The Economic Consequences of Homelessness in The US

transportation, and have more limited access to services, particularly those in rural
areas. These barriers to treatment may lead to increases in chronic conditions and may
hinder housing and income stability.
Research also indicates that individuals experiencing homelessness have a risk of
mortality that is 1.5 to 11.5 times greater than the risk in the general population.
Research across the European Union and Canada supports findings of higher mortality
rates and chronic disease loads among individuals experiencing homelessness than
among those who are housed. Living in an unsheltered or temporary location can
exacerbate conditions such as diabetes and
hepatitis C, which a study in Boston showed to be
two times and 12 times, respectively, more
prevalent in a cohort experiencing homelessness
than in the general population. Managing diabetes
requires access to clean needles and testing
supplies and refrigeration of insulin, and treating
hepatitis C depends on detailed medication
management, which can be difficult or impossible
for individuals experiencing homelessness. Along
with treatment of chronic health conditions, stable
housing is integral in preventing communicable
diseases such as tuberculosis and HIV. In
addition, food insecurity (defined as being without
access to food or not having the ability to acquire
food), as faced by many who are homeless, can further worsen mental health
outcomes.
Furthermore, individuals experiencing homelessness overuse emergency services,
leading to higher costs for treatment. Studies report that a quarter to one third of
homeless individuals are hospitalized during a given year and that these individuals
have significantly higher rates of emergency department (ED) use than the general
population. A national study of ED use showed that homeless individuals were three
times more likely than members of the non-homeless population to return to the same
ED within 3 days of an evaluation in that department and twice as likely to use an ED
within 1 week of a hospitalization. The study also revealed that homeless individuals
were more likely to be transported to the hospital via an ambulance, further increasing
treatment costs.
Research on factors predicting ED use among individuals experiencing homelessness
shows that unstable housing status and disease burden are more predictive of overuse
than insured status. A study in Toronto reported that homeless insured adults visited an
ED eight times more frequently than their low-income housed counterparts, while a
study in Boston concluded that unstable housing, mental illness, and substance use
disorders were significantly associated with frequent ED use among homeless insured
patients. These costs add up, and research estimates that maintaining a person living
on the street or in a shelter can cost between $35,000 and $150,000 annually,
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