Characteristics and priorities of patients temporarily-housed in project roomKey

Context: Individuals experiencing unsheltered homelessness experience higher rates of disease burden, limited access to healthcare, and inability to abide by COVID-19 public health recommendations (i.e. handwashing, stay-at-home-orders), leaving them at significant risk for COVID-19 infection and complications.

Objective: To describe a cohort of unsheltered homeless from Los Angeles County participating in Project RoomKey (PRK).

Study Design: Case series

Setting: PRK temporarily housed individuals in hotels/motels due to COVID-19 pandemic. Participants eligible if unhoused and: age 65+, had underlying medical conditions, or were medically compromised. Sample of 35 patients provided primary care by USC Street Medicine at single PRK site from July-September 2020. Sample comprised 62.9% male, 54.3% age 50+, 40% Hispanic/Latinx, 40% White, and 94.3% English-speaking.

Population Studied: Individuals experiencing unsheltered homelessness most likely to need hospitalization or critical care if infected with COVID-19. Study patients referred to street medicine when unmet health care needs identified or medical care requested by patient or PRK staff. Overall sample of n=35.

Instrument: HOUSED BEDS+ clinical tool for taking history on unsheltered homeless patients.

Results: Participants were asked to respond about their lives prior to entering PRK. All patients had ≥1 medical condition, 64.7% had ≥1 mental health condition, and 59.4% with tri-morbid condition. HOUSED BEDS framework revealed: Homeless history (H): 5.2 mean years homeless with 44.8% living on street and 34.5% combination of street, car, and/or shelter. Outreach (O): 92.6% received outreach. Utilization (U): 5.9 mean emergency department visits in past 6 months. Salary (S): 82.1% received government income. Eat (E): 73.7% received ≥7 meals per week. Drink (D): 80% reported clean water access. Bathroom (B): 86.4% reported bathroom access. Encampment (E): 61.9% reported safety concerns while living outside. Daily routine (D): 89.7% had access to a phone, 39.3% received social support from family and 28.6% from combination of family, friends, and/or partner. First priority for 25.9% was housing, 22.2% was income, 18.5% was social relationships, and 18.5% was health. Substance use (S): 93.1% had past or current substance use.

Conclusions: Analyses highlight importance of housing, income, social relationships, and health to adults over age 50 experiencing unsheltered homelessness.