Hospitalization, Rehospitalization, Repeat - Bridget Goodman

Hi everyone! My name is Bridget, and I have the absolute pleasure of leading API’s Education Policy Team. I’m a second-year journalism, comparative literature and Portuguese major from Decatur, Georgia. 

Earlier this month, at our general body meeting led by our very own Healthcare and Housing teams, we got to chat with a representative from Bigger Vision here in Athens who works with individuals experiencing homelessness. 

While chatting with us, he spoke about how, in his capacity coordinating services for individuals experiencing homelessness (as opposed to other groups, like families), one of the most heartbreaking challenges he sees is individuals experiencing homelessness from other Georgia counties who are discharged from hospitals to Athens-Clarke County. Without any connection to or familiarity with Athens-Clarke County, they are discharged to Athens-Clarke County because our county has more robust service than many other Northeast Georgia counties. 

In turn, patients experiencing homelessness are discharged to a county they are unfamiliar with, often without any support—they don’t know where the pharmacy is, they don’t have relatives nearby, they don’t know how to navigate the transit system here. The representative from Bigger Vision spoke about how this experience of displacement, after a hospital stay, frightens people. This fear propels people into a cycle—removed from the county they know, people often don’t access the care they need to stay out of the hospital, so they are eventually hospitalized again, and the cycle restarts.

This cycle of hospitalization, homelessness, and rehospitalization isn’t unique to Athens. People experiencing homelessness are continually exposed to potentially hostile climates, communicable diseases with lessened access to primary and preventative care, and the psychological stressor of experiencing homelessness. 

Simultaneously, homeless populations have a higher prevalence of mental illness and substance use disorders than housed populations. Therefore, it is no surprise that rehospitalization rates for people experiencing homelessness are higher than hospitalization rates for people who are housed, with mental health as the most common reason patients experiencing homelessness were rehospitalized.

During the last legislative session, SB 62 was passed under the Gold Dome as an attempt to limit the influx of these patients into Athens-Clarke County. The bill includes a provision prohibiting hospitals from discharging patients, without their consent, to counties that are neither their home county nor the county where the hospital is located. 

In July, SB 62 went into effect—allegedly. However, the representative from Bigger Vision who spoke to us said he has seen no difference since the bill went into effect. Ultimately, the bill did nothing to change the core reason Georgians from other counties who are experiencing homelessness are discharged to Athens: Athens has homelessness services—they may be strained or limited, but they exist. Many surrounding counties simply do not have services. At a state level, more than a quarter of Georgia counties had zero homeless services access points in 2023, according to Georgia Department of Community Affairs data. And so, unless that access to services across Georgia’s 159 counties changes, hospitals will likely continue to discharge patients to Athens-Clarke County in hopes they will be able to access services here.

These conditions make homelessness in Athens-Clarke County uniquely immense. According to Athens-Clarke County’s 2023 Strategic Plan to Address Homelessness, in 2022, homelessness in Athens rose 35%; in Georgia, homelessness only rose 4%. For further context, in 2022, the city of Atlanta had an estimated 2,017 people experiencing homelessness in a city of nearly 500,000 people; the same year, Athens-Clarke County, a county with under 130,000 people had an estimated 4,003 people experiencing homelessness.

Therefore, one component of effectively addressing the uptick in people experiencing in Athens-Clarke County means understanding the destructiveness of pretending homelessness can be addressed solely at a county level rather than at a regional level. 

The fact is Athens-Clarke County is a beacon for homeless services in Northeast Georgia, and that’s likely not going to change. What could change is how we view, and therefore work with, our neighboring communities. 

Actual solutions to homelessness demand collaborative–not punitive—partnerships between Georgia’s counties, and especially our neighboring counties. These partnerships are the foundation for providing people with needed services, effectively, rather than ineffective cycles of rehospitalization.

Beyond that, breaking cycles of homelessness means recognizing the realities of all members of our community in the policies we develop. For instance, understanding the unique challenges of people experiencing homelessness should not be an isolated responsibility of housing policy, but must be embedded in each policy area—in this instance, health policy must be reformed to include considerations for how to discharge patients experiencing homelessness in ways that set patients up for success, not for rehospitalization.