A new study finds that more than 40 percent of patients treated at U.S. community health centers have a history of housing problems. The report from investigators at Massachusetts General Hospital (MGH), Boston Health Care for the Homeless Program (BHCHP) and the University of North Carolina, Chapel Hill (UNC-Chapel Hill), appears in the Feb. 20 issue of JAMA.
“These findings suggest that we should consider screening all community health center patients for housing problems,” says study leader Travis Baggett, MD, MPH, of the MGH Department of Medicine, who is also BHCHP director of Research. “The Veterans Health Administration has set an important precedent in doing just that, and we could learn from their experience.”
Community health centers are overseen by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services and provide primary and preventive care services to underserved populations regardless of their ability to pay. In 2016, U.S. federally-funded community health centers provided care to more than 23 million patients. Although community health center patients are often socioeconomically disadvantaged, the extent of their housing problems was previously unknown.
Using data from the HRSA’s 2014 Health Center Patient Survey, the researchers examined the prevalence of various types of housing problems – such as frequent moves, difficulty paying rent, doubling up, and current or prior homelessness – among adult patients surveyed at federally-funded community health centers in 2014-2015. Of more than 3,100 patients who responded to questions about their housing status, 44 percent reported a history of housing problems ranging from current homelessness to currently stable housing with a history of homelessness.
The percentage who were currently homeless – 1.2 percent – was around seven times higher than the estimated prevalence in the U.S. population. The largest group of those with a history of housing problems – 27 percent of all respondents – were “unstably housed,” meaning that while they currently have their own place, they either moved two or more times during the past year or had been unable to pay their rent or mortgage at any time in the past. People with any type of housing problem were more likely to report health problems, emergency department use and delays in care.
“Stable housing is essential for health,” says senior author, Jessie Gaeta, MD, BHCHP Chief Medical Officer. “We’ve seen time and again in our research and clinical practice that when people lack that basic need, their health and well-being suffer.”
Co-author Seth Berkowitz, MD, MPH, formerly with the MGH Division of General Internal Medicine and now at the UNC-Chapel Hill School of Medicine, adds, “Identifying housing problems in a clinical setting makes sense. It offers an opportunity to initiate referrals for housing assistance, case management and other social services, which might be some of the most important things we could do for patients’ health.”
Vicki Fung, PhD, of the Mongan Institute Health Policy Center at MGH notes that Congress recently reauthorized funding for community health centers for the next two years. “That will be an important step in helping community health centers meet the needs of patients with housing problems.”
Baggett and Fung are both assistant professors of Medicine at Harvard Medical School, Gaeta is an assistant professor of Medicine at Boston University, and Berkowitz is an assistant professor of Medicine at UNC-Chapel Hill. Support for the study includes National Institutes of Health grants K23 DA034008 and K23 DK109200 and Agency for Healthcare Research and Quality grant R01 HS025378.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2017 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."