The Multidimensionality of Housing Insecurity In Hospital Settings: Findings and Implications from a Point-In-Time Survey

Background and Purpose: Housing insecurity describes a range of housing-related concerns, including instability, unaffordability, unsafe living conditions, and homelessness, and contributes to poor health and misuse of emergency services. To address this, hospitals are increasingly screening for housing insecurity; most measures focus on literal homelessness and overlook the many ways housing can be unstable compromising health. Growing evidence shows that individuals often experience multiple forms of housing insecurity, each of which affects health and health care in distinct ways, underscoring the need for a more nuanced and intentional understanding of housing insecurity among hospitalized patients. This study addresses this gap by documenting multiple forms of housing insecurity among hospitalized patients and caregivers, and by examining types, rates, and severity.

Methods: An observational, cross-sectional survey of hospitalized patients was conducted across three settings: an academic medical center, a children’s hospital, and a community hospital in Lexington, Kentucky. The survey leveraged point-in-time methods, surveying 306 patients and adult caregivers on a single night. We measured individual domains of housing insecurity, including instability, housing quality, unaffordability, temporary housing, and literal homelessness and then created a composite variable categorizing housing insecurity into three levels none, less severe, more severe. The rate of each housing insecurity type was calculated and Pearson's chi-squared tests were used to analyze the relationship between the three-level housing insecurity composite and demographic characteristics including age, race, gender, and county type (metropolitan or non-metropolitan).

Results: A total of 468 patients were approached and 306 consented: a 65.4% response rate. Sixty -five percent of participating hospitalized patients or caregivers reported at least one form of housing insecurity. The most common issues were unaffordability (33%) and worries about losing housing in the future (12.3%). Thirty-six percent of patients met criteria for less severe housing insecurity and 24% reported severe housing insecurity. There was a significant association between housing insecurity and gender, with male patients reporting more severe housing problems.

Conclusions and Implications: Our study found that many patients have unmet housing-related needs during their hospital admission. This study contributes to the literature on measuring housing insecurity in hospital settings by conceptualizing it across three levels, highlighting an important area for further inquiry. Given the documented challenges associated with housing insecurity among hospitalized patients, future research can address questions related to how experiences of multiple forms of housing insecurity may exacerbatebarriers to care and health care cost outcomes. Conceptualizing housing insecurity in hospital settings as a spectrum provides a lens for targeting interventions towards individuals at the highest risk of negative housing and health outcomes.