By Dorothy Brooks
While ED providers will know some patients who are homeless, the process of identifying many of these individuals can be challenging. Often, patients will not disclose they have no place to go. “We on the healthcare side don’t always ask the kinds of questions that will elicit this information. A huge responsibility on the part of healthcare is actually understanding and determining who might be at risk of experiencing homelessness,” explains Betsy Kammerdiener, market director for mission integration at CommonSpirit Health’s CHI Memorial Hospital in Chattanooga, TN.
It is important to ask questions in a way that elicits the most useful information, but also is culturally sensitive. For example, Kammerdiener notes it is helpful to ask patients where they slept last night or last week. Alternatively, if the patient is in the ED, perhaps ask where he or she is planning to sleep tonight. “Use open-ended questions rather than simply asking for an address. People can always give you an address, but it might be a place they lived two years ago,” Kammerdiener advises.
The idea is to understand whether the patient is couch-surfing or perhaps living in his or her car.
“Along the way, we can all be trained to pick up on the signals. But if you wait until discharge to get that information, and it is the first time you ask, you are not going to have the time to really help this person avoid getting back into the cycle of homelessness,” Kammerdiener says. “Staff at every point of contact should be alert to relevant patient needs, including housing status, food insecurity, and ability to pay. [These] are all the things that go into making medicine human,” Kammerdiener notes.
Kammerdiener has learned if hospitals ask the right questions to gather useful information on all the social determinants of health, they may be the first to know a person is underhoused or living in a trailer on a back lot that is unhabitable. If that is the case, hospitals must consider the responsibility to not only identify the problem, but also to share that information with partners in the community who are working on ending homelessness (while remaining mindful of privacy laws).
Staff at every point of contact should be alert to relevant patient needs, including housing status, food insecurity, and ability to pay. All these go into making medicine human.
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