People staying in shelter-in-place hotels used less acute health services

Unintended benefit of pandemic policy to protect homeless people from COVID-19

In the first year of the pandemic, San Francisco and other communities in California offered private hotel rooms, three meals a day, and on-site medical services to homeless people who were at risk of contracting a severe form of COVID-19.

The goal was to stop the spread of the virus among a highly vulnerable group, but the policy had another important effect, according to new research from UC San Francisco, UC Berkeley and the San Francisco Department of Public Health. This significantly reduced the need for acute medical care by hotel occupants who had used this type of care the most in the past.

Hotels provided varying levels of medical care, ranging from half-day on-site nursing care to full-time medical staff making daily rounds. The researchers said it solved two of the problems that unhoused people often face when they are seriously ill: difficulty accessing regular medical care and having nowhere to go once they get sick. they are ready to leave the hospital.

“Our research highlights how a program for homeless people, which was implemented quickly and out of necessity, had an impact beyond its primary purpose of mitigating COVID,” said Maria Raven, MD. , MPH, chief of emergency medicine at UCSF, vice chair of the UCSF department of emergency medicine, and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs. “It’s important to study interventions like this that have been put in place during a public health emergency, so that in a future crisis, we can implement evidence-based programs.”

The study was published Wednesday, July 27, 2022 in JAMA Network Open.

Utilization of medical care dropped dramatically across the population early in the pandemic as people were reluctant to go to emergency rooms, hospitals restricted visitors, and providers moved care online.

To see how hotels further reduced the use of acute care for the people they housed, researchers compared hotel occupants who had used the most acute care services in the nine months before the pandemic to a similar group of unsheltered people who had not been granted hotel rooms during the pandemic.

Acute care use decreased in both groups, but decreased much more among those in hotels. Among hotel occupants, ER visits fell 40%, hospitalizations fell 59%, and hospital days and psychiatric ER visits fell 75%, compared to the comparison group.

“We view these reductions in acute care utilization as evidence of the benefits of these programs beyond just reducing COVID-19,” said Mark Fleming, PhD, assistant professor at the Berkeley School of Public Health and first author of the study. “These are some of the most at-risk and needy people who are not well served by the current system.”

Authors: In addition to Raven and Fleming, other UCSF authors include Jennifer Evans, MS, Dave Graham-Squire, PhD, Caroline Cawley, MPH, Hemal Kanzaria, MD, MSc, and Margot Kushel.

Funding: This work was supported by grant K01HS027648 from the Agency for Healthcare Research and Quality and the Benioff Initiative for Homelessness and Housing at UCSF.

Disclosures: Available in the newspaper.

About UCSF: The University of California, San Francisco (UCSF) focuses exclusively on the health sciences and is dedicated to promoting global health through advanced biomedical research, teaching in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as the primary academic medical center at UCSF, includes leading specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. The UCSF School of Medicine also has a regional campus in Fresno. To learn more, visit or view our fact sheet.

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