428 Prevalence of Homelessness and Housing Insecurity in an Urban Emergency Department

Abstract

Homelessness is a substantial problem in the United States. Currently, the US Department of Housing and Urban Development estimates that over 560,000 people experience homelessness on any given night, and up to 1.5 million individuals experience homelessness over the course of a year. Homeless persons pose special challenges for the emergency provider. Prevalence of homelessness in the ED is primarily estimated from the ED component of the NHAMCS database, which estimates that homeless persons account for 0.5% of ED visits nationally. We hypothesized that this measure may underestimate the prevalence of homelessness and housing insecurity among ED patients as housing status is under-discussed in the acute care setting. The goal of this study is to determine the prevalence of homelessness and housing insecurity among ED patients in an urban safety net Atlanta hospital. A cross-sectional survey of a convenience sample of patients presenting to the ED over a 3-month span was performed. A team of trained research assistants administered a structured survey instrument. Patients were surveyed in all areas of the ED and at all times of the day. Patients were 18 years old, English-speaking, not incarcerated, and able to provide informed consent. 923 ED patients (55.1% Male; Median Age = 44) completed the survey. The racial makeup of the sample was as follows: 71.3% Black, 16.7% White, 6.5% Hispanic, 1.6% Asian and 4% self-identified as “other.” Most patients had at least a High school education (42.1% high school/GED; 41.5% at least some college; 16.4% did not High school and were unemployed (47.9% unemployed; 19.4% part-time; 32.7% full-time). 51.5% of surveyed ED patients reported some measure of housing insecurity in the past 12 months: moved in with others to save money (19.9%); lived with others but didn’t pay rent (30.2%); skipped mortgage or rent payment (12%); experienced eviction (8%); lived in a hotel or motel (21.2%); lived in a place not meant for human habitation (8.2%); slept in a shelter (14.2%); slept on the street (12.5%). 42% of homeless or housing-insecure women reported that they were also caring for children. The rate of housing-insecure patients at our hospital is substantially greater than the national estimates. While this may be a result of selection bias in our safety-net setting, our results suggest that homelessness and housing insecurity may be under-recognized among ED patients. Given the well-documented association between homelessness, poor health and repeat ED visits our study may have far reaching implications in recognizing and treating these patients in the ED. More research is needed on homelessness and its implications for ED Patients.