Homelessness is comorbid with all of the conditions mentioned: incarceration, psychiatric symptomatology, substance abuse and school failure or placement in special education, yet no protocol is in place to routinely screen those experiencing homelessness for traumatic brain injury or its neuropsychological sequelae.
COST OF HOMELESSNESS
At present, the impact of traumatic brain injury and cognitive dysfunction on the cost of homelessness cannot be calculated, since the research that would bring those costs to light has yet to be undertaken. Much is known, however, about the cost of homelessness in general. In many cities, homeless persons live in street, shelter, hospital, detox and jail in a cyclical fashion at great cost to themselves and society. In terms of medical care, homeless persons tend to use the most expensive interventions: Emergency settings, psychiatric units and detoxification facilities. On average, studies report that homeless persons spend four more days in hospital each year than nonhomeless people.31 To extrapolate, at current cost estimates it is possible that the 33,500 persons who are presently homeless every night in New York City generate $335 million more in hospital fees annually than non-homeless persons do.
Studies reveal that homeless persons also spend a disproportionate amount of time in jail and prison. In 2005, a year in prison cost an average of $23,876.32 Additionally, homeless shelters cost far more on average than does permanent housing: About $1,250 per month to shelter single persons and $2,000 to $2,500 per month for families in homeless shelters. For comparison, in New York City, permanent, supportive housing for eligible formerly homeless persons costs $215 per month. A recent study of long-term homelessness found that: “The 150,000 chronically homeless people in the United States cost $10.95 billion per year in public funds. If these individuals were all permanently housed, the expense would be expected to fall to $7.88 billion.” The study estimated that approximately 90% of these costs are comprised of medical care for this vulnerable population. 33
One of the causes of frequent use of high-cost medical services by homeless persons may be ease of access. In New York City, for example, hospital emergency departments cannot refuse uninsured persons medical care whereas in an outpatient setting, those who cannot pay will not be seen. Identification of cognitive dysfunction in homeless persons can enhance their ability to obtain SSI/SSD disability entitlements, which guarantees stable health insurance in the form of Medicaid and/or Medicare and may serve to curtail inappropriate emergency room use and avoidable hospitalizations.34