Social and medical factors affecting hospital discharge of persons with HIV/AIDS

Although outpatient care and pharmaceuticals have rendered community-based care possible, hospitals remain the locus of the most costly and intensive HIV/AIDS care. Little is know, however, about the impact of patients' social circumstances upon hospital length of stay. This paper examines the impact of housing status, living arrangements, and a range of barriers to discharge on hospital length of stay. Findings are based on retrospective medical chart reviews by nurses and social workers of 749 HIV/AIDS hospitalizations, occurring between June-August 1991 in four New York City medical centers. One third of the sample experienced at least one barrier to discharge. Medical need barriers were the most common (18%), and were associated with the longest length of stay (35.3 days), followed by home care and housing barriers (32.7 and 30.2 days, respectively). Fourteen percent of the sample were either homeless or in unstable housing situations (e.g., transient or "doubled up") prior to admission. Homelessness and unstable housing were associated with a 5 day increment in hospital length of stay, and remained a significant factor even controlling for morbidity. These results indicate that inadequate housing remains a significant barrier to discharge among hospitalized persons with HIV/ AIDS.