcare, including distrust of authority and negative experiences with healthcare providers. To address these challenges, various programs and policies have been developed to enhance care coordination and discharge planning for homeless patients. These initiatives aim to improve the continuity of care and increase cooperation with caregivers, recognizing the importance of preventing hospital revisits, which can be costly for the healthcare system. While there is limited research on hospital discharges and readmissions for homeless individuals, especially in the Canadian context, studies suggest that homeless patients may receive better care when treated at hospitals experienced in caring for homeless people.

Homeless people are more likely to be readmitted to hospitals

Furthermore, there is a high prevalence of mental health issues and substance abuse among the homeless population, which can lead to repeated hospitalizations. The lack of stable housing also makes it challenging for individuals to follow through with recommended treatments, adhere to medication regimens, or attend follow-up appointments, resulting in a higher likelihood of readmission. Trust issues with authority figures, including healthcare providers, can also contribute to homelessness and affect an individual's willingness to engage with the healthcare system proactively.

The transient nature of homelessness also plays a role in readmissions. Homeless individuals may not have a consistent place to recover after discharge, leading to a higher risk of readmission. They may also face challenges in accessing transportation to follow-up appointments or specialized care, further contributing to readmission rates. Additionally, the lack of systematic screening and limited specialty services within homeless assistance programs can hinder the identification and treatment of underlying health conditions, resulting in recurring health crises that require hospitalization.

To address these issues, there have been efforts to improve healthcare services for the homeless. Some hospitals and communities are developing on-site medical clinics and coordinating with local departments of community services to provide continuity of care. California, for example, has standardized payment for street medicine through its Medicaid program, enabling community and nonprofit hospitals to better serve the homeless population. By recognizing the unique needs of homeless individuals and implementing targeted interventions, readmission rates can potentially be reduced, improving health outcomes and overall well-being for this vulnerable population.

Hospitals experienced in treating homeless people can reduce readmissions

Homeless people have long relied on emergency rooms, clinics, hospitals, and other facilities that serve the poor to meet their healthcare needs. However, they face many obstacles in obtaining healthcare, including higher rates of mental illness and substance use disorder, as well as socioeconomic factors such as a lack of social support and limited financial resources. As a result, they are more susceptible to certain diseases and have greater difficulty accessing healthcare.

As the homeless population in the United States continues to grow, so does the challenge of providing effective care to this vulnerable group. Studies have shown that homeless patients have higher rates of readmissions and emergency department (ED) visits after hospital discharge compared to non-homeless patients. However, homeless patients treated at hospitals experienced in caring for the homeless ("homeless-serving" hospitals) exhibited lower rates of readmissions and ED visits.

For example, a study in Florida, Massachusetts, Maryland, and New York in 2014 found that homeless patients treated at homeless-serving hospitals had lower readmission rates (23.9% vs. 33.4%) and ED visit rates (31.4% vs. 45.4%) after discharge compared to those treated at non-homeless-serving hospitals. Similarly, a Hospital In-reach program piloted in two large NHS hospitals in Edinburgh, UK, in 2020 has shown promising results in reducing readmissions among the homeless population.

These findings suggest that hospitals experienced in treating homeless patients can play a crucial role in reducing readmissions and improving healthcare outcomes for this vulnerable population. By providing better discharge planning and care coordination, homeless-serving hospitals can help address the unique healthcare needs of homeless individuals and contribute to a more sustainable and equitable healthcare system.

Furthermore, addressing homelessness and connecting people to healthcare, social services, and housing are also key components in reducing readmissions. For instance, California has made addressing homelessness a top priority and is developing strategies to reduce homelessness and improve access to healthcare and housing. By integrating data from various sources, such as local housing assistance agencies and specialty mental health services, policymakers can develop more evidence-based policies to prevent homelessness and improve outcomes for those experiencing homelessness.

Hospitals are the frontline providers of healthcare for homeless people

Homeless people have long relied on hospitals, clinics, and other facilities that serve the poor to meet their healthcare needs. They are more susceptible to certain diseases and face greater challenges in accessing healthcare. As a result, hospitals have become the frontline providers of healthcare for the homeless.

Hospitals are often the only option for homeless people to access healthcare services. They may also rely on hospitals for shelter and food. The high disease profile and medical vulnerability of homeless people are well-known, with higher rates of mental illness and substance use disorders. They also face issues related to socio-economic factors, such as a lack of social support and limited financial resources, which further impact their health.

Hospitals with more experience treating homeless patients are better equipped to provide discharge planning and care coordination. This can lead to lower rates of hospital readmission and emergency department (ED) visits, which are quite common among the homeless population. Studies have shown that homeless patients are more likely to return to the ED within 30 days of discharge, especially when treated at hospitals with less experience serving the homeless. This may be due to a lack of appropriate discharge planning and coordination, as well as the lack of resources in emergency shelters to support critical follow-up care.

To address these challenges, federal and state governments have implemented programs and policies. For example, California requires hospitals to provide written plans for coordination and referrals to social service agencies for homeless patients upon discharge. Additionally, interdisciplinary teams of physicians, nurses, and social workers have been established on-site at hospitals and shelters to improve continuity of care. These efforts recognize the unique healthcare needs of homeless individuals and aim to enhance the effectiveness of healthcare delivery systems for this vulnerable population.

Homeless people face barriers to accessing healthcare

Homeless people face a multitude of barriers when accessing healthcare services. Firstly, homeless people are more susceptible to certain diseases and experience poor health and premature death due to their limited access to healthcare, which is further exacerbated by their lack of housing. This is evident in the higher rates of emergency department (ED) use by the homeless population, with studies suggesting that between 30% and 60% of homeless people access care at EDs, and even higher rates among the chronically homeless. The reliance on emergency rooms and hospitals for healthcare is a result of the barriers they face in obtaining regular healthcare services.

One of the primary barriers is the financial burden of healthcare. Living in poverty means that homeless people are constantly struggling to pay for basic needs such as food and housing, leaving little to no money for healthcare. This is further worsened when individuals lack the financial means to afford healthcare insurance, which further limits their access to healthcare services and treatment.

In addition to financial barriers, homeless people also face systemic issues such as discrimination, lack of resources, and programs that lack cultural competency. These issues disproportionately impact certain communities, such as BIPOC and LGBTQ+ populations, and contribute to the higher rates of homelessness within these groups. Furthermore, the lack of affordable housing and inadequate income support are also systemic issues that contribute to homelessness and limit access to healthcare.

The transient nature of homelessness also presents challenges in accessing healthcare. Many shelters are closed during the day, limiting the ability of homeless people to access healthcare services during regular hours. Additionally, the lack of a fixed address or medical records can create obstacles in registering for and receiving continuous healthcare services.

The complex relationship between homelessness and mental health further complicates access to healthcare. Mental illness can be both a cause and a consequence of homelessness. The stigma associated with mental illness and the lack of trust in authorities and healthcare providers can deter homeless individuals from seeking mental health treatment. The shortage of mental health resources and the limited specialty services available in shelters and hospitals also contribute to the barriers faced by homeless individuals in accessing the necessary care.

To address these barriers, comprehensive solutions are required, including systemic changes to increase affordable housing, improve income support, and enhance access to quality healthcare. These measures must be combined with direct responses to provide immediate shelter, supportive services, and pathways to permanent housing for those experiencing homelessness.

Hospitals use discharge data to inform homelessness policy

Homeless people are more likely to suffer from mental and physical health issues due to their exposure to the elements, disease, violence, unsanitary conditions, malnutrition, stress, and addictive substances. They also face challenges in accessing primary healthcare and often rely on hospitals for basic needs like food and shelter. As a result, hospitals have become the frontline of care for homeless people.

In recognition of this, a recent California state law (SB 1152) requires hospital emergency departments (EDs) to provide food, clothing, and appropriate referrals, among other services, during the discharge process for homeless patients. Hospitals must also keep a written record of what happens when a homeless patient is discharged, including medications and food offered, as well as referrals to assistance programs and outpatient health providers.

By comparing and linking this discharge data from EDs with details from homeless assistance programs and other state resources, policymakers can gain valuable insights into the size, distribution, and characteristics of the homeless population, as well as their interaction with hospital EDs. This information can then be used to inform and improve the state's response to homelessness by guiding decision-making and directing funding to the services that are most beneficial.

For example, in California, Medi-Cal covered 70% of ED visits by homeless patients. By integrating data between systems, such as county mental health services, jails, and hospital EDs, policymakers can identify patients who may not be getting connected to the right services and direct them to programs like CalAIM, which offers intensive case management and community services for homeless Californians.

Additionally, hospitals that serve a large number of homeless patients can use discharge data to conduct needs assessments and develop targeted, contextually flexible interventions and policies around discharge planning to better meet the needs of this vulnerable population. Effective discharge planning can improve recovery rates and reduce hospital costs by reducing readmission rates.

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