Out for the count: Hospitalization as an opportunity to intervene for patients experiencing homelessness

Hospitalists are no strangers to the impact of the social determinants of health on patients and their families. Housing insecurity, including homelessness, is one such determinant with undeniable impact on a range of health outcomes. Preventive health care, and the pursuit and realization of good health, are made more difficult, if not impossible, without access to basic needs like stable housing, clean water, and electricity. These challenges extend into the hospital, complicating discharges and transitions from illness back to wellness. When a patient meets discharge criteria, we must grapple with the reality that some will not have a health-promoting place to which they can return. For some patients, access to shelter is not enough. Fears of safety, health risks, and crowds can keep individuals out of shelters weighing one difficult option against another. It is, therefore, not surprising that many discharged patients soon find their way back into the hospital.