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Disparities in Delayed Discharge Among Patients Experiencing Homelessness
Lucie Richard1, Samantha Morais2, Kate Francombe Pridham1
1MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
JAMA Network Open
|July 17, 2026
Summary
Hospitalized patients experiencing homelessness face higher rates of alternate level of care (ALC) designation and longer stays. This highlights systemic barriers and the need for interventions like supportive housing to improve discharge.
Area of Science:
- Health Services Research
- Health Equity
- Population Health
Background:
- Patients experiencing homelessness encounter significant barriers to hospital discharge.
- This can lead to alternate level of care (ALC) designation, delaying hospital bed availability.
- Limited evidence quantifies ALC disparities for those with recent homelessness.
Purpose of the Study:
- To compare ALC rates in hospitalized patients with recent homelessness versus matched controls.
- To analyze disparities in ALC designation and duration.
Main Methods:
- Population-based matched cohort study in Ontario, Canada (2022-2024).
- Included 11,168 patients with recent homelessness and 40,209 matched controls.
- Used health administrative data and statistical models to assess ALC rates and duration.
Main Results:
- Patients with recent homelessness had over 4 times higher ALC designation rates (9.1% vs 2.0%).
- ALC stays were significantly longer for patients with homelessness (4.7 additional days).
- Substantial regional variation in ALC disparities was observed.
Conclusions:
- Recent homelessness is strongly associated with higher ALC rates and longer ALC stays.
- These findings underscore structural barriers in discharge planning and post-acute care.
- Interventions like medical respite and supportive housing are crucial for equitable care and reducing delayed discharges.
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