SOCIAL EM & POPULATION HEALTH
Addressing Housing Instability in the Emergency Department: Why Standardized Screenings Matter
SAEM PULSE | NOVEMBER-DECEMBER 2024
By Alana Moore and Orly Morgan on behalf of the SAEM Social Emergency Medicine & Population Health Interest Group
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Unstable housing is a global issue, affecting approximately 150 million homeless individuals and 1.8 billion people living in inadequate housing conditions. In the United States, about 653,104 people experience homelessness on any given night, and this number is rising. Despite the increasing number of people experiencing homelessness (PEH), access to resources — especially health care services designed to meet their needs — has not expanded proportionately. PEH visit emergency departments (EDs) at rates up to four times higher than those with stable housing. This increased utilization can likely be attributed to housing
instability worsens health outcomes, increasing the risk of infectious and chronic diseases, as well as injuries and disabilities. Another contributing factor is the lack of access to primary care and the exacerbation of complications from preventable illnesses. Moreover, PEH often rely on EDs for preventable or nonemergent conditions due to limited access to primary care. As a result, PEH face significantly higher rates of ED recidivism within 30 days of discharge compared to individuals with stable housing. Research shows that hospitals more skilled at managing social issues related to housing instability achieve better outcomes. A 2020
study found that these hospitals have lower rates of 30-day readmissions and ED visits among PEH. This suggests that training emergency physicians to better understand how housing instability impacts health outcomes and to implement best practices for providing medical care to those experiencing housing instability could make ED care more effective, reduce recidivism, and improve health outcomes. While health care settings routinely screen for risks such as cardiovascular disease, stroke, and cancer, many individuals lack access to a primary care physician and rely on EDs for such assessments.