No Fixed Address, Still in Need: Coordinating Inpatient Rehabilitation for People Experiencing Homelessness: A Case Series.

Abstract

Homelessness significantly hinders access to inpatient rehabilitation services, particularly for individuals with complex medical and functional needs. This case series presents three persons experiencing homelessness with disabilities-due to amputation, functional neurological disorder, and stroke-who require coordinated rehabilitation care. Each case illustrates the compounded barriers persons experiencing homelessness face, including lack of stable housing, limited access to follow-up care, and fragmented healthcare and social service systems. Through interdisciplinary collaboration involving physiatrists, outreach occupational therapists, and social workers, each patient successfully accessed inpatient rehabilitation and continued rehabilitation after discharge despite persistent challenges. The cases underscore the importance of low-barrier, community-based care models and policy changes that view housing as a critical component of health care. Recommendations include adopting an expanded Housing First (+) model, improving medical respite programs, and integrating social services into rehabilitation planning. These strategies can improve health outcomes and community reintegration for persons experiencing homelessness, highlighting the need for systemic reform to ensure equitable access to rehabilitation services.