Little is known about health care utilization among people experiencing homelessness (PEH) in rural areas, who are often unsheltered and face barriers from geographic isolation and resource shortages. We examined emergency department (ED) and acute hospitalization utilization in relation to weather patterns among PEH at a rural health care system in Northwest Michigan (2018-2022). Mental and behavioral health diagnoses accounted for 66.3% of ED visits and 84.4% of hospitalizations. Higher maximum daily temperature was associated with increased ED visits (β=0.017, 95% CI=0.01, 0.24), while total precipitation was associated with fewer visits (β=-0.053, 95% CI=-0.087, -0.021). Greater cumulative snow depth was linked to increased ED visits (β=0.022, 95% CI=0.008, 0.036) and hospitalizations (β=0.034, 95% CI=0.002, 0.065). Shelter availability was associated with lower monthly hospitalization rates (mean difference=-1.42, 95% CI=-2.46, -0.39). These findings underscore the need for targeted mental health services and weather-responsive care strategies for PEH in rural areas.
Community health centers (CHCs) have significantly expanded behavioral health (BH) and social service delivery in recent years. Using 2020 and 2024 Uniform Data System data and the 2023-2024 Commonwealth Fund CHC Survey data, this study describes trends and challenges in care provision. From 2020 to 2024, CHC BH and social services staffing, utilization, and patient volume increased markedly. Most CHCs offered onsite counseling for mental health (70.4% for long-term, 88.0% for short-term), while substance use disorder services were less common (66.1% onsite, 53.4% telehealth). The BH challenges most often cited by CHCs were provider shortages (66.0%) and BH needs outpacing capacity (64.0%). While over half reported routinely screening for patients' social needs, difficulty connecting patients to services was high-especially for housing (30.3% reported "Extremely difficult"). These findings underscore that CHCs are delivering comprehensive, community-anchored care, but rising behavioral and social needs call for targeted policy and financial support.
INTRODUCTION:People experiencing homelessness (PEH) face significant risks of early cancer-related mortality due to barriers of care for complex treatments. We describe our pilot study for PEH with advanced cancer undergoing treatment at a large safety-net hospital system. METHODS:We performed a retrospective case series of PEH with advanced cancer undergoing medical respite from 2020 to 2024. Descriptive statistics were used to describe patient characteristics and outcomes. RESULTS:Nineteen patients participated in medical respite program while undergoing cancer treatment. Patients were referred from hospitals, clinics, and prisons; 74% were men and 67% under age 65. The most common primary cancers involved the lung, colon or rectum, and oropharynx-53% with known metastatic disease. All patients were able to complete cancer-related treatment with 42% achieving treatment response and transitioning to long-term housing. CONCLUSION:We demonstrated that temporary housing and support facilitated cancer treatment, which is important as states adopt medical respite to address social needs.
Little is known about the civil legal needs (CLNs) of those experiencing intimate partner violence (IPV). In this convergent mixed-methods, cross-sectional study, we used quantitative and qualitative data from a national online survey linked to Veteran Affairs health records to describe and compare the CLNs of patients who have screened IPV-positive versus IPV-negative. Using chi-square tests, we found that those who screened positive were significantly more likely to have at least one CLN (70.9% vs. 53.7%, p<.01 for all) and to have three or more CLNs (29.1% vs. 11.9%) than those who screened negative. IPV-positive patients were also significantly more likely to have CLNs related to housing (23.6% vs. 8.9%), family (23.6% vs. 8.6%), protection orders (14.6% vs. 1.3%), and military discharge status (14.6% vs. 5.1%) than IPV-negative patients. These findings underscore the importance of raising provider awareness of the breadth of patient-survivors' CLNs and staffing medical-legal partnerships with legal professionals qualified to address a range of legal services.
