Madison Melton - Department of Emergency Medicine
For many Emergency Department (ED) providers, treating homeless patients is a part of every shift. Yet, it is uncommon to receive formal training on this patient population. In fact, most providers do not routinely ask about housing status when taking history and might not realize their patient is struggling with housing. Homelessness can have a huge impact on health, so why is there no consensus on how to best treat these patients in the ED?
Some providers do not ask because they believe there’s nothing they can do about it, but this information can be very useful. Homelessness “is a key predictor of poor health outcomes and early mortality,” and chronically, it is one of the most deadly conditions seen in the ED (Doran). Unstable housing also affects the ability to take medications, return for follow-ups, and follow discharge instructions. Unfortunately, there are also stereotypes that homeless patients use the ED “for a sandwich” or “just a place to sleep,” leading to frustration for providers (Doran). However, studies have shown that people experiencing homelessness have a similar severity of illness to other patients and are actually sicker on average. Also, providers should address these basic needs.
So what can be done to improve care for homeless patients? Delivering quality medical care requires knowledge of the patient’s living situation, and it must be standardized in order to identify people who are commonly overlooked like women, children, and the elderly. Formal education should be incorporated into emergency medicine residency programs, and research must go beyond ED admission rates.
In conclusion, emergency providers are in a unique position to be advocates for stable housing as an important component of good health. With proper training, they can better treat this patient population, make connections to housing services, develop medical respite programs, and work to prevent homelessness.
References:
Salhi, B. A., White, M. H., Pitts, S. R., & Wright, D. W. (2018). Homelessness and Emergency Medicine: A Review of the Literature. Academic Emergency Medicine, 25(5), 577-593. https://doi.org/10.1111/acem.13358
Doran, K., & Raven, M. (2018). Homelessness and Emergency Medicine: Where Do We Go From Here? Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 25(5), 598-600. http://dx.doi.org/10.1111/acem.13392 Retrieved from https://escholarship.org/uc/item/6424p4z6
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