California’s homeless population has increased in recent years, and so has public investment in addressing homelessness, making understanding the size and needs of the state’s homeless population more important than ever. Discharge data from emergency departments (EDs) can help. PPIC researcher Shannon McConville and UCSF professor Dr. Hemal Kanzaria outlined key findings from a new report and discussed the implications for policymakers.
McConville noted that EDs—particularly in county hospitals—are frontline providers for homeless Californians: “They are open 24 hours a day, 365 days a year, and are required by fed[eral] law to provide medical screenings and stabilizing treatment to anyone who seeks care, regardless of their insurance coverage, their ability to pay, or other circumstances.” A 2019 law that requires hospital EDs to expand and document discharge planning for patients experiencing homelessness is providing an additional source of information about this population.
For example, ED data shows that more men, middle-aged and older adults—and fewer children—are being treated in EDs than by homeless assistance programs. “Families with children may be prioritized to receive assistance from local agencies,” McConville said. It’s also possible that men and older adults are more likely to be identified as homeless in the ED setting.
McConville noted that patients who are identified as homeless are more likely to be admitted than other patients. This could be attributable to greater medical need, but it could also have to do with complex social issues. As Dr. Kanzaria, a report coauthor and an ED physician at Zuckerberg San Francisco General Hospital, put it, “Sometimes we do have to keep people in the hospital more for their social needs than their acute medical needs.”
Serving patients with such complex needs can create dilemmas for ED staff: “How do we take care of the person in front of us while also taking care of our community, which needs access to those inpatient beds?” asked Dr. Kanzaria. But it also represents an opportunity. “Really, health is more than health care,” he said. “We can’t just be thinking about prescriptions and follow-up visits. We have the opportunity to focus on the underlying social, environmental, economic, and political factors that affect our patients’ health.”
“We know the solution to homelessness,” he added. “The solution is housing.” But it is a complex solution to implement. As California continues to grapple with homelessness, linking ED discharge data to administrative data resources like homeless services data or MediCal data could inform policy and funding efforts. As McConville put it, “We really do need more sources of actionable and comprehensive information to guide the decision-making.”