According to a recent report from the Public Policy Institute of California, hospital emergency department (ED) discharge data can provide useful information on people experiencing homelessness across the state.
The report says the discharge data captures a substantial amount of California’s unhoused population, and that the state should give hospitals sufficient resources to connect unhoused individuals with housing, case management, and behavioral health services.
In 2019, unhoused patients made nearly 370,000 ED visits and represented about 4% of all ED visits by adults under age 65.
According to this 2019 data, the report says the vast majority of ED visits by unhoused patients were covered by Medi-Cal. The chart below shows the percentage of unhoused ED patients compared to housed ED patients covered by Medi-Cal, Medicare, private insurance, or uninsured.
About 80% of unhoused ED outpatient individuals were covered by Medi-Cal or Medicare, and about 90% of unhoused ED inpatient individuals were covered by one of those programs.
Hospitals in the Bay Area and Los Angeles regions reported higher percentages of ED visits by unhoused patients compared to total ED visits. The chart below shows the percentages of ED visits by unhoused patients compared to total ED visits in different regions across the state.
In terms of physical health conditions, a higher rate of unhoused ED patients were diagnosed with liver disease, hepatitis, COPD, and hypertension than housed ED patients. The chart below shows health conditions diagnosed in unhoused patients compared to housed patients.
Behavioral health conditions were also especially prevalent in unhoused ED patients, with nearly 40% of ED visits involving unhoused patients resulting in a mental health diagnosis and 30% resulting in a drug-related diagnosis. The chart below shows the percentage of ED visits during which the patient received a specific behavioral health diagnosis.
Schizophrenia and mood disorders were the most commonly diagnosed mental health conditions among unhoused patients.
The report’s authors recommend connecting hospital ED data with data from other social programs and supports so organizations can better identify who is at risk of experiencing or currently experiencing homelessness and quickly intervene.
“Linking the newly available HDIS data with hospital discharge data could fill an important gap in our understanding of the people who connect with local homeless assistance programs and those who do not,” the report stated. “Further links to other state administrative data—including Medi-Cal claims data, specialty mental health services, social services data like CalFresh or Supplemental Security Income (SSI)—would go a long way toward supporting research into interventions and funding for homelessness services.”