Boston Health Care for the Homeless Program (BHCHP) reviewed the deaths of 13 homeless persons on the streets of Boston between July 1998 and January 1999. Methods. BHCHP medical records were reviewed. Admission and discharge data were obtained from two public detoxification programs serving homeless persons. Results. All 12 men and one woman (100%) suffered from chronic alcoholism. Two-thirds (66%) suffered from severe and persistent mental illness as evidenced by a DSM-IV diagnosis in the medical record. Surprisingly, all decedents had multiple acute and chronic medical illnesses. No information has yet been obtained on the utilization of the mental health system by this cohort. The pattern of health care utilization by those who died showed multiple emergency room visits and hospitalizations, particularly in the six months prior to death. 9 of the 13(69%) had been seen in local emergency rooms or admitted to acute care hospitals within three weeks of the day of death. This frequency of utilization of the medical health care system was paralleled by a dramatic number of admissions to publicly-funded detoxification programs. Ten of the 13 (77%) had received detoxification from alcohol and other drugs within 6 weeks of death, with 3 (23%) having died on the streets within one week of discharge from a detoxification unit. Conclusions. Contrary to our original hypothesis, these individuals had not fallen through the safety net. Rather, this group was well-known to homeless providers on the streets, and had extraordinarily high utilization of the medical care and substance abuse systems.
Learning Objectives: 1. To understand the risk factors that identify high-risk homeless individuals living on the streets. 2. Describe the health care utilization patterns of the street population. 3. Understand the interaction among medical, psychiatric, and mental health problems of high-risk "rough sleepers"
Keywords: Death, Homeless Health Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.