The relationship of residential instability to medical care utilization among poor mothers in New York City

OBJECTIVES. This study examines the relationship between residential instab ility, including mobility and previous homelessness, and the use of medical cave among previously sheltered and never-sheltered mothers in New York Ci ty. The study represents one of the first efforts to follow up on families alter they are no longer homeless. METHODS. Mothers from 543 welfare families in New York City were interviewe d, once in 1988 (Time 1) and again beginning in 1992 (Time 2). The sample i ncluded 251 families who first entered shelters after their 1988 interview, and 292 families who spent no time in shelters before or after that: paint . Mothers were asked about the source and volume of medical care used in th e year before follow-up. RESULTS. Bivariate and multivariate analyses showed that previously shelter ed mothers had a greater reliance on emergency departments (EDs) and weaker ties to private physicians or health maintenance organizations (HMOs) than did mothers who never used shelters. Mobility before the Time 1 interview was associated with greater reliance on EDs and absence of a usual source o f care. More recent mobility was not associated with a usual source of care . Current residential stability reduced the likelihood of using an emergenc y department or having no regular source of care. None of the measures of r esidential instability were related to the volume of outpatient care used b y mothers. CONCLUSIONS; A history of residential instability, particularly previous sh elter use, strongly predicts where poor mothers currently seek health care. Further research is needed to determine whether these patterns of health c are use existed before mothers entered shelters. The study provides evidenc e that upon leaving shelters, mothers are not being well integrated into pr imary care services.