(December 5, 2018) Over half of hospitalizations for homeless individuals in recent years were due to mental illness or substance use disorders, according to a study of Florida, California, and Massachusetts State Inpatient Databases (SID) data from 2007 to 2013. In addition, hospitalization rates of homeless individuals nearly doubled in all three states during the last four years of the study period.
The retrospective study of Dr. Rishi Wadhera and colleagues sought a better understanding of acute illness in the larger homeless population as national policy makers aim at improving health outcomes for homeless people. After controlling for demographic characteristics, including age, sex, race, insurance payer, and state of residence, the researchers found that homeless individuals were more likely to be hospitalized than a comparative set of non-homeless individuals. As there are an estimated 169,000 individuals with serious mental illness who are homeless on any given night, these results highlight the challenges homeless populations have in navigating the behavioral health services in their respective communities.
Wadhera et al. use SID data from three geographically and demographically diverse states to examine hospitalization trends in homeless people from 2007 to 2013. They also compare various patterns and results of hospitalization between homeless and demographically similar non-homeless individuals, including reasons for admission, in-hospital mortality, length of stay, and costs of care.
Half of hospitalized homeless individuals lacked insurance at the time of admission, according to the study. Without insurance, this population has significant challenges accessing ambulatory care, preventive care, or many other services that are beneficial for longitudinal health.
In addition, implicit biases against homeless people by health care teams may drive inequalities in the care homeless individuals receive during hospitalization. The study found that, compared to non-homeless individuals, homeless people experienced longer lengths of stay during hospitalization while simultaneously showing lower total and daily expenditures. This is likely due to the requirement that hospitals discharge homeless persons to an established destination and the prescription of less intensive treatment during their stay.
Interestingly, in-hospital mortality rates were lower across both homeless and non-homeless individuals, according to the study. This finding contrasts with high mortality rates known globally among the homeless population, and may be explained by the greater access to health services through expanded health care coverage. In fact, early evidence suggests that Medicaid eligibility expansion led to significantly increased coverage and access to care for homeless individuals. Expanded Medicaid coverage also led to more treatment options.
Still, despite the implementation of health policy reforms meant to alleviate the suffering of homeless populations, the study indicates that hospitalization rates among homeless people with mental illness are on the rise. The results point to the need for continuing policy initiatives and increased funding for health care, coverage, and access for homeless individuals with mental illness to reverse this trend.
Grace Lim
Research Intern
References
- Wadhera, R. K. et al. (2018). Trends, Causes, and Outcomes of Hospitalizations for Homeless Individuals. Medical Care.