Massachusetts passed legislation in 2012 making it harder to be officially declared homeless. This was to help make shelters available to those who most needed them. The law defined homelessness as living somewhere “not meant for human habitation.” The emergency department (ED) qualified as one such location. Would this lead to more families going to the ED to become eligible for shelter? This was the question that Stewart et al. (10.1542/peds.2018-1224) attempted to answer in a retrospective study of ED visits for homelessness at one children’s hospital before and after this legislation was passed. During the period studied (2010-2016), there were 312 visits to the ED for homelessness, of which nearly all (95%; n=297) were after the policy was implemented. Most of these children had no medical complaint but showed up in the ED so they could be qualified to live in a shelter. The authors also point out that while the number of homeless increased 1.4 times during the 6 years of this study, ED visits for homelessness, especially after the policy passed, increased by 13 fold with the cost per ED visit far more than a night in a shelter.
Going to the ED to qualify for shelter not only increases costs but crowds the ED. To further emphasize the importance of understanding childhood homelessness the problems with the current legislation, and what we can do, we asked Dr. Benard Dreyer, child advocate for children facing poverty and homelessness and past president of the AAP, to provide a commentary (10.1542/peds.2018-2695). He points out the large amount of toxic stress that children and families who are homeless experience and notes that homelessness is a serious consequence of poverty. His commentary not only demonstrates the psychosocial and medical complications that can result from homelessness, but also calls for solutions to this problem at a federal and municipal level to improve access to housing for homeless families rather than have them end up in an ED for a shelter. Homelessness has become a crisis in our society especially in large urban areas, and this article and commentary should be a rally cry to do something about this. Learning what you can do begins by reading this article and commentary and then helping turn words into actions so that this problem starts getting better before it gets worse.
