ACP Recommends Ways to Better Meet Health Care Needs of the Unhoused Population

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Calls for an effective, evidence-informed, sustainable and sufficiently funded long-term strategy to address homelessness

March 8, 2024 (ACP) -- The American College of Physicians is taking a stand regarding medical care and support for homeless people. In a policy paper published Feb. 27 in the Annals of Internal Medicine, ACP provides recommendations to guide policymakers in addressing the underlying drivers of homelessness and better meeting the health care needs of this population.

"ACP has long had policy on the books regarding social drivers of health. We see this as a natural and needed extension of previous policy work addressing social drivers more generally, but also specific drivers as they disproportionately and uniquely impact different communities," said Josh Serchen, ACP associate for health policy. "Through these policies and series of papers, ACP is ultimately reaffirming its belief that any effort to improve health and health outcomes of our patients that do not address the various interconnected determinants of health will ultimately fail at accomplishing its goal."

As the authors note in the policy paper, lack of access to housing can cause and exacerbate behavioral health and substance use conditions, worsen injuries and illnesses and prevent proper storage of medications for chronic disease. Some shelter conditions can increase risks for communicable diseases and offer poor access to healthy food. And, of course, homelessness exposes people to dangerous weather conditions such as rain, snow, cold and extreme heat.

"Policymakers are really beginning to grapple with the very poignant impact social factors have on producing and maintaining health," Serchen said. For example, in recent years, the Centers for Medicare and Medicaid Services has allowed state Medicaid programs to use federal funds to cover nonmedical, health-related social services such as housing support.

In the paper, ACP urges policymakers to commit to address the structural underlying drivers of homelessness within society and to adequately fund programs that seek to meet the immediate health care and shelter needs of unhoused individuals.

ACP also calls for an effective, evidence-informed, sustainable and sufficiently funded long-term national strategy to address homelessness. Additionally, ACP supports the implementation and evaluation of Medicare and Medicaid demonstration projects that provide housing support and targeted medical services to those who are unhoused or are at risk for becoming unhoused. ACP encourages states to implement effective models in their own Medicaid programs.

On other fronts, ACP calls for homelessness and related issues to become part of medical education at all levels, and it supports laws and regulations that decriminalize symptoms of housing instability and homelessness. Finally, ACP urges public and private payers to cover the provision of health care services for unhoused populations.

"We hope this paper will allow for additional advocacy to bolster resources to address homelessness and housing insecurity and invest in health care delivery systems equipped to adequately meet the health needs of homeless populations," Serchen said. "The health care system should be seen as an important entry point for identifying and addressing these needs. Payers and health systems should be designed to screen for housing, treat the unique health needs of those experiencing homelessness and meet homeless individuals where they are in the community."

However, "we recognize that addressing homelessness through the medical setting is only a Band-Aid solution," he added. "Fundamentally addressing the core causes of homelessness will require a radical restructuring of societal priorities and resource allocation involving multidisciplinary stakeholders."

More Information

The position paper, "Meeting the Health and Social Needs of America's Unhoused and Housing-Unstable Populations," is available on the Annals of Internal Medicine website.

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Back to the March 8, 2024 issue of ACP Advocate