Caring for Underserved Communities: Using the HOUSED BEDS Tool

Hundreds of thousands of people in the U.S. experience homelessness, and those individuals face unique barriers when they come in to see us for medical care. Learning to ask the right questions, while using a trauma-informed approach, can help us better treat our patients. One tool to remember: HOUSED BEDS.

You can use the “HOUSED BEDS” tool to guide you in taking a comprehensive history of a patient experiencing homelessness. 

• H=Homelessness. Ask about the patient’s history of being unhoused. When was the last time they were stably housed?
• O=Outreach. Find out who else is engaging with this patient, and gather specific names of organizations or individuals on outreach teams. What social services are supporting them?
• U=Utilization. Find out if the patient is utilizing  healthcare, social services, or the judicial system. How many times have they been to the ER in the last year, and were they hospitalized? Do they have a primary care provider?
• S= Salary. Find out how the patient is obtaining financial resources. Are they getting financial help through state or federal programs?
• E=Eat. Ask about the patient’s access to food and frequency of food intake. What are they eating every day?
• D=Drink. Ask about the patient’s access to clean water. This may alter treatment and influence medication decisions. Where do they get drinking water?
• B=Bathroom. Ask the patient about their access to toilets. Where do they go to the bathroom?
• E=Encampment. Find out about the person’s sleeping arrangements, including: location, type of shelter, position of sleep, and time of day sleeping occurs. Where are they staying right now?
• D=Daily Routine. Find out how your team can naturally fit into this individual's routine and avoid competing priorities. What do they do every day?
• S=Substance Use. Ask about the patient’s substance use history; if they have a substance use disorder, ask about their openness to quitting. What, if any, substances are they currently using?

Obtaining detailed information through the acronym “HOUSED BEDS” enables us as clinicians to tailor goals and plans to meet individual patient needs. This goes beyond prescriptions and requires addressing needs like socks, showers, shoes, and food. Flexibility is required when taking care of unhoused people, and keeping this acronym in mind will help us better understand the barriers our patients face.

For more on this topic, listen to “Caring for Underserved Communities: Going Beyond” on Primary Care Rap December 2023.