{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T12:14:38Z","timestamp":1762776878936,"version":"build-2065373602"},"reference-count":75,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>While healthcare systems have long attempted various strategies to care for unhoused patients, the rising complexity and severity of the homelessness crisis have underscored the urgent need for systemic approaches. Such efforts are critical as current federal policies push more responsibility for homelessness prevention and response to states and localities. Few studies have identified frameworks that healthcare systems can use to guide unified responses to the homelessness. In particular, support is needed to address how healthcare systems can operate across levels beyond individual care to improve patient health. To assess current and potential best practices, we conducted a literature search on healthcare system involvement in homelessness and conducted key informant interviews with experts from healthcare systems and national and local homelessness organizations. We grouped a wide spectrum of health-system responses into ten categories: screening, Health Care for the Homeless programs, medical respite, wraparound services, medical-legal partnerships, investment in affordable housing, healthcare and housing partnerships, data sharing, anchor institutions, and implementation of federal programs. Drawing on the socioecological model, this typology provides a framework that presents the ten categories for homelessness interventions on three interconnected levels\u2014institution-based practices, community partnerships, and public policy. It also provides a foundation for further research, financial impact analysis, and program evaluation.<\/jats:p>","DOI":"10.3389\/fpubh.2025.1642073","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T12:09:31Z","timestamp":1762776571000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Homelessness response: a framework for action by hospitals and healthcare systems"],"prefix":"10.3389","volume":"13","author":[{"given":"Joy C.","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine J.","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff","family":"Olivet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily E.","family":"Lazowy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard K.","family":"Koh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1377\/hlthaff.2023.01049","article-title":"Homelessness and health: factors, evidence, innovations that work, and policy recommendations","volume":"43","author":"Garcia","year":"2024","journal-title":"Health Aff (Millwood)"},{"key":"ref2","article-title":"USICH releases guidance for health systems and hospitals","year":"2024"},{"key":"ref3","article-title":"The 2024 annual homelessness assessment report (AHAR to congress) part 1: point-in-time estimates of homelessness, December 2024","author":"Tanya","year":""},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1001\/jamainternmed.2018.2924","article-title":"Mortality among unsheltered homeless adults in Boston, Massachusetts, 2000-2009","volume":"178","author":"Roncarati","year":"2018","journal-title":"JAMA Intern Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1353\/hpu.2022.0035","article-title":"The impact of homelessness on mortality of individuals living in the United States: a systematic review of the literature","volume":"33","author":"Funk","year":"2022","journal-title":"J Health Care Poor Underserved"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S372","DOI":"10.1093\/infdis\/jiac353","article-title":"Public health and homelessness: a framework","volume":"15","author":"Mosites","year":"2022","journal-title":"J Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e85","DOI":"10.1017\/S0950268820000722","article-title":"Communicable disease among people experiencing homelessness in California","volume":"148","author":"Liu","year":"2024","journal-title":"Epidemiol Infect"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e3718","DOI":"10.1093\/cid\/ciaa787","article-title":"Invasive group a streptococcal infections among people who inject drugs and people experiencing homelessness in the United States, 2010-2017","volume":"73","author":"Valenciano","year":"2021","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkz006","article-title":"The epidemiology of Cancer among homeless adults in metropolitan Detroit","volume":"3","author":"Holowatyj","year":"2019","journal-title":"JNCI Cancer Spectr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"108714","DOI":"10.1016\/j.drugalcdep.2021.108714","article-title":"The association of opioid use disorder and homelessness nationally in the veterans health administration","volume":"223","author":"Manhapra","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1001\/jamapsychiatry.2024.0426","article-title":"Prevalence of mental health disorders among individuals experiencing homelessness: a systematic review and Meta-analysis","volume":"81","author":"Barry","year":"2024","journal-title":"JAMA Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"S294","DOI":"10.2105\/AJPH.2013.301369","article-title":"A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance","volume":"103","author":"Hwang","year":"2013","journal-title":"Am J Public Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"778","DOI":"10.2105\/ajph.92.5.778","article-title":"Emergency department use among the homeless and marginally housed: results from a community-based study","volume":"92","author":"Kushel","year":"2002","journal-title":"Am J Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1215\/03616878-11567700","article-title":"Entrenched opportunity: Medicaid, health systems, and solutions to homelessness","volume":"50","author":"Willison","year":"2025","journal-title":"J Health Polit Policy Law"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1377\/hlthaff.2019.01246","article-title":"Quantifying health systems\u2019 investment in social determinants of health, by sector, 2017\u201319","volume":"39","author":"Horwitz","year":"2020","journal-title":"Health Aff Millwood"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"309","DOI":"10.2105\/AJPH.2019.305472","article-title":"Anchor institutions: best practices to address social needs and social determinants of health","volume":"110","author":"Koh","year":"2020","journal-title":"Am J Public Health"},{"key":"ref17","article-title":"Community solutions","author":"Anna","year":"2022"},{"key":"ref18","year":"2019"},{"key":"ref19","article-title":"Trump administration has gutted an agency that coordinates homelessness policy","volume-title":"NPR","author":"Ludden","year":"2025"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1037\/0003-066X.32.7.513","article-title":"Toward an experimental ecology of human development","volume":"32","author":"Bronfenbrenner","year":"1977","journal-title":"Am Psychol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"S210","DOI":"10.2105\/AJPH.2013.301398","article-title":"Universal screening for homelessness and risk for homelessness in the veterans health administration","volume":"103","author":"Montgomery","year":"2013","journal-title":"Am J Public Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1111\/1475-6773.13050","article-title":"Predictive modeling of housing instability and homelessness in the veterans health administration","volume":"54","author":"Byrne","year":"2019","journal-title":"Health Serv Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1377\/hlthaff.2022.00680","article-title":"A new way to support frequent emergency department visitors","volume":"41","author":"Tuller","year":"2022","journal-title":"Health Aff (Millwood)."},{"key":"ref24","year":"2018"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1111\/1468-0009.12563","article-title":"A mixed methods evaluation of interventions to meet the requirements of California senate bill 1152 in the emergency departments of a public hospital system","volume":"100","author":"Taira","year":"2022","journal-title":"Milbank Q"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.5811\/WESTJEM.60853","article-title":"Implementation and impacts of California senate bill 1152 on homeless discharge protocols","volume":"24","author":"Aridomi","year":"2023","journal-title":"West J Emerg Med"},{"key":"ref27","article-title":"How hospital discharge data can inform state homelessness policy","author":"McConville","year":"2022"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1111\/acem.14442","article-title":"Patient views on emergency department screening and interventions related to housing","volume":"29","author":"Kelly","year":"2022","journal-title":"Acad Emerg Med Off J Soc Acad Emerg Med"},{"key":"ref29","year":"2021"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1001\/jamainternmed.2024.1662","article-title":"Patient navigation for lung cancer screening at a health care for the homeless program: a randomized clinical trial","volume":"184","author":"Baggett","year":"2024","journal-title":"JAMA Intern Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e2342012","DOI":"10.1001\/jamanetworkopen.2023.42012","article-title":"Ambulatory intensive Care for Medically Complex Patients at a health Care Clinic for Individuals Experiencing Homelessness: the SUMMIT randomized clinical trial","volume":"6","author":"Chan","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"888","DOI":"10.3122\/jabfm.2023.230403R1","article-title":"Perceptions of medically complex patients enrolled in an ambulatory intensive care unit at a healthcare-for-the-homeless clinic","volume":"37","author":"Chan","year":"2025","journal-title":"J Am Board Fam Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e14359","DOI":"10.1111\/1475-6773.14359","article-title":"Organizational and patient factors associated with positive primary care experiences for veterans with current or recent homelessness","volume":"59","author":"Kertesz","year":"2024","journal-title":"Health Serv Res"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1186\/s12875-022-01932-3","article-title":"Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings","volume":"23","author":"Ramirez","year":"2022","journal-title":"BMC Prim Care"},{"key":"ref35","article-title":"How to start a health Care for the Homeless Program. National Health Care for the homeless council","author":"Rabell","year":"2021"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1111\/phn.12589","article-title":"Health care utilization following a homeless medical respite pilot program","volume":"36","author":"Biederman","year":"2019","journal-title":"Public Health Nurs"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1080\/10530789.2023.2229993","article-title":"Evaluation of the implementation of a medical respite program for persons with lived experience of homelessness","volume":"33","author":"Hoang","year":"2024","journal-title":"J Soc Distress Homelessness"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1080\/07370016.2014.926675","article-title":"Assessing the need for a medical respite: perceptions of service providers and homeless persons","volume":"31","author":"Biederman","year":"2014","journal-title":"J Community Health Nurs"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1353\/hpu.2018.0059","article-title":"Medical respite for people experiencing homelessness: financial impacts with alternative levels of Medicaid coverage","volume":"29","author":"Shetler","year":"2018","journal-title":"J Health Care Poor Underserved"},{"key":"ref40","article-title":"National Health Care for the homeless council","year":"2020"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.2105\/AJPH.2009.173609","article-title":"The Boston health Care for the Homeless Program: a public health framework","volume":"100","author":"O\u2019Connell","year":"2010","journal-title":"Am J Public Health"},{"key":"ref42","article-title":"How a medical respite care program offers a pathway to health and housing for people experiencing homelessness","author":"McCarthy","year":"2021"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/MLR.0000000000001998","article-title":"Delivering the right care, at the right time, in the right place, from the right pocket: how the wrong pocket problem stymies medical respite Care for the Homeless and What can be Done about it","volume":"62","author":"Walton","year":"2024","journal-title":"Med Care"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1771","DOI":"10.1001\/jama.2009.561","article-title":"Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial","volume":"301","author":"Sadowski","year":"2009","journal-title":"JAMA"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1353\/hpu.2013.0053","article-title":"Medical respite programs for homeless patients: a systematic review","volume":"24","author":"Doran","year":"2013","journal-title":"J Health Care Poor Underserved"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e1154","DOI":"10.1002\/cl2.1154","article-title":"A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness","volume":"17","author":"Moledina","year":"2021","journal-title":"Campbell Syst Rev"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"101657","DOI":"10.1016\/j.eclinm.2022.101657","article-title":"Hospital-based preventative interventions for people experiencing homelessness in high-income countries: a systematic review","volume":"54","author":"Luchenski","year":"2022","journal-title":"eClinicalMedicine"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1111\/acem.14610","article-title":"ED-home: pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use","volume":"29","author":"Fazio","year":"2022","journal-title":"Acad Emerg Med"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.22.0403","article-title":"Redesign of a primary care\u2013based housing intervention to address upstream housing needs","volume":"4","author":"Arbour","year":"2023","journal-title":"NEJM Catal."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s10488-022-01224-z","article-title":"Supporting vulnerable people during challenging transitions: a systematic review of critical time intervention","volume":"50","author":"Manuel","year":"2023","journal-title":"Admin Pol Ment Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1086\/684122","article-title":"Time-limited case management for homeless mothers with mental health problems: effects on maternal mental health","volume":"6","author":"Samuels","year":"2015","journal-title":"J Soc Soc Work Res"},{"key":"ref52","article-title":"Medical-legal partnership","year":""},{"key":"ref53","volume-title":"Financing medical-legal partnerships. The National Center for medical-legal Partnership at the George Washington University","author":"Trott","year":"2019"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"2195","DOI":"10.1377\/hlthaff.2017.0759","article-title":"Medical-legal partnerships at veterans affairs medical centers improved housing and psychosocial outcomes for vets","volume":"36","author":"Tsai","year":"2017","journal-title":"Health Aff (Millwood)"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"398","DOI":"10.2105\/AJPH.2016.303596","article-title":"Civil legal services and medical-legal partnerships needed by the homeless population: a National Survey","volume":"107","author":"Tsai","year":"2017","journal-title":"Am J Public Health"},{"key":"ref56","article-title":"Partnerships for action: California Health Care & Homelessness Learning Collaborative","year":"2022"},{"key":"ref57","article-title":"Detroit\u2019s comprehensive medical respite program for homeless secures multi-sector investment","volume-title":"Kresge Foundation","author":"Carrig","year":"2023"},{"key":"ref58","article-title":"Health care and homelessness","year":""},{"key":"ref59","article-title":"Health care\u2019s role in ending homelessness","author":"Davis","year":"2024"},{"key":"ref60","article-title":"Learning brief: data-sharing between homelessness and health systems","author":"Andi","year":"2023"},{"key":"ref61","article-title":"Mayors and CEOs for U.S. housing investment","year":""},{"key":"ref62","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1056\/NEJMp2213465","article-title":"The anchor strategy \u2014 a place-based business approach for health equity","volume":"388","author":"Ansell","year":"2023","journal-title":"N Engl J Med"},{"key":"ref63","article-title":"Fresno housing collaborate to address affordable housing crisis and provide healthy homes in Fresno County","year":"2022"},{"key":"ref64","year":""},{"key":"ref65","article-title":"Kaiser Permanente is spending $400 million on affordable housing initiatives","year":"2022"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1001\/archpsyc.60.9.940","article-title":"Cost-effectiveness of supported housing for homeless persons with mental illness","volume":"60","author":"Rosenheck","year":"2003","journal-title":"Arch Gen Psychiatry"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"1440","DOI":"10.2105\/AJPH.2019.305231","article-title":"Housing and urban development-veterans affairs supportive housing vouchers and veterans\u2019 homelessness, 2007-2017","volume":"109","author":"Evans","year":"2019","journal-title":"Am J Public Health"},{"key":"ref68","article-title":"VA announces goal to house 38,000+ veterans experiencing homelessness in 2023 - VA news","year":"2023"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"610","DOI":"10.2105\/AJPH.2024.307625","article-title":"First decade of supportive Services for Veteran Families Program and Homelessness, 2012-2022","volume":"114","author":"Wilkinson","year":"2024","journal-title":"Am J Public Health"},{"key":"ref70","article-title":"Section 1115 Medicaid waiver watch: a closer look at recent approvals to address health-related social needs (HRSN). KFF","author":"Hinton","year":"2024"},{"key":"ref71","article-title":"Medicaid section 1115 waivers: the basics. KFF","author":"Hinton","year":"2025"},{"key":"ref72","article-title":"Published: Medicaid waiver tracker: approved and pending section 1115 waivers by state. KFF","year":"2025"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1001\/jama.2025.1042","article-title":"Medicaid spending and health-related social needs in the North Carolina healthy opportunities pilots program","volume":"333","author":"Berkowitz","year":"2025","journal-title":"JAMA"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"23.0073","DOI":"10.1056\/CAT.23.0073","article-title":"Transforming care delivery and outcomes for multivisit patients","volume":"4","author":"Ma","year":"2023","journal-title":"NEJM Catal"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14620","article-title":"Health, housing, and justice: two-year implementation evaluation of a health system\u2019s multi-state medical-legal partnership to address housing instability","volume":"60","author":"Arora","year":"2025","journal-title":"Health Serv Res"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1642073\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T12:09:33Z","timestamp":1762776573000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1642073\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":75,"alternative-id":["10.3389\/fpubh.2025.1642073"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1642073","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,10]]},"article-number":"1642073"}}