Association of Shelter-in-Place Hotels With Health Services Use Among People Experiencing Homelessness During the COVID-19 Pandemic

• Published in: JAMA network open 2022-07, Vol.5 (7), p.e2223891
• Main Authors: Fleming, Mark D, Evans, Jennifer L, Graham-Squire, Dave, Cawley, Caroline, Kanzaria, Hemal K, Kushel, Margot B, Raven, Maria C
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; COVID-19 - epidemiology; Drug use; Emergency medical care; Emergency Shelter; Female; Health Policy; Health Services; Homeless people; Hospitalization; Hotels & motels; Humans; Ill-Housed Persons - psychology; Male; Mental health; Middle Aged; Online Only; Original Investigation; Pandemics; Retrospective Studies; Shelter in place; Substance-Related Disorders - epidemiology
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2022.23891

Some jurisdictions used hotels to provide emergency noncongregate shelter and support services to reduce the risk of COVID-19 infection among people experiencing homelessness (PEH). A subset of these shelter-in-place (SIP) hotel guests were high users of acute health services, and the association of hotel placement with their service use remains unknown. To evaluate the association of SIP hotel placements with health services use among a subset of PEH with prior high acute health service use. This study used a matched retrospective cohort design comparing health services use between PEH with prior high service use who did and did not receive a SIP hotel placement, from April 2020 to April 2021. The setting was 25 SIP hotels in San Francisco, California, with a daily capacity of 2500 people. Participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. Data analysis for this study was performed from February 2021 to May 2022. SIP hotel placement with on-site supportive services. The primary outcomes were ED visits, hospitalizations and bed days, psychiatric emergency visits, psychiatric hospitalizations, outpatient mental health and substance use visits, and outpatient medical visits. Of 2524 SIP guests with a minimum of 90-day stays, 343 (13.6%) met criteria for high service use. Of 686 participants with high service use (343 SIP group; 343 control), the median (IQR) age was 54 (43-61) years, 485 (70.7%) were male, 283 (41.3%) were Black, and 337 (49.1%) were homeless for more than 10 years. The mean number of ED visits decreased significantly in the high-user SIP group (1.84 visits [95% CI, 1.52-2.17 visits] in the 90 days before SIP placement to 0.82 visits [95% CI, 0.66-0.99 visits] in the 90 days after SIP placement) compared with high-user controls (decrease from 1.33 visits [95% CI, 1.39-1.58 visits] to 1.00 visits [95% CI, 0.80-1.20 visits]) (incidence rate ratio [IRR], 0.60; 95% CI, 0.47-0.75; P