Population Care

Homeless people need more help, not stays in jail: AMA

Sara Berg, MS , News Editor

Homeless people are more likely than the general population to experience behavioral health disorders, acute and chronic conditions, and injuries resulting from assaults and accidents, according to an AMA Board of Trustees report whose recommendations were adopted at the 2019 AMA Annual Meeting in Chicago.

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Highlights from the 2019 AMA Annual Meeting

The increase in health complications, as well as a lack of insurance or access to medical care, leads homeless people to seek care in emergency departments (EDs) at a high rate. This also increases their rates of hospitalization.

“We know that many factors contribute to adverse health outcomes for homeless individuals. To help improve the health and well-being of people who experience homelessness, we must take a multipronged approach that includes collaboration among the community, government, social service organizations and physicians,” said AMA Board Member E. Scott Ferguson, MD.

“With homeless individuals relying heavily on emergency departments as their regular source of care, it is especially important that we reach beyond the hospital and into the community to offer clinical and social services to these vulnerable patients,” Dr. Ferguson added.

Nearly two-thirds of homeless people visit an ED annually, compared with about 20% of the general population. Meanwhile, homeless people are hospitalized at a rate nearly quadruple that of people who have homes, the report says.

The AMA House of Delegates (HOD) adopted policies for the AMA to encourage:

  • The development of holistic, cost-effective, evidence-based discharge plans for homeless patients who present to the emergency department but are not admitted to the hospital.
  • Collaborative efforts of communities, physicians, hospitals, health systems, insurers, social service organizations, government and other stakeholders to develop comprehensive homelessness policies and plans that address the health care and social needs of homeless patients.

The AMA also will “partner with relevant stakeholders to educate physicians about the unique health care and social needs of homeless patients and the importance of holistic, cost-effective, evidence-based discharge planning, and physicians’ role therein, in addressing these needs.”

In a separate action, the HOD took adopted policy on the criminalization of homelessness.

Laws criminalizing homelessness, or laws prohibiting life-sustaining activities in public spaces when there are no sheltered alternatives, have increased in U.S. cities over the past decade. These laws trap vulnerable populations in the criminal justice system and raise both human rights and constitutional concerns.

“While there are instances where the government needs to act to protect public health and safety, such as during an infectious-disease outbreak, governments should work to mitigate hazards and direct individuals to resources and services outside of the criminal justice system. Criminal sanctions should be a last resort,” says a separate AMA Board of Trustees report whose recommendations also were adopted.

To address criminalizing homelessness, the HOD adopted policy to:

  • Support laws protecting the civil and human rights of individuals experiencing homelessness.
  • Oppose laws and policies that criminalize individuals experiencing homelessness for carrying out life-sustaining activities conducted in public spaces that would otherwise be considered noncriminal activity (i.e. eating, sitting or sleeping) when there is no alternative private space available.
  • Recognize that stable affordable housing is essential to the health of individuals, families and communities.
  • Support policies that preserve and expand affordable housing across all neighborhoods.