“The city’s annual census, known as the Homeless Population Outreach Estimate (HOPE), has served as a tool to measure our progress in ending homelessness on the streets. However, HOPE is missing out on a critical component of the New York City ecosystem: the hospitals. By ignoring this segment of the population, the city is underestimating the actual number of people experiencing homelessness.”
On a cold night in January 2020,they were seeking refuge in the emergency departments of New York City hospitals. Hospitals have long been places where homeless and homeless New Yorkers seek care and shelter, but those who do are rarely counted in the city’s official count of homeless populations.
These people, whose number has probably increased due to the recentY Y , often fall between the cracks of two disjointed systems, lacking the coordination, expertise, and resources to adequately support the homeless with medical needs. Now more than ever, we need better communications between health care systems and homeless services to correctly count unsheltered populations, support homeless patient populations, and address overburdened health care systems.
This week, the New York City Department of Homeless Services (DHS) is sending out its homeless outreach teams to estimate how many New Yorkers are without shelter. Since it was established in 2005, this annual census, known as the(HOPE)—has served as a tool to measure our progress toward ending homelessness on the streets. However, HOPE is missing out on a critical component of the New York City ecosystem: the hospitals. By ignoring this segment of the population, the City underestimates the actual number of people experiencing homelessness.
This underestimation has direct budgetary implications. HOPE results are used to allocate city resources to the homeless population, includingand the hiring of street extension teams. Also, someone who spends every night in the ER and is not known by one of the city’s contracted homeless outreach teams, may not be eligible for permanent housing programs that require verification of homelessness. . In the absence of an accurate HOPE count, our organization has created a and has urged DHS to include hospitals in its annual census. In our most recent count, we found that 22 percent of respondents reported visiting the emergency room every day in the past year. These individuals deserve to be accounted for and cared for.
New York City hospitals need support to manage this patient population. Historically, hospital staff have allowed homeless people to sleep in non-treatment areas, such as waiting rooms or auditoriums, buthave . Hospitals and healthcare workers are stretched to capacity, and most hospitals that have been providing these services lack adequate resources and established partnerships to do so effectively.
“When an ER doctor looks at the patient status dashboard and sees that there are 15 other patients in various disease states waiting to be seen, that will not encourage or support meaningful patient engagement on issues related to homelessness and homelessness. housing insecurity,” he said. Dr. Jeffrey Lazar, vice president and medical director of emergency medicine at St. Barnabas Health System in the Bronx.
Limited guidance from hospital leadership on how healthcare workers should respond to homeless patients has resulted in a lack of standard protocols and minimal communication between the healthcare and homeless services systems. Currently, private hospitals do not have access to DHS street and shelter outreach data, which would allow them to know if a patient is already assigned to a shelter or engaged with a street outreach team. Meanwhile, the shelter or street staff may not know that their client is in the hospital.
Access to data between systems is necessary to maintain coordination; without it, patients suffer.revealed that 69 percent of respondents do not have a doctor outside of the ED, indicating that EMS workers often serve as primary care providers in addition to providing other social services.
Healthcare workers and the homeless deserve better. Hospital leadership must recognize that stable housing is a critical health issue. Partnerships and policies must be established to ensure that housing is prioritized as a key component of patient care. New York City hospital systems must collaborate to establish shared standards of care for homeless patients. Private hospitals should have access to DHS street and shelter outreach data, and all hospitals should use the same intake assessments that include housing questions to ensure data consistency across systems.
New York City’s public hospital system, NYC Health + Hospitals, may offer a promising approach. His recent releaseThe initiative connects homeless patients with short-term respite care, home navigation and supportive housing throughout the city, including units built on hospital grounds. They can leverage their position as a city agency to build strong partnerships with DHS and other care providers in the city. And they already have a long-standing role as the city’s leading healthcare provider for the homeless, serving more than 43,500 adult homeless patients each year.
DHS should partner with public and private hospitals to establish long-standing, institutionally entrenched partnerships with community organizations and street outreach teams. This will take the burden off already overstretched hospital staff to provide the social support homeless patients require, and make better use of already established systems and resources.
Hospitals serve as critical safety nets for homeless New Yorkers and should be treated as such. For many homeless people, hospitals are a respite from the harsh reality of living on the streets, but care must go beyond a sandwich and a waiting room chair to sleep on. With strong commitment from the city and hospital leadership, we can ensure these systems provide the comprehensive care and support homeless New Yorkers deserve.
Bonnie Mohan is Co-Founder and Executive Director of the Health & Housing Consortium, a nonprofit organization that works to support and integrate the health care and housing systems in New York City. Tess Sommer is the Consortium’s program director.