Shelter Environment Research Articles

The Impact of Job Demands, Job Resources, and Organisational Justice on Global Health and Turnover Intentions in Animal Care Workers

Animal care workers in sheltering, rescue, and management are exposed to occupational stressors which negatively impact health. While the negative mental health impacts have been previously documented in this population, physical health, and its contributing factors, have not. This study investigated how job demands, job resources, and organisational justice relate to mental and physical health, and how they subsequently affect turnover intentions. Of the 285 participants, aged 19 to 94 years, who completed the online anonymous questionnaire, below average mental and physical health was reported. Mental health, but not physical health, was inversely related to intentions to leave. After controlling for age, hierarchical multiple regressions showed high emotional demands and direct euthanasia exposure significantly predicted poorer mental and physical health, while high levels of social support predicted better mental and physical health. No additional variance in either health domain was accounted for by organisational justice. It was concluded that both physical and mental health may be negatively impacted in those who work in shelter, rescue, and management environments which could lead to high turnover and poor outcomes for individuals and organisations. Monitoring through ongoing health records to enable early intervention and accommodations should be considered to promote the health of these workers.

An Integrated Algorithm Fusing UWB Ranging Positioning and Visual–Inertial Information for Unmanned Vehicles

During the execution of autonomous tasks within sheltered space environments, unmanned vehicles demand highly precise and seamless continuous positioning capabilities. While the existing visual–inertial-based positioning methods can provide accurate poses over short distances, they are prone to error accumulation. Conversely, radio-based positioning techniques could offer absolute position information, yet they encountered difficulties in sheltered space scenarios. Usually, three or more base stations were required for localization. To address these issues, a binocular vision/inertia/ultra-wideband (UWB) combined positioning method based on factor graph optimization was proposed. This approach incorporated UWB ranging and positioning information into the visual–inertia system. Based on a sliding window, the joint nonlinear optimization of multi-source data, including IMU measurements, visual features, as well as UWB ranging and positioning information, was accomplished. Relying on visual inertial odometry, this methodology enabled autonomous positioning without the prerequisite for prior scene knowledge. When UWB base stations were available in the environment, their distance measurements or positioning information could be employed to institute global pose constraints in combination with visual–inertial odometry data. Through the joint optimization of UWB distance or positioning measurements and visual–inertial odometry data, the proposed method precisely ascertained the vehicle’s position and effectively mitigated accumulated errors. The experimental results indicated that the positioning error of the proposed method was reduced by 51.4% compared to the traditional method, thereby fulfilling the requirements for the precise autonomous navigation of unmanned vehicles in sheltered space.

Features of causes of indirect certified disaster-related death in areas affected by the Fukushima Daiichi nuclear power plant accident: an observational study

ObjectivesTo investigate the details of disaster-related deaths due to the indirect health effects of the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident following the Great East-Japan Earthquake in 2011 and...

Leptospira spp. Antibody Seroprevalence in Stray Dogs and Cats: A Study in Milan, Northern Italy

Leptospirosis is a widespread zoonosis recognised as a re-emerging infectious disease in both humans and dogs, yet the actual seroprevalence of Leptospira in pets in Italy is relatively unknown. The aim of this study was to evaluate Leptospira antibody prevalence in dogs and cats from a shelter by the microscopic agglutination test (MAT), the gold standard test in leptospiral serology, and to assess risk factors for Leptospira infection. This seroepidemiological study investigated the prevalence of leptospiral antibodies in a cohort of 106 dogs and 51 cats housed in a municipal shelter in Milan. Blood samples were collected from the animals during two sampling periods: spring/summer 2014 and autumn/winter 2016/2017. Eight serogroups were evaluated: L. Australis, L. Ballum, L. Canicola, L. Grippotyphosa, L. Icterohaemorrhagiae, L. Pomona, L. Sejroe, and L. Tarassovi. Antibody titres ranged from 1:100 to 1:6400. The results indicated that 21.7% of dogs had antibodies against serogroups L. Icterohaemorrhagiae and L. Australis, making them the most often found. Conversely, none of the cats showed any presence of antibodies. Seropositivity was higher in the spring/summer period (32.7%) than in autumn/winter (11.1%), and no statistically significant results were found regarding sex or age. These findings underscore the importance of ongoing serological surveillance and biosecurity measures in shelter environments to mitigate the zoonotic risk posed by leptospirosis.

Assessment of the quality of life of cats affected by paraparesis/paraplegia and urinary retention, and their impact on caregivers.

In cats affected by severe thoracolumbar spinal cord pathologies, paraplegia and paraparesis, often accompanied by urinary retention, pose significant challenges, impacting both the cats' welfare and owners' lives. This study aimed to assess the quality of life (QoL) of cats affected by these conditions, and to evaluate the social and familial implications for caregivers. The study was structured into two parts. The first part comprised direct observations of aspects of QoL in cats both in household and shelter settings, while the second part involved the distribution of questionnaires to cat owners and shelter operators. Cats with paraplegia/paraparesis and urinary retention can maintain a good QoL, with hindlimb mobility significantly influencing QoL scores. Shelter cats showed a comparable QoL to household cats, challenging the anecdotal beliefs that shelter cats with severe neurological impairments are destined to lead substandard lives. Operator surveys highlighted the feasibility of managing these cats in shelter environments, emphasising the importance of collaboration between caregivers and veterinary professionals. Likewise, owner surveys revealed a manageable time commitment for care, with most owners achieving proficiency in manual bladder expression within 1 month. Despite challenges, most of the owners reported positive experiences and did not contemplate euthanasia for their cats. Regular veterinary visits and occasional physiotherapy were common practices among caregivers. Owners who respond to the questionnaire and shelter operators have a high commitment to cats with paraplegia/paraparesis. Although the study acknowledges this potential bias, it suggests that dedicated care can ensure a good QoL for cats with severe spinal injuries, both in shelter and household settings. Effective communication between caregivers and veterinary professionals is essential for accurate information dissemination and optimal care provision. This research contributes to raising awareness of managing these conditions and emphasises the importance of collaborative care approaches in veterinary medicine.

Assessment of Physicochemical Properties and Consumer Preferences in Cherry Tomato Cultivars Observe under Growing Climates and Watering Regimens

ABSTRACTThe physicochemical and antioxidant qualities of cherry tomatoes are getting more and more valued, and this has a significant effect on consumer choices and market dynamics. With irrigation schedules of 100%, 75%, and 50% field capacity, Ruby and Fortesa cultivars were grown in a greenhouse, rain shelter, and screen house climates in this experiment, which used a Randomized Complete Block Design (RCBD) factorial technique. The chroma value, flavonoid content, phenolic content, vitamin C content, and antioxidant activity of cherry tomatoes are the main quality parameters investigated in this study, along with the effects of cultivars, growing climates, and watering regimens. According to the results, the cultivar significantly affected chroma value, with Fortesa showing the highest value. Cultivar and growing climate significantly affected flavonoid content, with Fortesa and rain shelter environments exhibiting the most significant values. Cultivar and growing climate significantly impacted vitamin C content; ruby and greenhouse conditions produced the maximum amounts. Across all parameters, there were significant variances in antioxidant activity; Ruby showed the maximum activity, and the rain shelter provided the ideal growing environment. The market analysis conducted for the study reveals that higher‐quality cherry tomatoes are famous among upscale and health‐conscious consumers due to their high flavonoid and phenolic content, brilliant chroma value, and considerable antioxidant activity. With the help of this research, targeted cultivation techniques and marketing strategies may be created to cater to specific consumer desires and maximize market positioning and profitability.

Investigation of Bus Shelters and Their Thermal Environment in Hot–Humid Areas—A Case Study in Guangzhou

The acceleration of urbanization intensifies the urban heat island, outdoor activities (especially the road travel) are seriously affected by the overheating environment, and the comfort and safety of the bus shelter as an accessory facility of road travel are crucial to the passenger’s experience. This study investigated the basic information (e.g., distribution, orientation) of 373 bus shelters in Guangzhou and extracted the typical style by classifying the characteristics of these bus shelters. Additionally, we also measured the thermal environment of some bus shelters in summer and investigated the cooling behavior of passengers in such an environment. The results show that the typical style of bus shelters in the core area of Guangzhou is north–south orientation, with only one station board at the end of the bus, two backboards, two roofs (opaque green), and the underlying surface is made of red permeable brick. The air temperature and relative humidity under different bus shelters, tree shading areas, and open space in summer are 34–37 °C and 49–56%, respectively. For the bus shelters with heavy traffic loads, the air temperature is basically above 35.5 °C, and the thermal environment is not comfortable. During the hot summer, when there is no bus shelter or trees to shade the sun, the waiting people adjust their position with the sun’s height, azimuth angles, and direct solar radiation intensity to reduce the received radiation as much as possible, which brings great inconvenience to them. When only bus shelters provide shade, people tend to gather in the shaded space, and cooling measures such as umbrellas, hats, and small fans are still needed to alleviate thermal discomfort. However, the aforementioned various spontaneous cooling behaviors still cannot effectively alleviate overheating, and it is very important to increase auxiliary cooling facilities in bus shelters.

The Increasing Adoption Potential of Undersocialized Cats and Kittens: Blessing or Curse?

The most appropriate management strategy for a cat entering a shelter environment varies based on many factors. Perhaps the most important of these is the cat's level of socialization to people. For unsocialized/poorly socialized cats, pathways such as TNR or alternative placement are typically considered more appropriate for their quality of life. This is particularly true for older cats, outside of the socialization phase. However, as supply of cats have declined and rates of pet ownership have increased, there is increasing pressure for shelters to find homes for cats with socialization histories that would not have been deemed adoptable previously, and adopters are more willing to adopt poorly socialized cats. There has been no investigation of the well-being of poorly socialized cats in their adoptive homes or the experience of these adopters. Adopters of 57 adult cats identified as undersocialized and 155 control cats (not suspected of being undersocialized) were surveyed about their cat’s behaviour and their own satisfaction. Control cats were rated as less fearful, more affectionate, more likely to engage when approached (by either a stranger or their adopter), and more likely to enjoy petting (by either a stranger or their adopter) than undesocialized cats. Owners of control cats also reported greater satisfaction and were more likely to state that their cat would be happier in a home environment than regularly fed outdoors. Adopters of 134 kittens identified as undersocialized and 591 control kittens (not suspected of being undersocialized) were surveyed about their kitten’s behaviour and their own satisfaction. In this survey, control kittens were rated as less fearful, and more likely to engage when approached by a stranger or enjoy a stranger petting them, but there was no difference in ratings of affection, relationship with their owner (either by engaging when approached or enjoyment of petting), adopter satisfaction, or what environment the adopter states the kitten would be happier. Results suggest that although it is becoming more possible to place undersocialized cats in homes, these environments may not be in the best interests of the cats’ or adopters’ quality-of-life. Results for undersocialized kittens suggest that while they may still be prone to fear, particularly towards strangers, both the kitten and the owners have good quality-of-life and satisfaction post-adoption.

Nonparametric assessment of two-dimensional density of nonlinear location signal distribution for object recognition despite background noise

Problem statement Searching for objects in shelter environments is a challenge associated with the difficulty of obtaining and interpreting search results. Currently, within the statistical theory of detection and recognition, no models and methods have been developed that allow automatically identifying the detected object. This is due to the difficulty of describing signal and noise models in the form of known statistical distributions. The variety of signals leads to the inability to describe them by any universal law of distribution. Therefore, traditional detection and recognition criteria do not provide high reliability of object search and identification. The purpose of the study. To develop and test the method for nonparametric estimation of nonlinear location signals, assess the potential possibilities of applying the developed method for automatic (automated) signal detection (recognition) systems. Results. The model for recognizing nonlinear location signals based on nonparametric approximation of two-dimensional probability distribution densities is presented. The potential possibility of improving the efficiency of nonlinear locators is shown. Practical significance. For nonlinear location systems a toolkit for estimating the probability of the detected object belonging to a given class of objects is proposed.

Improving Animal Welfare in Shelter Environments in Northern Cyprus

Animal shelters are facilities established to meet the shelter needs of animals that have no home or have been abandoned by their owners. Animal shelters in contemporary aim to provide homeless animals with a temporary house and at the same time try to help feed them and healthily care for them. The continuously growing animal population in Northern Cyprus highlights the importance of animal shelter design and operational aspects for animal well-being. Drawing on interdisciplinary principles from interior design, spatial quality, and animal psychology, the study aims to transform shelters from confinement spaces into environments that promote long-term welfare. Using a qualitative, interpretive approach, the research conducts a systematic review of existing literature to analyze shelter conditions, human-animal interactions, and spatial dynamics in current facilities. The implications of this study are expected to make a valuable contribution to the development of design principles and standards that target the improvement of both the physical and psychological living conditions in animal shelters. The goal of the study is to maximize the current state of shelter conditions and lead the way in maximizing animal welfare. These principles aim to provide real solutions to reduce the stress of animals in animal shelters in North Cyprus, to increase adoption rates, and more importantly to develop a humane shelter system. Through the systematic examination of these overlooked concerns, the present study substantially enhances the welfare of animals in shelters while simultaneously optimizing the efficacy of the animal care methodologies.

Process Mapping: The Path Taken by Health Service Waste in a Hospital

Purpose: This research aimed to map the waste management process of the health services of the medical clinic of a university hospital in the south of the country. Theoretical framework: The theoretical basis involves the approach of process mapping, as well as the management and management of health services waste. Method: This is a qualitative research carried out in the medical clinic of a university hospital in the south of the country. Data collection took place through non-participant observation and the data obtained were compiled in a Microsoft® Word file (2021) and used to build the process map of health services waste from the medical clinic, developed through a flowchart. Results and conclusions: It was evident that the medical clinic of the investigated hospital has the recommended documentation, as well as human and material resources. However, inconsistencies were identified in the process, which emphasizes the need for educational actions, replacement of damaged equipment, identification of dumpsters, transport cars and shelters, adequacy of the temporary shelter environment, and restriction of the external shelter to access only for those involved in waste management. Research implications: It was possible to understand the management of clinical medical waste and identify inconsistencies that impact on the effectiveness of its management, highlighting the relevance of mapping processes, especially in the context of health waste. Originality/value: The research contributes by inciting interest in research and practical reflection on the way waste is organized and treated, especially in the context of health.

Research on Sustainable Temporary Shelters for Climate Refugees-Taking New York as an Example

As homelessness in New York has become increasingly serious in the aftermath of the epidemic and government-provided housing is far from adequate to meet the needs of the homeless, this paper applies the concept of sustainability to how housing is provided for the homeless to solve the problem of homelessness as quickly as possible while protecting the environment and reducing unnecessary pollution. For sustainability, this paper focuses on two main aspects, namely the use of materials and water recycling systems. As for the environment of the homeless shelter, the main factor considered is the airflow within the building. Out of consideration for the different needs of different people, this design will be built in a modular way to allow for the regeneration of the shelter and the building to meet individual needs. The paper, therefore, concludes with ideas, designs, and proposals for providing housing for the homeless in New York to meet the needs of sustainability in today's environment. Also in response to the growing environmental crisis, the research in this paper will also serve as an attempt to address the issue of future refugees caused by the environmental crisis.

Nocturnal activity as a useful indicator of adaptability of dogs in an animal shelter and after subsequent adoption

Dogs in shelters are faced with the challenge of adapting to a kennel after relinquishment and to a novel home after adoption. To measure adaptability of dogs, more feasible behavioural and physiological parameters need to be validated in different contexts. To evaluate nocturnal activity as an indicator of adaptability, we compared nocturnal activity, urinary cortisol:creatinine ratio (UCCR), and body weight changes of sheltered dogs the first period after intake in the shelter and after adoption. Nocturnal activity and UCCRs were significantly lower the first days after adoption than in the shelter. After adoption, nocturnal activity was significantly lower on night 2 than night 1, but not on night 3 and 4, suggesting a form of ‘rebound of resting’ during night 2 in the new home. UCCRs significantly decreased 7 days after adoption. Body weight decreased in the shelter but increased again after adoption. These findings suggest that overall, dogs rest better in a novel home than in a novel shelter but, in both contexts, some form of adaptation takes place. Nocturnal activity measured by an accelerometer differentiated well between shelter and home environments, and corresponded to UCCR responses, which supports usefulness of the method to monitor canine adaptability to novel environments.

An Aptian sponge-associated decapod crustacean assemblage from Cal Cassanyes (Catalonia, north-east Iberian Peninsula): Taxonomy and palaeoecological implications

A highly diverse decapod crustacean fauna is described from the classic Aptian outcrop of Cal Cassanyes (Castellet i la Gornal) in Catalonia. Although decapod crustaceans are a minor component of the rich invertebrate assemblages at that locality, the just over fifty specimens collected comprise sixteen taxa assignable to the Macrura, Anomura and Brachyura. Of these, the last-named are the most prominent group, comprising eleven species, representing seven families, inclusive of one representative of the Eubrachyura. On the basis of this material, two new genera and five new species are erected, namely Pagurus? garrafensis sp. nov., Garrafosopon gen. nov. angustus (Wright and Collins, 1972) comb. nov., Vectis blesai sp. nov., Mesodromilites prietoi sp. nov., Necrocarcinus mariae sp. nov. and Iberodorippe vinea gen. nov., sp. nov. In addition, Hoploparia sp., an indeterminate axiid and one paguroid, as well as one indeterminate galatheoid are recorded here. Material of Distefania incerta (Bell, 1863), the commonest species at the study site by far, of Goniodromites laevis (Van Straelen, 1940) and of Etyxanthosia fossa (Wright and Collins, 1972) represents the first Aptian and stratigraphically oldest records for these taxa. Added to this list are also Eodromites sp., Paranecrocarcinus? sp. and Pseudonecrocarcinus? sp. The high decapod crustacean diversity at Cal Cassanyes establishes this locality as the richest Aptian assemblage from the Iberian Peninsula, but also one of the richest in the world. The faunal assemblages here are dominated by sponges, and the varied composition of the decapod crustacean faunas can be linked to upwelling currents which provided abundant nutrients. In fact, the establishment of sponge communities played a crucial role in activating the food chain and functioned similarly to a patch reef, creating a relatively sheltered environment that facilitated the colonisation of other invertebrate communities, including decapod crustaceans. The latter occupied various trophic levels as both primary and secondary consumers. Current knowledge of Early Cretaceous decapod crustaceans is scant and hinders a thorough palaeobiogeographical analysis. The present study emphasises the challenges surrounding the identification of endemic taxa, thus impacting our understanding of decapod crustacean palaeobiogeography of the late Early Cretaceous.

Prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and feline enteric coronavirus (FECV) in shelter-housed cats in the Central Valley of California, USA.

Non-human animals are natural hosts for the virus causing COVID-19 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and a diversity of species appear susceptible to infection. Cats are of particular concern because of their close affiliation with humans and susceptibility to infection. Cats also harbour feline enteric coronavirus (FECV). Our objectives were to document the prevalence of SARS-CoV-2 and FECV in feline populations with high turnover and movement among households in the Central Valley of California, USA. A cross-sectional study of 128 shelter and foster cats and kittens in the Central Valley of California was performed from July to December 2020. PCR was performed on rectal and oropharyngeal samples to detect SARS-CoV-2 RNA and on rectal samples to detect FECV RNA. Among 163 rectal and oropharyngeal fluid samples gathered from sheltered and fostered cats and kittens in central California, SARS-CoV-2 nucleic acids were not detected from any cat or kitten. In contrast, FECV nucleic acids were detected in 18% of shelter-housed cats; 83% of these positive samples were collected from cats housed in adjacent cages. These data may be helpful when considering the allocation of resources to minimise the harm of FECV and SARS-CoV-2 in household pets and shelter environments.

Discovery of Influenza A (H7N2) in a Cat After Admission to an Animal Shelter: A Case Report

This case report describes the discovery of a low pathogenic avian lineage influenza A (H7N2) (A/feline/New York/16-040082-1/2016) infecting a cat in a shelter environment. Low pathogenic avian influenza virus H7N2 had previously circulated in poultry and farmed waterfowl and had reportedly been eradicated from live bird markets in 2006. Its appearance in a cat caused concern for the local cat population and had the potential to negatively impact the agricultural industry and human health. The first cat diagnosed presented to the shelter with no apparent clinical signs. Later, conjunctivitis developed and then upper respiratory congestion, which progressed to severe pneumonia that was unresponsive to treatment and characterized by dyspnea, tachypnea, and collapse. A second cat, who had entered the shelter 17 days earlier and had died at an emergency clinic, was later considered to be the index case. The second cat had similarly arrived with no apparent clinical signs, developed respiratory congestion leading to pneumonia with tachypnea and dyspnea, and tested positive for influenza A. Clinical consultation and diagnostic testing through multiple organizations identified the virus as an avian lineage H7N2 influenza virus.

Venous Screening Activities at the Site of Hokkaido East Iburi Earthquake: Report from the Result of Venous Screening in Preventive Awareness Activities

After previous earthquakes, high prevalence of cardiovascular diseases including venous thromboembolism (VTE) has been reported. We performed venous screening at the site of Hokkaido East Iburi Earthquake which happened at 6th September 2018. VTE screening using ultrasound sonography was performed for total 7 days at Atsuma town, Mukawa town and Abira town (total 9 shelters). Deep vein thrombosis (DVT) was found in 19 of 195 evacuees (9.7%), including 8 fresh thrombus cases (4.1%). On multivariable analysis of evacuees and shelter environment factors, systolic blood pressure, use of cardboard bed and toilet environment were significant predictor of DVT. Introduction and setting-up of cardboard beds were found as an important shelter environment factor. (This is secondary publication from Jpn J Phlebol 2021; 32(1): 5-10.).

Exploring Frontline Shelter Staff Perspectives on the Healthcare Needs of Clients Experiencing Homelessness

ABSTRACT Purpose To examine healthcare service development needs for persons experiencing homelessness from the perspective of frontline staff at a homeless shelter in Montreal, Quebec. Design Qualitative descriptive design. Methods Purposive sampling, semi-structured interviews with frontline shelter staff (n = 8), and thematic analysis. Findings Themes included: 1) Challenges meeting healthcare service needs in a shelter environment. 2) Visions for improving healthcare services while accounting for health issues and barriers to care. 3) Participants’ own knowledge gaps around health and healthcare services. Conclusions Future research should emphasize this group’s crucial role in homelessness healthcare services development.

Perspectives and recommendations of opioid overdose survivors experiencing unsheltered homelessness on housing, overdose, and substance use treatment in Boston, MA.

Opioid overdose causes one in four deaths among people experiencing homelessness in Boston, MA. To reduce overdose risks, the experience and perspectives of people experiencing homelessness should be incorporated into housing, overdose prevention, and substance use treatment efforts. In 2021, we conducted qualitative interviews with 59 opioid overdose survivors to inform equitable access to treatment services. In response to policy debate surrounding a public drug scene near a key recruitment site, we conducted a targeted thematic analysis of transcribed interview data from a subset of participants experiencing unsheltered homelessness (n=29) to explore their perspectives and recommendations on housing, overdose prevention, and substance use treatment. Among 29 participants who identified as non-Hispanic Black (n=10), Hispanic/Latinx (n=10), or as non-Hispanic White (n=9), the median number of self-reported opioid overdoses in the past three months was 2.0 (SD 3.7). Three themes emerged from this targeted analysis: (1) Participants described inadequate housing resources and unwelcoming shelter environments. (2) Participants near a large public drug scene explained how unsheltered homelessness was chaotic, dangerous, and disruptive to recovery goals. (3) Participants provided recommendations for improving housing and addiction treatment systems and including their perspectives in the development of solutions to the intersecting housing and opioid overdose crises. The overdose prevention, housing and substance use treatment systems must address the needs of opioid overdose survivors experiencing unsheltered homelessness. Overdose survivors experiencing unsheltered homelessness described a chaotic public drug scene but resorted to residing in nearby encampments because the existing shelter, housing, and addiction treatment systems were unwelcoming, difficult to navigate, or unaffordable. Despite efforts to provide low-threshold housing in Boston, additional low-barrier housing services (i.e., including harm reduction resources and without "sobriety" requirements) could promote the health and safety of people who use drugs and are experiencing homelessness.

"Shelter is Stressing Me Out": Challenges Meeting Health Care Needs of Older Adults in Congregate Shelters

Abstract: Older adults experiencing homelessness are a growing population with high rates of medical, psychiatric, and substance use-related health conditions. This mixed-methods study sampled older adults experiencing homelessness admitted to an academic safety-net hospital. We analyzed chart review data on the cohorts' medical and psychiatric conditions and their health care utilization. Qualitative interviews examined the impact of the congregate shelter environment on health. The sixteen participants with experiences living in a shelter had high rates of depression (56%), alcohol use disorder (52%) and hypertension (39%). Annually, participants averaged 2.8 hospitalizations and 8.5 emergency department visits. Forty-four percent (44%) of participants were discharged from hospital to shelter. Qualitative interviews linked living in congregate shelters to challenges meeting daily physical and psychological needs and barriers to medical system engagement. Our study highlights the complex health and psychological needs of this population, and challenges meeting those needs across congregate shelters and acute hospital settings.