Faculty AdvisorCarole Upshur
UMass Chan AffiliationsDepartment of Family Medicine and Community Health
Health Care for the Homeless (HCH) Program
Community Health and Preventive Medicine
Health Services Administration
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AbstractBackground: Homelessness in America is a growing problem. An estimated 1.59 million people spent at least one night in an emergency shelter or transitional housing program in 2010. Of this group, an estimated 2.8% were over the age of 62. The number of elderly homeless individuals is expected to increase by about 33% between 2010 and 2020 and more than double by 2050. Programs like the Health Care for the Homeless serve to both medically care for this growing population as well as collect data about their specific demographics and health care needs. Objectives: We studied demographic and health care needs unique to the rapidly growing elderly female population and reviewed current literature with the goal of identifying possible pathways to homelessness among this population as well as provider-based initiatives needed to better care for this homeless subset. Methods: Health Care for the Homeless data are collected in all fifty states, the District of Columbia, and Puerto Rico in the form of de-identified surveys completed by clinic personnel and submitted to the Uniform Data System (UDS), which compiles an aggregate report. The frequencies of key demographic variables and diagnostic and preventative health variables between 2006 and 2010 were analyzed using nonparametric Chi-square tests. Results: Between 2006 and 2010, the number of elderly female patients increased by almost a third. Chronic illness and gender-related cancer screens improved, but are well below national averages. Additionally, the housing and insurance statuses of the homeless population appear to be in flux. Fewer HCH patients are living in homeless shelters (-4.3%) and on the street (-0.7%) and more are reporting transitional housing (+1.6%) or doubling-up (+5.8%). Data further reveal fewer patients presenting without insurance (-5.3%) and more who have Medicaid (+3.7%), Medicare (+0.3%), other public insurance (+0.9%) and private insurance (+0.4%). There were no statistically significant changes between age, gender, housing, or insurance status groupings when comparing 2006 and 2010 aggregate data. Conclusion: The elderly homeless comprise a small, but growing subset of the national homeless population. This group is particularly susceptible to economic vulnerability and unmet health care needs. Elderly females are at an increased risk for common diseases and co-morbidities that affect individuals in their age group, including inability to perform activities of daily living, falls, impaired cognitive and executive function, frailty, and depression. Additionally, homelessness itself increases their risk of developing many acute illnesses and chronic conditions. This population is particularly susceptible to mental illness which may be further exacerbated by a lack of coping skills and resources to recover from their homeless situation.
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/49189
Medical student Jennifer Aborn Russo participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.
This poster is accompanied by a detailed paper available under "Additional Files."
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Provision of contraceptive services to homeless women: results of a survey of health care for the homeless providersSaver, Barry G.; Weinreb, Linda F.; Gelberg, Lillian; Zerger, Suzanne (2012-03-29)Homeless women have both a higher rate of pregnancy and a higher proportion of unintended pregnancies than other American women. The authors sought to learn about contraception services offered by providers of health care to homeless women and barriers to provision of long-acting, reversible contraception in these settings. A survey of the 31 member organizations in the national Health Care for the Homeless Practice-Based Research Network was conducted, inquiring about services provided and barriers to service provision. Among the 20 responding organizations (65% response rate), 17 directly provided contraceptive services; two referred patients elsewhere, and one provided no contraceptive services. All 17 that provided such services provided condoms; 15 provided oral contraceptives; 14 provided injectable contraception; 6 provided intrauterine devices, and 2 provided contraceptive implants. Barriers to providing the last two methods included lack of provider training, lack of resources for placement, costs, and concerns about complications. The present survey results suggested very limited access for homeless women across the country to the two most effective means of long-acting, reversible contraception. Modest investments of resources could reduce a number of barriers to providing these services.
Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age SixClark, Robin E.; Weinreb, Linda; Flahive, Julie M.; Seifert, Robert W. (2019-05-01)Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.
Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothersWeinreb, Linda F.; Goldberg, Robert J.; Perloff, Jennifer N. (1998-07-21)OBJECTIVE: To compare the health characteristics and service utilization patterns of homeless women and low-income housed women who are heads of household. DESIGN: Case-control study. SETTING: Community of Worcester, Massachusetts. PARTICIPANTS: A sample of 220 homeless mothers and 216 low-income housed mothers receiving welfare. MEASUREMENTS AND MAIN RESULTS: Outcome measures included health status, chronic conditions, adverse lifestyle practices, outpatient and emergency department use and hospitalization rates, and use of preventive screening measures. Both homeless mothers and housed mothers demonstrated low levels of physical and role functioning and high levels of bodily pain. Prevalence rates of asthma, anemia, and ulcer disease were high in both groups. More than half of both groups were current smokers. Compared with the housed mothers, homeless mothers reported more HIV risk behaviors. Although 90% of the homeless mothers had been screened for cervical cancer, almost one third had not been screened for tuberculosis. After controlling for potential confounding factors, the homeless mothers, compared with the housed mothers, had more frequent emergency department visits in the past year (adjusted mean, homeless vs housed, 1.41 vs .95, p = .10) and were significantly more likely to be hospitalized in the past year (adjusted odds ratio 2.22; 95% confidence interval 1.13, 4.38). CONCLUSIONS: Both homeless mothers and low-income housed mothers had lower health status, more chronic health problems, and higher smoking rates than the general population. High rates of hospitalization, emergency department visits, and more risk behaviors among homeless mothers suggest that they are at even greater risk of adverse health outcomes. Efforts to address gaps in access to primary care and to integrate psychosocial supports with health care delivery may improve health outcomes for homeless mothers and reduce use of costly medical care services.