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Trends in Homeless Children and Young Adults Seeking Shelter in a Boston Pediatric Emergency Department Following

Mia Kanak1, Amanda Stewart1, Robert Vinci1

  • 1Mia Kanak is with the Department of Pediatrics at Boston Children's Hospital/Harvard Medical School and Boston University School of Medicine/Boston Medical Center, Boston, MA. Amanda Stewart is with the Division of Emergency Medicine, Boston Children's Hospital/Harvard Medical School. Robert Vinci and Megan Sandel are with the Department of Pediatrics, Boston University School of Medicine/Boston Medical Center. Shanshan Liu is with the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital.

American Journal of Public Health
|June 22, 2018
PubMed

Insights

A state housing policy change in 2012 significantly increased emergency department (ED) visits by homeless youth. This led to higher healthcare costs, particularly for Medicaid, highlighting the need to consider health impacts in housing policy.

Area of Science:

  • Public Health
  • Health Services Research
  • Pediatrics

Background:

  • Homelessness among children and young adults is a significant public health issue.
  • Housing policies can impact healthcare utilization among vulnerable populations.
  • Understanding the healthcare costs associated with homelessness is crucial for resource allocation.

Purpose of the Study:

  • To analyze trends in emergency department (ED) use by homeless children and young adults before and after a 2012 state housing policy change.
  • To quantify the financial and time costs incurred by the healthcare system due to these ED visits.

Main Methods:

  • Retrospective review of de-identified electronic medical records.
  • Analysis of data from homeless children and young adults (0-21 years) at an urban tertiary pediatric ED in Boston, MA.
  • Data collected from September 1, 2011, to August 31, 2016.

Main Results:

  • A total of 1078 ED visits for homelessness by 916 individuals were identified.
  • Monthly ED visits increased from a median of 3 to 17 after the policy change (P < .001).
  • Total hospital charges amounted to $578,351, with $214,231 in net payments (97% by Medicaid); average length of stay was 8 hours, totaling over 8500 hours.

Conclusions:

  • The housing policy change was associated with a significant increase in pediatric ED visits for homelessness.
  • These increased visits resulted in substantial resource burdens on the ED and the Medicaid system.
  • Policymakers should integrate potential healthcare costs into housing policy design and invest in housing solutions to reduce unnecessary ED utilization.
Abstract

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