Video Transcript: Housing as a Social Determinant of Health
Use code category Z59 to screen and document factors related to housing as a social determinant of health.
Category Z59 describes issues involving both housing and economic circumstances like:
- Homelessness
- Inadequate housing
- Housing instability
- Discord with neighbors, lodgers, and landlord
- Problems related to living in residential institutions
- Lack of adequate food and food insecurity
- Extreme poverty, low income, or insufficient social insurance and welfare support
Screening for homelessness is difficult. Directly asking “Are you homeless?” typically doesn’t identify homelessness.
- People often don’t identify themselves as homeless because of stigma, shame, or perceptions of what a home is
- Some people provide a home address that belongs to a friend, relative, shelter, church, or previous residence
- People also move between places
- Bad past experiences prevent some people from disclosing homelessness for fear of being treated poorly
So why screen for homelessness and other social determinants of health?
Screening patients for social determinants of health can help you assess community needs.
For example, screening can support:
- Initiatives to explore costs or service use
- Advocacy for resources
- Referrals to community resources
- And eventually, alternative payment methods
There’s no common way to screen for homelessness in health care settings.
Some facilities ask a short series of questions about a patient’s living situation.
Other facilities have a more formal procedure.
Consider when to ask your patients about housing during a visit and how to document the information in your electronic health record (or EHR).
Think about how you’ll use the information you collect about homelessness. You may want your EHR to flag homelessness for medical providers or trigger referrals to case managers or social workers.
You should also consider adding homelessness to the patient problem list and entering the relevant Z59 code with other clinical information. It may also mean adding a searchable “no fixed address” or “homeless” option to your EHR.
Train your staff to ask questions about housing status and to sensitively respond to answers. Continuous trainings and reminders help reinforce positive interactions with homeless patients and consistent use of coding strategies.
Many private and public initiatives at local, state, and national levels focus on homelessness.
Each community approaches the issue differently, but many rely on partnerships between health and housing providers.
- Supportive Housing: This is safe, affordable, and community-based housing that provides tenants with the rights of tenancy and links to voluntary and flexible supports and services.
- Medical Respite Care: This is acute and post-acute medical care for people who are homeless and too ill or frail to recover from illness or injury on the streets or in a shelter, but not ill enough for a hospital.
- Superutilizer or frequent user initiatives: This is targeted outreach and services delivered to homeless patients who frequently use hospital emergency services. Services try to find regular primary care for patients, improve patient navigation skills, and help patients get housing and other resources.
- Health Homes: This is a Medicaid state plan option that provides a comprehensive system of care coordination for Medicaid patients with chronic conditions. Health home providers coordinate primary, acute, behavioral health, and long-term services and try to treat the whole person.