Articles

Commissioning and System Design for Housing Instability: Multi-Agency Operating Models, Roles, and Accountability
Housing instability drives avoidable ED use and fragmented care when health, housing, and community partners operate on separate timelines and data rules. This article sets out commissioning-ready operating models—clear roles, shared workflows, and governance—so systems can fund continuity and evidence impact. Read more...
Medication Continuity Without Stable Housing: Storage, Access Pathways, and Safe Adherence Support
Medication plans often assume refrigeration, secure storage, consistent meals, and predictable pharmacy access. For people experiencing housing instability, those assumptions fail and medication harm becomes a system-design issue. This article sets out practical workflows for access, storage, adherence support, and audit-ready governance. Read more...
Care Coordination When Contact Is Unreliable: “Reachability” Design, Backup Channels, and Continuity Tracking
When phones change, voicemail is unsafe, and people move frequently, care coordination fails unless “reachability” is designed as a workflow. This article sets out practical reachability models—backup channels, consent-aware partner messaging, and continuity tracking—so services can evidence follow-up completion and reduce missed deterioration. Read more...
Hospital Discharge and Transitions Without Housing: Building Continuity Pathways That Prevent Rapid Re-Presentation
Discharge processes often assume a safe place to recover, store medications, and attend follow-up—assumptions that fail when housing is unstable. This article sets out practical transition workflows (early identification, warm handoffs, and step-down recovery options) with governance and measurable outcomes to reduce avoidable ED returns. Read more...
Safeguarding, Safety Planning, and Rights in Housing Instability: Coordinating Care When Environments Are Unsafe
Housing instability increases exposure to exploitation, violence, coercion, and unsafe care conditions—often in ways standard care plans do not anticipate. This article sets out practical safeguarding and safety-planning workflows that coordinate across shelters, outreach, and clinical teams while protecting rights, documentation quality, and accountability. Read more...
Mobile-First Care Access: Outreach, Pop-Up Clinics, and Appointment Models That Work Without Stable Housing
Traditional appointment systems assume stable housing, reliable phones, and predictable routines—conditions that housing instability often removes. This article sets out mobile-first care access models (outreach routing, pop-up clinics, and flexible scheduling) with governance, documentation, and measurable continuity outcomes. Read more...
Hospital Discharge Without a Stable Address: Preventing Rapid Readmission Through Housing-Aware Transitions
Discharging a person into housing instability is a predictable pathway to missed medications, failed follow-up, and rapid readmission. This article sets out housing-aware discharge and step-down workflows that community providers can run with hospitals, outreach teams, and shelters—built for documentation, accountability, and real-world delivery. Read more...
Care Coordination With Housing Partners: Making Referrals, Consents, and Follow-Up Work When Housing Is Unstable
Housing instability turns “care coordination” into a contact, consent, and follow-up problem that standard workflows cannot absorb. This article sets out practical, oversight-ready ways to coordinate with shelters, housing teams, and outreach partners so referrals close the loop, information sharing is lawful and clear, and care tasks stay continuous. Read more...
Street Outreach to Scheduled Care: Building Reliable Pathways From Homelessness to Ongoing Support
Many systems can locate people in crisis but cannot reliably transition them into scheduled care that sticks. This article explains how to operationalize the handoff from outreach to ongoing support—using shared workflows, defined thresholds, and documentation that makes continuity real even when housing remains unstable. Read more...
Housing Instability and Care Access: Designing Services That Don’t Collapse When Address Changes
Housing instability is not a side issue—it is a primary driver of missed visits, medication disruption, avoidable ED use, and failed care plans. This article explains how U.S. community services can build housing-aware workflows, escalation rules, and documentation so care remains safe, continuous, and oversight-ready when a person’s living situation changes. Read more...