Recorded presentation

James J. O'Connell, MD¹, H. Joslyn Allen, MSSW¹, Jill Roncarati, PA-C¹, Cheryl Kane, RN, MEd¹, Eileen Reilly, MD², and Stacy Swain, MPH¹. (1) Boston Health Care for the Homeless Program, 729 Massachusetts Avenue, Boston, MA 02118, 617-414-7763, jallen@bhchp.org, (2) Massachusetts Mental Health Center, 74 Fenwood Rd., Boston, MA 02115

BACKGROUND: Rough sleepers are a vulnerable subset of homeless persons who live on the streets and avoid shelters. Little is known of the health care needs of this elusive population. The multidisciplinary street team of the Boston Health Care for the Homeless Program (BHCHP) has provided direct care services to urban street dwellers for over a decade. METHODS: A four-year prospective study of 127 high-risk, chronically homeless rough sleepers was undertaken in January 2000. Criteria for inclusion in this cohort include age over 18, living on the streets for at least six consecutive months, and one or more of seven identified risk factors. Data sources, including BHCHP’s electronic medical record, medical records at two academic teaching hospitals, a supplemental Palm Pilot street database, and death certificates, provide the team with data about the cohort’s burden of illness, service utilization, housing disposition, and causes of death. RESULTS: After four years, the whereabouts of all but 8 individuals was known. 26 (20%) persons died: 6 cirrhosis, 6 alcohol or drug overdose, 4 cancer, and 3 AIDS. Another 15 (12%) are currently in health care facilities (hospitals, respite care, and nursing homes), while 7 are incarcerated. Over a quarter of this population transitioned to housing during these years of intensive care management. CONCLUSION: Rough sleepers suffer extraordinarily high rates of morbidity and mortality. Improved coordination of care and access to housing may help reduce mortality and improve health status in this vulnerable population.

Learning Objectives:

At the conclusion of the session, the participant will be able to
• recognize the complexity of need and articulate the most prevalent obstacles to care faced by rough sleepers;
• discuss methods to improve coordination of care for rough sleepers;
• understand the causes of death and underlying medical problems of a cohort of urban rough sleepers

Keywords: Homeless Health Care, Mortality

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employment

Recorded presentation