By Lisa Rapaport

(Reuters Health) – Emergency room visits for homelessness surged at a large urban children’s hospital after Massachusetts made it harder for families to get into shelters, a new study suggests.

In 2012, Massachusetts shelters began requiring additional documentation of homelessness, such as sleeping in a place “not meant for human habitation,” which could include an emergency room, researchers note in Pediatrics.

At Boston Children’s Hospital, ER visits for homelessness more than quadrupled after the shelter eligibility rule change, the new analysis found.

“While the (emergency room) is chaotic and potentially very frightening to children, it is the best of many bad options for families who are forced to spend a night in a place ‘not meant for human habitation’ in order to qualify for emergency assistance shelter,” said lead study author Dr. Amanda Stewart of Boston Children’s Hospital and Harvard Medical School.

“In an (emergency room), families have a roof over their head and have access to a bed, food, and a social worker,” Stewart said by email. “The emergency department also offers an easier method of documenting their homelessness, since they receive discharge paperwork stating they were in the emergency department for homelessness.”

The study, conducted from 2010 to 2016, suggests many families brought kids to the emergency room for reasons not directly related to medical problems.

Overall, 65 percent of the children seen in the ER didn’t have a medical problem, and their diagnosis was homelessness, not a health issue, the study found.

Children seen in the ER after the shelter rules changed were more than three times more likely to lack a medical reason for being in the hospital, the study found.

Although the number of homeless children in Massachusetts increased by 40 percent over the study period, ER visits for homelessness surged 13-fold.

Payments for these hospital visits averaged $557, more than four times what it might cost for a night in a shelter, the study authors note. Overall, 89 percent of these ER payments were covered through state-based insurance plans.

One limitation of the study is that it reflects what happened at only a single hospital, the authors note. Another drawback is that Massachusetts is the only state with a “not meant for human habitation” shelter eligibility policy, so the results might not explain what could happen elsewhere.

Still, the results suggest that children and families would benefit from changing the Massachusetts policy to avoid the need for documenting the lack of housing, Stewart said.

“This would remove the requirement which forces children into ERs or unsafe locations,” Stewart said.

Beyond this, every city and state should set aside shelter space specifically for homeless families with children, said Dr. Benard Dreyer, past president of the American Academy of Pediatrics and author of an accompanying editorial.

“Family homelessness is an epidemic in the U.S. today,” Dreyer, of Bellevue Hospital Center and New York University School of Medicine in New York City, said by email.

Almost 300,000 children are living in shelters for at least part of the year and 2.5 million children a year experience some form of homelessness, Dreyer said.

“Poor families simply cannot afford housing,” Dreyer added. “While some jurisdictions, such as New York City and Massachusetts, guarantee shelters for those families, 10 percent of homeless families nationwide are living in cars, or on the street.”

SOURCE: Pediatrics, online October 15, 2018.