When I see people on the street who are homeless, my gaze quickly travels from their faces to their wrists. I often notice something unusual: hospital ID bands, sometimes several, decorating each arm, like white paper-plastic badges of honor.
As an emergency department physician in New York City, this comes as no surprise. In my work I see a disproportionately large number of patients who are homeless.
On any given day, nearly 600,000 people are homeless across America. A large cohort of frequent ED users comes from their ranks. They account for a disproportionate share of hospital readmissions. Many have prolonged lengths of stay for each hospitalization. Addressing the problem of homelessness is critical to reducing healthcare costs.
In New York City, the Department of Homeless Services asks hospital EDs to voluntarily count their homeless patients for its annual single-night count, but few do. This year the Bronx Health and Housing Consortium took its own count in eight Bronx hospital EDs. They found 120 homeless people there, while on the same night the official city count identified only 69 homeless people on the streets of the Bronx.
It is often assumed that homeless people use the ED just as a place to sleep. But research tells us they disproportionately suffer from physical and behavioral health problems, which drive their use of EDs.
The solution to reducing their ED use, then, is not just to give them an alternative place to sleep. They need an end to their homelessness.
One obvious solution is to give people some type of home. The U.S. Interagency Council on Homelessness provides a comprehensive roadmap of how to end homelessness in its "Opening Doors" report. The healthcare system could and should be part of providing these resources, not just because of the profound effect of homelessness on our nation's health, but because of its impact on the healthcare system's overall costs.