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With nowhere else to go, some Massachusetts families are sleeping in the ER


In Massachusetts, pediatric emergency rooms are seeing a fair number of patients who do not actually need medical care. As Gabrielle Emanuel of member station WBUR reports, families experiencing homelessness are turning to ERs for shelter in record numbers.

GABRIELLE EMANUEL, BYLINE: At Boston Medical Center, Oscar confided in an ER doctor that she and her 8-year-old son had nowhere to live.

OSCAR: (Speaking Creole).

EMANUEL: She says the situation was really stressful. They'd just arrived in Massachusetts after a five-year journey from Haiti. We're using her middle name because her family was a target of violence there.

OSCAR: (Speaking Creole).

EMANUEL: Hospital staff sent Oscar and her son to a field office for the state-run family shelter system. But by the end of the day, they still had nowhere to go.

OSCAR: (Speaking Creole).

EMANUEL: She says a state employee called an Uber and sent them back to the hospital in pouring rain to spend the night there. Melissa Deane from Boston Children's Hospital says many families tell her similar stories. They say they were sent by state officials, people at the airport, relatives, even strangers. This past year, her hospital saw about 550 families in the ER whose primary concern was housing.

MELISSA DEANE: It's massive. We have had to dedicate I would say close to 40% of our social work resources to this problem.

EMANUEL: For decades, ERs all over the country have been a place where people experiencing homelessness can go. Yet Massachusetts is in a unique situation. It's the only state that legally guarantees housing for eligible families. But as those families work through the shelter application, they sometimes have nowhere to go except the ER. This is becoming a particular problem lately because the number of families turning to ERs has ballooned. It's because an affordable housing crisis is colliding with a spike in migration. Deane and her staff of ER social workers help parents navigate the shelter application.

DEANE: The process is quite complex. You know, whether or not a family is income-eligible can be as tedious as looking at every little deposit.

EMANUEL: It can take days to track down everything for the application - birth certificates, housing history, bank statements. Many families stay in the ER that whole time. And since these kids don't usually have medical concerns, they wait as all the patients with health issues are seen first. Amanda Stewart, an ER doctor at Boston Children's, says pediatric hospitals are so busy right now that families in need of housing often stay in the ER waiting room all night, never getting a room or a bed.

AMANDA STEWART: There are alarms going off 24/7. There's just lots of potentially scary things happening. And not to mention, of course, there's infectious diseases that we don't need to expose them to if they aren't there for medical reasons.

EMANUEL: Stewart says it all takes a toll on the family's mental health. One family stayed at Boston Children's for nearly a month. Plus, it's expensive. The Massachusetts Medicaid system usually picks up the tab, paying for each child each night.

STEWART: The average was $557, which, at the time when we studied it, was about 4-1/2 times the cost of a night in a shelter. And so these are just completely preventable, unnecessary costs to the health care system.

EMANUEL: But in Massachusetts, there's not another 24-hour option for families who are newly homeless. So some end up sleeping in cars, staying outside or going to the ER.

STEWART: They're choosing between a bunch of really terrible options, and so I think that's how we end up becoming this kind of front door to the shelter system for people.

EMANUEL: Massachusetts officials declined interview requests, but a spokesperson says it's not state policy to direct families to the ER. Oscar and her son got lucky. After going to the ER two nights in a row, they found temporary housing with a nonprofit while applying for the shelter system. With all their stuff packed into a few little bags, Oscar and her son get into a taxi.


UNIDENTIFIED PERSON: All right. Thank you. Bye-bye.

OSCAR: Thank you.


EMANUEL: They wave goodbye to their caseworker and head to a family shelter.

OSCAR: (Speaking Creole).

EMANUEL: Oscar says she's hoping to find stability and a school for her son.


EMANUEL: They've made it through the Massachusetts family shelter system's front door, but experts estimate dozens of other children and parents are still seeking shelter in local ERs each night. For NPR News, I'm Gabrielle Emanuel in Boston. Transcript provided by NPR, Copyright NPR.

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