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Prevalence of Homelessness in the Emergency Department Setting

  • Author(s): Feldman, Brett J
  • Calogero, Cristina G
  • Elsayed, Kareem S
  • Abbasi, Osman Z
  • Enyart, Joshua
  • Friel, Timothy J
  • Abunamous, Yasir H
  • Dusza, Stephen W
  • Greenberg, Marna Rayl
  • et al.
Abstract

Background/Objective: To determine the prevalence of homelessness or at-risk for homelessness in the ED setting.

Methods: Using a 5 question screening tool derived from teh US department of Housing and Urband Development (HUD), Health and Human Services (HHS) and the Beterans Administration (VA) definition for homelessness, we surveyed all patients meeting inclusion criteria on scheudled shifts in one of three EDs in Northeastern Pennsylvania  Two survey periods were selected to represent seasonal variations.

Results: 4395 subjects were included in the analysis.  The mean age of participants was 50.8 (SD 20.5) and 2,557(58.2%) were women.  The mean age of those who screened positive for homelessness or at-risk for homelessness was 43.1 (SD16.6). Overall, 136 (3.1%) participants screened positive for at-risk for homelessness and 309 (7.0%) screened positive for homelessness.  103 (9.8%) subjects screened positive for homelessness or at-risk for homelessness on weekends and 312 (10.3%) on weekedays (p=-.64).  The proportion of those screening positive for homelessness or at-risk for homelessness varied by site: 145 (7.5%) at hte trauma cetner, 151 (9.1%) at the suburban site and 149 (18.7%) at the center city site, p<0.001.  There was no statistical significance to the difference between the trauma center and the suburban site (p=.088), but there was statistical significance between both the suburban and the trauma cneter when compared to the center city site (both p<0.0001).  The proportion of those screening positive for homelessness in the summer months (156,7.5%) was similar to those in the winter months (153, 6.6%), p=-.23, but it did favor summer months if those who were at-risk for homelessness were included (230, 11.1%, summer versus 215, 9.2% winter; p=0.045).

Conclusions: In our study, the overall prevalence of homelessness or at-risk for homelessness was 10.1%. This prevalence did not seem to vary between weekdays and weekends.  Additionally summer months had a prevalence that was was concerning as winter months.  The prevalence does, however, seem to vary by institutional characteristics even in the same geographic region.  Understanding the patterns of prevalence of homelessness is a step toward considering possible interventions to assist this vulnerable population

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