Prevalence and Temporal Characteristics of Housing Needs in an Urban Emergency Department

Introduction: Our objective was to determine the proportion of patients in our emergencydepartment (ED) who are unhoused or marginally housed and when they typically present to the ED.Methods: We surveyed patients in an urban, safety-net ED from June–August 2018, using asampling strategy that met them at all times of day, every day of the week. Patients used two socialneeds screening tools with additional questions on housing during sampling shifts representingtwo full weeks. Housing status was determined using items validated for housing stability, includingPRAPARE, the Accountable Health Communities Survey, and items from the United StatesDepartment of Health and Human Services. Propensity scores estimated differences amongrespondents and non-respondents.Results: Of those surveyed, 35% (95% confidence interval [CI], 31-38) identified as homelessand 28% (95% CI, 25-31) as unstably housed. Respondents and non-respondents were similarby propensity score. The average cumulative number of homeless and unstably housed patientsarriving per daily 8-hour window peaks at 7 AM, with 46% (95% CI, 29-64) of the daily aggregate ofthose reporting homelessness and 44% (95% CI, 24-64) with unstable housing presenting over thenext eight hours.Conclusion: The ED represents a low-barrier contact point for reaching individuals experiencinghousing challenges, who may interact rarely with other institutions. The current prevalence ofhomelessness and housing instability among urban ED patients may be substantially higher thanreported in historical and national-level statistics. Housing services offered within normal businesshours would reach a meaningful number of those who are unhoused or marginally housed.