Housing Instability and Quality

Distinct from homelessness, housing instability can include moving frequently between residences (also known as “couch surfing”), being behind on rent payments, or being threatened with evictions. While estimating the number of people with unstable housing is difficult given inconsistent definitions, 2.3 million people annually face evictions alone. In addition to housing instability, six million households live in substandard housing conditions nationally, an estimate virtually unchanged in 20 years. Unstable housing and poor housing quality are associated with adverse health outcomes, particularly for those with chronic diseases, and are therefore an important consideration in the management of emergency department patients. Research across settings has found that both housing instability and poor housing quality are common among emergency department patients. This chapter provides guidance for emergency providers on assessing and responding to patients’ housing stability and quality status in the emergency department and beyond.