As an emergency physician at Bellevue Hospital in New York City, I encounter patients who are homeless on every single shift I work in the emergency department (ED). Some patients we know by name because they visit us in the ED several times per week, or even several times in a single day. These are most often patients who are not only chronically homeless, but also have some combination of co-occurring substance abuse, mental illness, or complex medical problems.
Amidst the stress and competing demands of a busy emergency department, these homeless patients are sometimes met with an eye roll or a groan: “He’s back again.” The more experienced doctors and nurses know better; we have seen that, sooner rather than later, these patients do stop coming back. It used to be that after a few weeks we would inevitably get the news from our paramedic colleagues that Joe, or Frank, or George died at another hospital, thus explaining the eerie absence of “our patient.” Lately, though, sometimes these stories have happier endings, when we learn that our missing patient has actually been placed in supportive housing and – miraculously to us – is doing much better. Research done by my colleague Ryan McCormack shows that even the most seemingly intractable frequent ED users can be helped.
I teach our emergency medicine residents (doctors in training) that the chronically ill, chronically homeless patients who we see so frequently in the ED are likely to be dead within a few years if we do not do something to change their situations. Multiple studies have shown that people who are homeless have much lower life expectancies than average. In fact, a person who is homeless has an average lifespan more closely resembling that of someone from Guatemala or Laos than someone from the U.S. The natural trajectory of chronic homelessness paired with chronic illness, substance abuse, and/or mental illness is early death. Supportive housing can break that trajectory. Studies have shown supportive housing can lead to reductions in hospital use, improved health, less substance use, and lower health care costs for certain subsets of people.
I recently wrote an article with Elizabeth Misa and Nirav Shah on New York’s innovative Medicaid-funded supportive housing initiative, which was published in the New England Journal of Medicine. In the article we focused primarily on the cost savings to Medicaid possible from supportive housing. Such dollars and cents arguments are often the most persuasive to policy-makers, but we cannot forget the less quantifiable yet no less important human benefits that come from moving someone from homelessness into supportive housing. My experience working in the emergency department has shown me that supportive housing is not only cost saving, but life-saving. Any loss of human life due to homelessness is a tragedy, especially because we have a solution – supportive housing – at our fingertips.
Kelly Doran is an emergency physician and health services researcher in the Departments of Emergency Medicine and Population Health at the NYU School of Medicine. She tweets about homelessness and health policy @KellyMDoran.
