When families face financial insecurity, even modest health shocks can put their housing at risk.

In a study of nearly 3,000 families, those who reported recent ER visits or hospitalizations were 5 percentage points more likely to experience housing hardships than families who did not report using such care.¹

Sarah (Gold) Pachman at Princeton University and Brandon Wagner at Texas Tech used data from the Future of Families and Child Wellbeing Study (FFCWS), a longitudinal study of about 5,000 children born between 1998 and 2000 in large U.S. cities. They examined the association between a family’s acute health care use (defined as ER visits and hospitalizations) and subsequent housing hardships, including eviction, moving in with others, homelessness, and inability to pay rent or mortgage.

The researchers also explored whether the association between care use and housing struggles depends on whether the patient is the parent or the child, and whether perceived social support provides any sort of buffer.

Regardless of Who Uses Care, Family Housing is Jeopardized

Of the 2,801 families in the study sample, about 30% saw some form of housing hardship, according to the mothers’ responses to FFCWS interviews when children were ages 5 and 9. About two-fifths (40%) reported either a hospitalization or an ER visit in the 12 months before the age 9 FFCWS interview.

Acute care use was associated with housing hardship regardless of whether a parent or child was the patient, Pachman and Wagner reported. Pediatric acute care was associated with a slightly smaller increase in housing hardship (4 percentage points), perhaps due to the relatively lower cost of children’s health care or the loss of income when parents miss work for care, they posited.

The researchers considered whether pre-existing conditions could be the primary driver of housing hardship, but the associations held even after controlling for health status prior to the hospitalization or ER visit.

Social Support Helps When Kids Need Care—but Offers No Buffer When Adults Do

Among families who used any acute care, those who said they could rely on friends or other family for instrumental support—such as money, routine child care, or a place to stay after an eviction—were significantly less likely than those without such support to see subsequent housing hardship, Pachman and Wagner found.

But here, who was hospitalized mattered. When a child received care, perceived social support lowered the odds of housing hardship; when an adult received care, perceived social support had no effect. This difference in social buffer may reflect the relative difficulty of providing support when adults need hospital care, the researchers noted: for example, a friend or relative can sit with a child in the hospital but cannot replace a sick adult at their job.

Policies that Build Family Financial Security Could Reduce the Impact of Health Shocks

For families already struggling to pay the bills, a hospital visit can be the difference between housing and homelessness.

Because social support is not a reliable buffer, Pachman and Wagner propose that policies to reduce the link between acute care use and housing hardship look beyond informal social safety nets and focus on building family financial security before, during, and after health shocks. Specifically, they suggest that paid sick and family medical leave and housing assistance or child allowance programs could reduce the negative economic impacts of unexpected hospital care.

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).