NHS FPX 6008 Assessment 2 Needs Analysis for Change

Student Name

Capella University

NHS-FPX 6008 Economics and Decision Making in Health Care

Prof. Name

Date

Needs Analysis for Change

Homelessness in California presents significant economic challenges, straining healthcare resources, increasing costs, and worsening health disparities. Limited access to preventive care leads to higher emergency visits and hospitalizations, further burdening the system. Vulnerable populations, including those with chronic illnesses and mental health conditions, are disproportionately affected. Urgent action, including investment in affordable housing, integrated healthcare services, and policy reforms, is necessary to improve outcomes and promote health equity.

Summary of Homelessness as Economic Issues

Homelessness in California is a critical economic issue, straining healthcare resources, increasing costs, and exacerbating health disparities. In 2023, 337,735 people were homeless in California, with 73.4% unsheltered, 55% men, and 45% women (CHCF, 2024). People experiencing homelessness (PEH) face barriers to care, leading to higher rates of chronic illness, such as hypertension (30.1%), diabetes (11.1%), heart disease (15.1%), and pulmonary illness (25.2%) (Statista, 2024). These health issues contribute to increased hospitalizations, emergency visits (37.2%), and readmissions (27.4%), further burdening healthcare providers and facilities (Miyawaki et al., 2020).

The cost of providing shelter services is also significant, averaging $208,000 per bed and $278,000 per unit (Hoover Institution, 2023). This issue directly impacts my work as a nurse by increasing patient complexity, requiring additional care coordination, and straining hospital resources. It affects colleagues by contributing to burnout and challenges organizations by raising operational costs due to frequent readmissions and uncompensated care. Communities experience worsening public health outcomes, increased healthcare disparities, and economic strain.

The rationale for addressing homelessness lies in its widespread impact on healthcare access, cost, and equity. PEH accounted for 3.4% of hospital admissions and 2.8% of emergency visits in 2020 (CHCF, 2024). Unprotected PEH have a 2.7 times higher chance of death than the general population (Liu et al., 2020). A major contributing gap is the lack of integrated healthcare services, affordable housing, and social support systems, preventing effective intervention. Addressing this gap through policy reforms, expanded healthcare access, and housing initiatives is essential to improving outcomes and reducing economic strain.

Socioeconomic or Diversity Disparities

Homelessness in California disproportionately affects minority populations, with Black, American Indian, and Pacific Islander Californians experiencing significantly higher rates of housing instability. Black Californians, who make up only 5.3% of the state’s population, represent 26.6% of unhoused individuals assisted by homeless service providers. Similarly, American Indian/Alaska Native individuals account for 1.2% of the unhoused population despite comprising only 0.03% of the state’s total population (Davalos & Kimberlin, 2023). These disparities stem from historical and systemic inequalities, including discriminatory housing policies, economic instability, and limited access to high-wage jobs. Addressing these disparities requires targeted interventions such as expanded affordable housing, economic support programs, and policies that dismantle structural barriers contributing to homelessness among marginalized communities.

Evidence-Based Sources for Combatting Homelessness

Addressing homelessness among minority populations requires evidence-based strategies to mitigate systemic disparities and improve housing stability. Research highlights the connection between racial inequities, economic insecurity, and homelessness. A study by Sandu et al. (2021) underscores that housing-first approaches significantly improve long-term stability for marginalized population groups.

The lack of affordable housing disproportionately affects renters of color, as they are more likely to have extremely low incomes. According to the National Low Income Housing Coalition (2023), 19% of Black households, 17% of American Indian or Alaska Native households, and 14% of Latino households fall into this category, compared to only 6% of White non-Latino households. A study by Olivet et al. (2021) found that expanding rental assistance programs could reduce homelessness among Black and Latinx individuals. Implementing evidence-based strategies, such as permanent supportive housing and job training programs, is critical to closing the racial gap in homelessness rates and fostering long-term economic stability for affected populations (Aubry et al., 2020).

Opportunities and Predicted Outcomes

Expanding housing-first initiatives and rental assistance programs in California can significantly reduce homelessness among minority populations, leading to economic and social benefits. Research indicates that stable housing lowers healthcare costs by decreasing emergency room visits and hospitalizations, disproportionately high among unhoused individuals (Olivet et al., 2021). Additionally, permanent supportive housing has been shown to reduce interactions with the criminal justice system, further alleviating public expenditures (Aubry et al., 2020). By addressing the root causes of homelessness through evidence-based interventions, California can reduce the economic burden on healthcare systems and social services while improving health outcomes for vulnerable populations.

Furthermore, increasing access to affordable housing and job training programs can enhance financial stability and economic mobility for historically marginalized communities. Expanding rental subsidies and workforce development initiatives can empower these populations to achieve long-term economic independence, reducing reliance on emergency shelters and public assistance programs (Sandu et al., 2021). These targeted interventions promote equity and contribute to a stronger, more resilient economy by fostering stable employment and increasing consumer spending within communities.

Conclusion

Addressing homelessness in California, particularly among minority populations, requires a multifaceted approach that integrates housing-first strategies, rental assistance, and workforce development programs. By tackling systemic disparities and expanding access to affordable housing and healthcare, the state can alleviate economic burdens on healthcare systems, reduce recidivism rates, and improve long-term stability for vulnerable populations. Implementing evidence-based interventions promotes health equity and fosters economic growth by empowering individuals to achieve financial independence. Through targeted policies and community-driven initiatives, California can create a more inclusive and sustainable solution to homelessness, ultimately benefiting affected individuals and society.

References

Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T., Alkhateeb, Q., Xie, E., Mathew, C., Hannigan, T., Costello, C., Thavorn, K., Stergiopoulos, V., Tugwell, P., & Pottie, K. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review. The Lancet Public Health, 5(6), 342–360. https://doi.org/10.1016/s2468-2667(20)30055-4 

Olivet, J., Wilkey, C., Richard, M., Dones, M., Tripp, J., Beit-Arie, M., Yampolskaya, S., & Cannon, R. (2021). Racial inequity and homelessness: Findings from the SPARC study. The ANNALS of the American Academy of Political and Social Science, 693(1), 82–100. https://doi.org/10.1177/0002716221991040 

NHS FPX 6008 Assessment 2 Needs Analysis for Change

Sandu, R. D., Anyan, F., & Stergiopoulos, V. (2021). Housing first, connection second: the impact of professional helping relationships on the trajectories of housing stability for people facing severe and multiple disadvantage. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10281-2 

CHCF. (2024). People experiencing homelessness in California Almanac. California Health Care Foundation. https://www.chcf.org/publication/people-experiencing-homelessness-in-california-almanac/#related-links-and-downloads

Hoover Institution. (2023). ‌Sheltering California’s homeless is insanely expensive. It doesn’t have to be. Hoover Institution.org. https://www.hoover.org/research/sheltering-californias-homeless-insanely-expensive-it-doesnt-have-be

Liu, C. Y., Chai, S. J., & Watt, J. P. (2020). Communicable disease among people experiencing homelessness in California. Epidemiology and Infection, 148. https://doi.org/10.1017/s0950268820000722

Miyawaki, A., Hasegawa, K., Figueroa, J. F., & Tsugawa, Y. (2020). Hospital readmission and emergency department revisits of homeless patients treated at homeless-serving hospitals in the USA: Observational Study. Journal of General Internal Medicine, 35(9), 2560–2568. https://doi.org/10.1007/s11606-020-06029-0

NHS FPX 6008 Assessment 2 Needs Analysis for Change

Statista. (2024). Chronic health conditions among homeless in California 2022. Statista. https://www.statista.com/statistics/1462846/chronic-health-conditions-homeless-california-adults/#:~:text=A%20survey%20of%20homeless%20adults,health%20conditions%20as%20of%202022.

Davalos, M., & Kimberlin, S. (2023, March). Who is experiencing homelessness in California? California Budget and Policy Center. https://calbudgetcenter.org/resources/who-is-experiencing-homelessness-in-california/ 

National Low Income Housing Coalition. (2023, March 16). NLIHC releases the gap 2023: A shortage of affordable homes. National Low Income Housing Coalition. https://nlihc.org/news/nlihc-releases-gap-2023-shortage-affordable-homes