Biweekly Briefing Articles

Point-in-Time Counts Reveal Urgent Need for Solutions to Homelessness Crisis

In January, over 1,000 volunteers conducted the annual Point-in-Time Count to assess homelessness in San Diego and Imperial counties. Part of a nationwide effort from the U.S. Department of Housing and Urban Development, the count surveys those who are unsheltered, on the streets, or in shelters the morning of the count. While the 2024 numbers will be released this spring, we are likely to see the continuation of a trend that started in 2023. Last year, San Diego County saw a 35% increase to approximately 6,500 unhoused individuals, while Imperial County experienced a 23% increase to more than 1,300 individuals. 

Hospitals, which provide essential care to all who walk through their doors, are witnessing this escalating crisis firsthand. Each January, hospitals conduct their own internal point-in-time count of homeless patients to understand their unique challenges. Thank you to the hospitals that participated in this year’s count, which identified over 500 homeless patients receiving care in San Diego hospitals each day during the week of Jan. 22-28. That’s consistent with 2023 numbers. 

People experiencing homelessness often turn to emergency departments for food, clothing, and assistance due to long wait times for shelter beds or other supportive services. These individuals frequently grapple with behavioral health issues and substance use disorders, requiring comprehensive care strategies. Hospitals have stepped up to address these needs and more, guided in part by the passage of Senate Bill 1152 in 2018. However, we cannot do it alone — our staff and systems are at the breaking point. 

That’s why we need a broader, community-wide solution. Civic leaders, elected officials, businesses, nonprofits, social service organizations, and more must play a role in addressing this issue. Crisis stabilization units, mobile crisis teams, recuperative care facilities, and street medicine are all effective models to reduce dependence on hospital emergency departments and provide immediate treatment in the community. 

Insurance companies must also play a role. Patients with behavioral health issues have had their discharge delayed by days or — in extreme cases — for as long as a year because insurers have inadequate post-discharge care options. 

The 2022 HASD&IC Community Health Needs Assessment identified homelessness and affordable housing as top concerns in San Diego County. Housing prices have become increasingly out of reach, pushing more individuals into homelessness and putting them at heightened risk of illness and injury. Many seek emergency department services as a last refuge. 

Point-in-time counts are not just data; each number represents a neighbor in distress. This vital information for our communities reminds us of the challenges hospitals face in serving people experiencing homelessness and reflects the urgency to find solutions.