Housing problems found to be common at safety-net community health centers

February 20, 2018, Massachusetts General Hospital

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 ," 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 centers meet the needs of with problems."

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