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 In 2012, Massachusetts shelters began requiring additional
documentation of homelessness, such as sleeping in a place "not
meant for human habitation," which could include an emergency room,
researchers note in Pediatrics.
At Boston Children's Hospital, ER visits for homelessness more than
quadrupled after the shelter eligibility rule change, the new
analysis found.
"While the (emergency room) is chaotic and potentially very
frightening to children, it is the best of many bad options for
families who are forced to spend a night in a place 'not meant for
human habitation' in order to qualify for emergency assistance
shelter," said lead study author Dr. Amanda Stewart of Boston
Children's Hospital and Harvard Medical School.
"In an (emergency room), families have a roof over their head and
have access to a bed, food, and a social worker," Stewart said by
email. "The emergency department also offers an easier method of
documenting their homelessness, since they receive discharge
paperwork stating they were in the emergency department for
homelessness."
The study, conducted from 2010 to 2016, suggests many families
brought kids to the emergency room for reasons not directly related
to medical problems.
Overall, 65 percent of the children seen in the ER didn't have a
medical problem, and their diagnosis was homelessness, not a health
issue, the study found.
Children seen in the ER after the shelter rules changed were more
than three times more likely to lack a medical reason for being in
the hospital, the study found.
Although the number of homeless children in Massachusetts increased
by 40 percent over the study period, ER visits for homelessness
surged 13-fold.
Payments for these hospital visits averaged $557, more than four
times what it might cost for a night in a shelter, the study authors
note. Overall, 89 percent of these ER payments were covered through
state-based insurance plans.
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One limitation of the study is that it reflects what happened at
only a single hospital, the authors note. Another drawback is that
Massachusetts is the only state with a "not meant for human
habitation" shelter eligibility policy, so the results might not
explain what could happen elsewhere.
Still, the results suggest that children and families would benefit
from changing the Massachusetts policy to avoid the need for
documenting the lack of housing, Stewart said.
"This would remove the requirement which forces children into ERs or
unsafe locations," Stewart said.
Beyond this, every city and state should set aside shelter space
specifically for homeless families with children, said Dr. Benard
Dreyer, past president of the American Academy of Pediatrics and
author of an accompanying editorial.
"Family homelessness is an epidemic in the U.S. today," Dreyer, of
Bellevue Hospital Center and New York University School of Medicine
in New York City, said by email.
Almost 300,000 children are living in shelters for at least part of
the year and 2.5 million children a year experience some form of
homelessness, Dreyer said.
"Poor families simply cannot afford housing," Dreyer added. "While
some jurisdictions, such as New York City and Massachusetts,
guarantee shelters for those families, 10 percent of homeless
families nationwide are living in cars, or on the street."
SOURCE: http://bit.ly/2NHxss4 Pediatrics, online October 15, 2018.
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