Identifying and Addressing Housing Insecurity in Older Patients: Trends, Referrals, and Inequities in a California Medical System.

BACKGROUND AND OBJECTIVES

Housing insecurity is rising among older adults, especially for racially minoritized people. Few studies have evaluated whether healthcare institutions are meeting that challenge. Using data from a large California medical system, we examined how often older patients are (A) identified as housing insecure and then (B) referred to social services, as well as inequities in those rates.

RESEARCH DESIGN AND METHODS

We analyzed electronic health records (2013-2022) for 119,127 older adults (55+) receiving primary or emergency care. We used a natural language processing model to identify housing insecurity and social services referrals/connections from unstructured notes, with referrals also captured via structured data. Trends in identification were compared to eviction and homelessness trends in the general population. Racial inequities in referrals were evaluated using logistic regression.

RESULTS

0.6% of encounters (n = 6,253) screened positive for housing insecurity. Positive screening trends were nonlinear, with initial increases followed by declines to baseline (roughly tracking regional eviction trends). Only 7% of patients identified as housing insecure were referred to social services, and connections were more likely in primary than emergency care (odds ratio [OR] = 2.04, 95% confidence interval [95% CI]: 1.41-2.96). Asian patients had lower odds of referral than non-Hispanic White patients (OR = 0.51, 95% CI: 0.28-0.95).

DISCUSSION AND IMPLICATIONS

We identified urgent unmet needs for housing intervention among older patients. Healthcare systems must do more to ensure older patients, especially racially minoritized older adults, are screened for housing insecurity and connected to housing services.