Association Between Reported Homelessness and Inpatient Resource Use for Medicare Beneficiaries

Evaluate the association between reported homelessness and inpatient resource use among Medicare beneficiaries, and investigate variation therein.

Cross-sectional study of 6.3 million 2022 Medicare inpatient claims from 3,200 U.S. hospitals, examining the association between homelessness and three outcomes: cost, length of stay (LOS), and non-intensive care days using multilevel models. Robustness checks were conducted on five cross-sectional clinical subgroups.

Among Medicare inpatient discharges, 0.63% reported homelessness, with teaching hospitals reporting 0.67%, in contrast to 0.55% in non-teaching hospitals. Overall, homelessness is associated with $829 (p<.001) higher costs and 2.45 (p<.001) longer LOS, primarily days outside of intensive care. For some patient subpopulations, the homelessness-cost association was greater than the national $829 magnitude.

Reported homeless rates vary by hospital type and involve different hospital resources depending on hospital and patient type, including higher costs and longer inpatient hospital stays.