Canadian hospital data show longer, costlier stays for patients experiencing homelessness

Nearly 30,000 people last year were homeless when admitted to hospital and/or discharged from hospital, a first-of-its-kind Canadian analysis shows. Almost all of these inpatients were admitted following a visit to an emergency department, and the complexity of their illnesses meant they stayed twice as long as the national average.

"What's most troubling, based on what we know from other research, is that so many were discharged into the community without stable housing," says study co-author Dr. Cheryl Forchuk, Ph.D., Assistant Scientific Director at Lawson Health Research Institute.

"We need to see housing as a health intervention, and an integral part of a health strategy," says Dr. Forchuk, a trailblazer in researching health impact and solutions for people experiencing homelessness.

The new analysis—using a database from the Canadian Institute for Health Information (CIHI)—is the first detailed look at Canadian hospitals' use of Z59.0, a mandatory record-keeping code intended to identify and improve services for patients experiencing homelessness.

Key findings from this study include:

• Nearly 30,000 patients identified as living without housing were hospitalized across Canada last year.
• Average length of stay for people experiencing homelessness was 15.4 days, compared with the national eight-day average.
• About 12% of patients had hospital stays of more than one month.
• Average cost per stay was $16,800, compared with the national average of $7,800.
• Substance use, schizophrenic disorders and cellulitis (a bacterial infection) are the three most common reasons for hospital stays. Of these patients, 93% were admitted to hospital after an emergency department visit.

Dr. Forchuk notes that the longer hospital stays, with more complex care for marginalized populations, can lead to evictions from private apartments or rooming houses.

"In London, we're in a position to showcase what a community in partnership can do," Dr. Forchuk notes. "We've done a lot of work to prevent discharge into homelessness, including the City of London and other partners prioritizing housing for people who are discharged from hospital."

The study highlights how housing is intimately connected to health and well-being, and the importance of hospitals like London Health Sciences Centre (LHSC) and St. Joseph's Health Care London (St. Joseph's) participating in initiatives like the Health & Homelessness Whole of Community Response in London, Ontario.

"As health care providers, we recognize the importance of accurate data for understanding an individual's care journey across sectors and organizations, especially when addressing homelessness," says Brad Campbell, Corporate Hospital Administrative Executive, LHSC.

"For example, hospital and service utilization data has been essential to understanding emergency department patterns for those living without stable housing in our community, enabling us to improve care for marginalized people through different service delivery models. Through collaborations like our partnership with London Cares, we've leveraged data to help individuals in our community access supportive housing and comprehensive 24/7 health and social support services."

Campbell notes this work aligns to priorities in the Ontario health-care sector by increasing collaboration across sectors and removing barriers to care by enabling inter-agency communication to support increased capacity and access to health-care supports.

"Housing is health care," adds Dr. Forchuk. "Gathering and analyzing this data gives us more tools to find workable solutions to the complex problem of how people experiencing homelessness receive, or don't receive, the health care they need."