“I Need My Own Place for My Health to Get Better” – Patient Perspectives on the Role of Housing in Potentially Preventable Hospitalizations

Objective:  Potentially preventable hospitalizations are the focus of considerable research and policy attention. Housing-related factors likely have an important role in preventable hospitalizations, but this relationship is understudied.

Methods: Individuals hospitalized with either a congestive heart failure or diabetes-related preventable hospitalization (n=90) at the largest hospital in Hawai’i completed a semi-structured, in-person interview followed by open-ended questions asking for patient perspectives on key factors leading to their preventable hospitalization.  Using the framework approach, 2 independent coders identified key themes.

Results: Respondents were 52% Native Hawaiian or other Pacific Islander, 19% White, 16% Filipino and 13% other Asian.  Most respondents (70%) were under 65 years; 90% had health insurance, and 66% had previously been hospitalized for the same problem.  Overall, 23% reported housing as a key factor in their preventable hospitalization and 11% specifically reported not having a regular place to stay when out of hospital. Those with housing-related issues were more likely to be Native Hawaiian or Pacific Islander.  Key themes related to housing were difficulties handling chronic care management in unstable housing, challenges following a healthy diet without cooking facilities, and experiencing stress, stigma and prejudice related to housing insecurity.

For instance, one respondent described the mismatch between clinical advice and his circumstances: “So they tell me ‘don’t drink water.’ I tell them ‘you try not drink water where I live.’ It’s cool talking about that when you in your AC and you talking to me about what you gotta do … I cannot live like that.” Another patient reported his challenges in following a healthy diet: “The only problem is: I don’t have a kitchen. So I’m just running off of a toaster oven, microwave, little broiler.”  Others lacked any cooking facilities, leading to problems described by this respondent: “ I’m living right now in a transition home.  I barely ate at where I’m staying at.  It’s because of the food they give us, and I cannot eat a lot of salt and most of the food is salt.”

Conclusion:  Almost a quarter of patients hospitalized with a potentially preventable hospitalization described housing as a key factor.  Current federal policies include penalties for hospitals with preventable re-hospitalizations, yet our study highlights important precipitating social factors outside of the traditional purview of the hospital and clinical medicine.  Innovative partnerships and policy initiatives should address housing issues among those with preventable hospitalizations.