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Study Sheds Light on Impact of Patient Housing Instability in Behavioral Health
New research from the University of Michigan Institute for Healthcare Policy and Innovation (IHPI) has found that 50% of hospital stays for individuals with documented housing issues were for mental, behavioral, and neurodevelopmental care—a rate 10 times higher than the percentage of stays for these conditions for those who didn’t have housing instability listed on their patient chart.
Findings from the study published in JAMA Network Open “identify the business case for synergistic collaborations between housing, hospital, and mental health experts,” according to its authors.
The study was made possible by a change in 2016 that allowed US hospitals to begin tracking patients’ housing status, including housing instability and homelessness—a nod to the role of housing as a key social determinant of health.
Hospital staff recorded housing instability for just 1% of admissions in the national sample collected between 2017 and 2019. However, despite having codes, known as “Z codes,” tracking 5 categories of housing instability, nearly all of the patients who reported instability were recorded as experiencing homelessness. Patients with housing instability were found to have longer lengths of stay, averaging an additional 2 days, and also accounted for 10% of inpatient days for mental, behavioral, and neurodevelopmental care.
The researchers also calculated that caring for hospitalized individuals with documented housing instability in the populations study cost $9.5 billion overall and $3.5 billion specifically for behavioral healthcare. Further, individuals struggling with homelessness are more likely to have Medicaid coverage (55%) or no insurance (12%), leaving state programs and hospitals to bear the brunt of costs.
“Because of the lack of use of Z codes, our findings are likely the tip of the iceberg,” IHPI scholar Kimberly Rollings, PhD, said in a news release. “If we want to improve care for these individuals, and make the best use of hospital beds, healthcare professionals and their institutions need to do more to improve screening for this important social driver.”
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