A SAFE DC: A conceptual framework for care of the homeless inpatient

A structured approach to the inpatient care of the unstably housed patient is suggested, represented by a simple mnemonic checklist "A SAFE DC," and evidence-based adaptations of care are described, where available, and systems-based approaches to discharge are discussed.

Abstract

Homeless patients suffer disproportionately from medical disease and from barriers to healthcare, affecting their likelihood of presentation, severity of disease, long-term outcomes, and mortality. In the hospital, homeless patients are frequently cared for by hospitalists. Homeless patients' unstable social situation may challenge usual systems of inpatient care and discharge. To provide more effective care for this group, it is important to recognize the demographics of the hospitalized homeless patient. We suggest a structured approach to the inpatient care of the unstably housed patient, represented by a simple mnemonic checklist "A SAFE DC," describing evidence-based adaptations of care, where available, and discussing systems-based approaches to discharge.