What would you do if you saw someone having a medical emergency out on the street? Think about the actions you’d take; most likely, you’d call for help if you aren’t medically trained. Now think about what that would look like if an unhoused person out on the street were having a medical issue. Would the response be different? In most cases, hopefully it would not, the action would be the same: to get help quickly, call 911
We know that the health outcomes of those who are unhoused tend to be poorer than those of their housed counterparts. Both scenarios above require help, but what happens after that call is made for our unhoused person, and what it does cost our community, is a common occurrence worth understanding.
Who’s Calling, and How Often
Individuals experiencing homelessness use emergency medical services at rates that are dramatically higher than those of the general population.
A peer-reviewed study published in Prehospital Emergency Care analyzed all 911 incidents in Los Angeles over a full year. Unhoused patients were involved in EMS incidents at a rate 14 times higher than housed residents. When it came to ambulance transports to the emergency department, the rate was 19 times higher than for housed patients, according to an article published on Taylor & Francis Online
The same study found something that matters for understanding why this happens: unhoused patients had, on average, lower-level, non-emergency conditions than housed patients. That means many of these calls weren’t life-threatening emergencies. They were people with real needs, cold exposure, untreated chronic illness, mental health crises, who had nowhere else to turn.
The True Cost of a 911 Call
Every ambulance response carries a cost to the EMS system, to the hospital, and to taxpayers. When the same individuals cycle through those systems repeatedly without access to stable housing or primary care, those costs compound quickly.
People experiencing homelessness typically visit the emergency department as often as five times a year, sometimes even weekly, and annual emergency department costs can reach as much as $44,000 for a single frequent user. According to the Healthcare Financial Management Association.
The ambulance ride, triage, clinical time, discharge with nowhere to go, and then the same person back in a week. That cycle is financially and emotionally expensive for everyone.
The Revolving Door Problem
Here’s what makes this particularly hard to solve: the ER can treat what walked in the door, but it can’t address the reason the person came in the first place, or the toll that being unhoused takes.
A hospital can stabilize someone with frostbite, treat a wound, or manage a mental health episode. But when the discharge papers are signed, nothing has changed about the fact that the person has nowhere to go. So, they go back to the street. And often, they’re back in the ER within days, where an emergency shelter is not available.
What Actually Breaks this Cycle
The research is clear. What reduces emergency service use among people experiencing homelessness isn’t more ER capacity or stricter triage policies. It’s stable housing and the support services that make stability possible.
When someone has a safe place to sleep, consistent meals, access to hygiene, and a case manager who knows their name and their situation, something shifts. They stop cycling through the emergency system. Preventable health problems get addressed before they become crises. Chronic conditions become manageable. The revolving door slows down, and eventually, for many people, it stops.
An emergency room is built to treat what walks in the door. It is not built to ask why that person had nowhere to go last night, or the night before, or for the past three months. It cannot follow up. It cannot coordinate. It cannot call to check in. It discharges people back into the same conditions that brought them in, and it hopes for the best.
We can do all of those things at Nest, and we have for 25 years.
What NEST Actually Provides
We are the only year-round emergency shelter in Michigan City. When someone comes through our doors, they don’t just get a bed for the night. They get a hot meal, access to hygiene, and a case manager working alongside them toward something more permanent. They get stability, and, as the research makes clear, stability is the single most powerful predictor of better health outcomes. They also gain access to additional support services through our network of partners.
The difference between a person who calls 911 at 2 a.m. because they have nowhere else to turn, and a person who sleeps safely, takes their medication, and makes their doctor’s appointment in the morning, is often a shelter bed. It is often us.
The Cost of NEST Not Being There
When organizations like ours are underfunded, under-resourced, or simply not there, people do not disappear. They survive however they can.
For some, that means an ambulance. For some, it means an ER waiting room used as a warming center. For some, it means a police call, a hospital bed for a preventable condition, a discharge to a sidewalk, and the cycle starts again.
Every dollar invested in Nest is a dollar that interrupts that cycle before it becomes a 911 call. Every bed filled here keeps someone out of an emergency department that was never designed to handle what we manage every single day.
For 25 years, Michigan City has had an answer to that cycle. We are it.
