Homelessness at record high: What it means for hospitals

A record number of Americans are experiencing homelessness in 2023 amid rising housing costs and other societal challenges. The increase could put additional strain on the U.S. healthcare system and lead to worse patient outcomes if health systems do not take actions to improve the health of those experiencing homelessness. 

More than 577,000 people are experiencing homelessness in the U.S., marking an 11 percent increase from 2022, according to The Wall Street Journal's review of available data. This increase marks the largest jump seen since the federal government started tracking homelessness rates in 2007.

The Journal's preliminary tally is based on a review of data from more than 300 organizations that track homelessness rates in various U.S. cities and states. These entities accounted for eight of every nine people experiencing homelessness last year, according to the report. The data are still preliminary, the Journal noted, adding that the U.S. Department of Housing and Urban Development is slated to share a final estimate by the end of the year.

Research has long linked homelessness to poor health outcomes. A 2022 study published in JAMA Internal Medicine found older adults who remained homeless during the four-and-a-half year study period were 80 percent more likely to die than those who regained housing.

In addition, many people who are homeless often use hospital emergency departments as their only source of healthcare. These utilization trends prove challenging for ED clinicians to provide adequate care, as many people experiencing homelessness "often have a multitude of diagnosed and undiagnosed health conditions, in addition to poor social circumstances," according to a study published in the International Journal of Emergency Medicine.

Health systems are working to address homelessness through a variety of approaches and initiatives, including offering housing assistance, opening community clinics and partnering with social organizations. Donna Lynee, CEO of Denver Health, said one of the system's biggest areas for growth in the next three years is more integration with nonprofits and government agencies to better address homelessness, mental health and substance abuse. 

"These services are fragmented and coordination across these sectors can improve outcomes and reduce costs," she told Becker's in June. 

CMS is also aiming to better support hospitals in these endeavors. Earlier this month, the agency finalized plans to increase payments to hospitals for treating homeless patients.

"As part of CMS' health equity goals, we are rewarding hospitals that deliver high-quality care to underserved populations and, for the first time, also recognizing the higher costs that hospitals incur when treating people experiencing homelessness," CMS Administrator Chiquita Brooks-LaSure said in an Aug. 1 news release.

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