Homelessness and Health

Section Leader(s): Dr. Christopher Steele, MD MPH MS and Emma Kryzanski

 

Introduction:

According to the HEARTH act, a person is considered homeless if they are with primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation, living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements, exiting an institution where they resided for 90 days or less or resided in an emergency shelter or place not meant for human habitation immediately before entering that institution, or individuals or families who will imminently lose their primary nighttime residence within 14 days.¹ In short, homelessness is the situation of an individual or family without stable, permanent, appropriate housing, or the immediate prospect, means, and ability of acquiring it.²

Homelessness, regardless of its form, can harm an individual’s health with higher risk for chronic illness, morbidity, and mortality.¹ With an estimated 2.5-3 million people in the United States experiencing homelessness in a year1, all medical providers should be able to identify a patient’s homelessness and understand the ability they have as a provider to help a patient achieve housing stability and greater health.

The goal of this module is to introduce homelessness, its diversity as an experience, and how it can impact a patient physically, mentally, and socially. The module aims to provide the knowledge and experience needed for a medical provider to help a patient address their housing instability as well as the health problems it may cause.

 

Learning Objectives

By the end of this module, learners will be able to do the following:

1. Define homelessness, and differentiate between various types of homelessness.
2. Describe epidemiology and risk factors associated with homelessness.
3. Discuss the impact that homelessness can have on someone’s health.
4. Describe a provider’s role in assessing patients for homelessness and methods to screen.
5. Discuss the Housing First approach to homelessness and its associated health impacts for patients.
6. Identify resources with which you can connect patients in order to address homelessness and apply them in a clinical scenario.
7. Discuss how the impacts of homelessness can be considered in a patient’s medical care.

 

Content Materials

1. E. Kryzanski Homelessness and Health
2. E. Kryzanski Caring for a Homeless Patient
3. Andermann A, Bloch G, Goel R, Brcic V, Salvalaggio G, Twan S, Kendall CE, Ponka D, Pottie K. Caring for patients with lived experience of homelessness. Can Fam Physician. 2020 Aug;66(8):563-570. PMID: 32817028; PMCID: PMC7430777.https://drive.google.com/file/d/1L5Gpf_a9UAPGn-XuCFxWAvz9l2gfv57y/view?usp=sharing 
4. Nilsson SF, Nordentoft M, Hjorthøj C. Individual-Level Predictors for Becoming Homeless and Exiting Homelessness: a Systematic Review and Meta-analysis. J Urban Health. 2019;96(5):741-750. doi:10.1007/s11524-019-00377 https://drive.google.com/file/d/1agbAZLjNVUNDGNALJIaz0EIckLC38ekz/view?usp=sharing 
5. Baxter AJ, Tweed EJ, Katikireddi SV, Thomson H. Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. J Epidemiol Community Health. 2019;73(5):379-387. doi:10.1136/jech-2018-210981
   https://drive.google.com/file/d/1wR9qttc4p9en9d2dv_EVvkVk7Np0858D/view?usp=sharing

 

Tools for Assessing and Addressing a Patient’s Homelessness

Assessing a Patient’s Housing Stability

• Assess a patient’s current housing status and priority for housing intervention with: https://aspe.hhs.gov/system/files/pdf/75736/report.pdf

Addressing a Patient’s Homelessness

• Find the nearest homeless shelter for your patient: https://www.homelessshelterdirectory.org/
• Use https://www.findhelp.org/ to find local resources for housing payment, short-term housing, housing advice, etc…
• Use www.211.org to find local resources for housing!

Finding Health Care for a Homeless Patient

• Locate the nearest Community Health Center, including Health Care for the Homeless Programs: https://findahealthcenter.hrsa.gov/
• National Health Care for the Homeless Council Medical Respite Care Directory: https://nhchc.org/clinical-practice/medical-respite-care/medical-respite-directory/ 

 

Optional Reading Materials

• King TE, Wheeler MB, Kushel M, Jain S. Care of the Homeless Patient. In: Medical Management of Vulnerable and Underserved Patients: Principles, Practice, and Populations. 2nd ed. McGraw Hill Education; 2016:311-319.
• National Health Care for the Homeless Council Best Practices: https://nhchc.org/clinical-practice/homeless-services/best-practices/ 
• Beharry MS, Christensen R. Homelessness in Pediatric Populations: Strategies for Prevention, Assistance, and Advocacy. Pediatr Clin North Am. 2020;67(2):357-372. doi:10.1016/j.pcl.2019.12.007
  • https://www.sciencedirect.com/science/article/abs/pii/S003139551930183X?via%3Dihub 
• Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiol Rev. 2015;37:177-195. doi:10.1093/epirev/mxu004
  • https://academic.oup.com/epirev/article/37/1/177/412707 
• Fraser B, Pierse N, Chisholm E, Cook H. LGBTIQ+ Homelessness: A Review of the Literature. Int J Environ Res Public Health. 2019;16(15):2677. Published 2019 Jul 26. doi:10.3390/ijerph16152677
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695950/ 
• Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. JAMA Netw Open. 2019;2(9):e1911514. Published 2019 Sep 4. doi:10.1001/jamanetworkopen.2019.11514
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752088/ 
• Housing Status Assessment Guide for State TANF and Medicaid Programs. ASPE. https://aspe.hhs.gov/basic-report/housing-status-assessment-guide-state-tanf-and-medicaid-programs#tool. Published February 21, 2017. Accessed July 2, 2021.
  • https://aspe.hhs.gov/sites/default/files/private/pdf/75736/report.pdf

 

References

1. King TE, Wheeler MB, Kushel M, Jain S. Care of the Homeless Patient. In: Medical Management of Vulnerable and Underserved Patients: Principles, Practice, and Populations. 2nd ed. McGraw Hill Education; 2016:311-319.
2. Andermann A, Bloch G, Goel R, Brcic V, Salvalaggio G, Twan S, Kendall CE, Ponka D, Pottie K. Caring for patients with lived experience of homelessness. Can Fam Physician. 2020 Aug;66(8):563-570. PMID: 32817028; PMCID: PMC7430777.
3. Nilsson SF, Nordentoft M, Hjorthøj C. Individual-Level Predictors for Becoming Homeless and Exiting Homelessness: a Systematic Review and Meta-analysis. J Urban Health. 2019;96(5):741-750. doi:10.1007/s11524-019-00377-x
4. Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiol Rev. 2015;37:177-195. doi:10.1093/epirev/mxu004
5. Fraser B, Pierse N, Chisholm E, Cook H. LGBTIQ+ Homelessness: A Review of the Literature. Int J Environ Res Public Health. 2019;16(15):2677. Published 2019 Jul 26. doi:10.3390/ijerph16152677
6. Kidd SA, Greco S, McKenzie K. Global Climate Implications for Homelessness: A Scoping Review. J Urban Health. 2021 Jun;98(3):385-393. doi: 10.1007/s11524-020-00483-1. Epub 2020 Sep 23. Erratum in: J Urban Health. 2020 Dec 18;: PMID: 32965555.
7. Baxter AJ, Tweed EJ, Katikireddi SV, Thomson H. Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. J Epidemiol Community Health. 2019;73(5):379-387. doi:10.1136/jech-2018-210981