Trends in Homeless Children and Young Adults Seeking Shelter in a Boston Pediatric Emergency Department Following State Housing Policy Changes, 2011-2016.

Abstract

To describe a trend in emergency department (ED) use by homeless children and young adults before and after a state housing policy change in 2012 and to quantify financial and time costs to the health care system. We retrospectively reviewed de-identified electronic medical records of homeless children and young adults aged 0 to 21 years seeking shelter at an urban tertiary pediatric ED in Boston, Massachusetts, between September 1, 2011, and August 31, 2016. We identified 1078 visits for homelessness by 916 children and young adults. The median number of visits per month increased from 3 before the policy change to 17 after (P < .001). The total hospital charges were $578 351, with a net payment of $214 231, 97% paid by Medicaid. The average length of stay was 8 hours, totaling more than 8500 hours of occupancy. The number of homeless children and young adults who visited a pediatric ED increased significantly following a housing policy change, leading to substantial resource burdens on the ED and Medicaid. Public Health Implications. Policymakers should consider potential health care costs when designing housing policies and consider investing in housing to prevent unnecessary ED visits.