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Health Care Reform
December 2018

Dialysis for Patients With End-stage Renal Disease Who Are Homeless

Author Affiliations
  • 1Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland
  • 3Division of Nephrology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
JAMA Intern Med. 2018;178(12):1581-1582. doi:10.1001/jamainternmed.2018.5470

End-stage renal disease (ESRD) affects more than 700 000 individuals in the United States and accounts for $33 billion in annual Medicare spending.1 Since 1973, the Medicare program has provided health coverage for most individuals with ESRD regardless of their age. About 34% of people with newly diagnosed ESRD live in areas where more than 1 in 5 households are below the federal poverty level.2 Although the prevalence of homelessness among patients with ESRD is unknown, such patients would benefit from safe and stable housing. Homelessness imposes substantial barriers to good medical care.3 We highlight the challenges faced by patients with ESRD who are homeless, recommend measures to determine the prevalence and outcomes of homelessness among Medicare beneficiaries with ESRD, and propose approaches, including a federal demonstration project, to potentially improve outcomes through supportive housing.

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