Beyond housing and health service use outcomes in research on the homeless: Nursing homes and jails

Introduction: Homeless outcomes research has focused on costly hospitalizations and emergency room visits. There are other costly outcomes of the homeless that are relevant to policy makers, namely nursing home and incarcerations stays.

Methods: We conducted a Randomized Controlled Trial of 407 homeless adults with chronic medical illnesses, following them for 18 months. Enrollment occurred in two Chicago hospitals. Adults who were able to self-care upon hospital discharge were eligible. We interviewed participants six times between their enrolling hospitalization and the 18 month study follow-up period to assess their housing and health service locations after enrollment. In addition, we conducted active surveillance of the local and state jail and prisons, as well as verified reported nursing homes stays.

Results: Our sample was 75% men, 75% African American, 34% HIV seropositive with a median age of 47. Our follow-up rate at the 18 month study end point was 81% interviewed; and higher for surveillance outcomes such as incarceration stays. During the study follow-up period 18% (n=74) stayed in nursing homes for a total of 10,559 days with direct costs of $1,065,153. Similarly 17% (n=69) were incarcerated for a total of 10,178 days. These incarceration days represent direct costs of $814,240.

Conclusions: Nursing home and incarceration stays and their resultant costs were substantial in this cohort. Cost effectiveness studies of the homeless should include nursing home stays and incarceration days in addition to traditional health and housing outcomes.