The city’s homelessness counter is missing a critical demographic – New Yorkers without shelter in hospitals

“The city’s annual census — known as the Homeless Outreach Population Estimate (HOPE) — served as a tool to measure our progress toward ending street homelessness. However, HOPE overlooks a crucial component of NYC’s ecosystem: hospitals. By ignoring this segment of the population, the city underestimates the true number of homeless people.”

Adi Talwar

Outside Lincoln Medical Center in the Bronx.

On a cold night in January 2020, 226 homeless people sought shelter in hospital emergency rooms across New York City. Hospitals have long been places where homeless New Yorkers seek care and refuge, but those who do are rarely counted on the city’s official list of vulnerable populations.

These individuals, whose numbers have likely increased due to the recent COVID-19 and flu outbreaks and Mayor Eric Adam’s new enforced hospitalization plan, often fall between the cracks of two disjointed systems that lack the coordination, expertise, and resources needed , to adequately support the homeless people with medical needs. Now more than ever, we need improved communication between health systems and homeless services to properly count vulnerable populations, support those without shelter, and address overburdened health systems.

This week, the New York City Department of Homeless Services (DHS) will send its homeless teams to estimate how many New Yorkers are homeless. Since its inception in 2005, this annual census — known as the Homeless Outreach Population Estimate (HOPE) — has served as a tool to measure our progress in ending homelessness on the streets. However, HOPE overlooks a crucial component of NYC’s ecosystem: hospitals. By ignoring this segment of the population, the city underestimates the actual number of homeless people.

This underestimation has direct implications for the budget. Results from HOPE will be used to allocate city resources to the homeless population, including distributing Safe Haven beds and commissioning street teams. Additionally, someone who spends every night in the emergency room and is unknown to any of the city’s contracted homeless teams may not be eligible for permanent housing programs that require homelessness screening. In the absence of an accurate HOPE census, our organization produced an annual Hospital Homeless Census and requested DHS to include hospitals in its annual census. In our most recent census, we found that 22 percent of respondents said they had visited the emergency room every day in the past year. These individuals deserve to be considered and cared for.

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