Do you want to avoid the hassle of traveling with your printed poster? IAPHS2026 is pleased to make poster printing available to you through our supplier PosterSessionOnline. Your poster will be professionally reviewed, printed and shipped directly to Portland and you will be able to pick it up from the Poster desk. Click here to learn more.
Primary Submission Category: Health equity
Shelter Type and the Impact on Health Outcomes and Healthcare Access in Northern Arizona
Authors: Colleen Hackett, Dixie Clinkenbeard,
Presenting Author: Colleen Hackett*
The population of people experiencing homelessness (PEH) across the United States has significantly increased in the past few years, exacerbated by a lack of affordable housing inventory, persistent poverty, stagnant wages, cuts to social services, and limited housing assistance programs. The annual Point-In-Time count found that approximately 770,000 people were unhoused on a single night in 2024, an 18% increase from the year prior (de Sousa & Henry, 2025). This is the highest number of PEH recorded since data collection began in 2007, with notable increases among families with children, unaccompanied youth, and those experiencing chronic homelessness. The crisis of homelessness poses significant challenges to public health and the well-being of the most vulnerable people in our society.
In 2024, 64% of the population experiencing homelessness were in an emergency shelter, and the remaining 36% were unsheltered (de Sousa & Henry, 2025). Unsheltered homelessness is associated with extreme health and safety risks, including exposure to the elements, violence and assault, and limited access to hygiene necessities and healthcare (Richards & Kuhn, 2022). Emergency shelters provide temporary relief for individuals and families experiencing homelessness, often providing beds, meals and hygiene supplies, and connecting people to supportive services and healthcare. For this reason, emergency shelters have been a crucial tool in addressing the immediate needs of individuals and families experiencing homelessness.
The most common type of emergency shelters are congregate spaces meant to temporarily house large numbers of PEH. Though these spaces offer a reprieve from the health and safety risks of unsheltered homelessness, congregate shelters can also expose PEH to shelter- based violence, theft and robbery, impaired sleep, and infectious disease outbreaks (Kerman et al., 2023; Pope et al., 2020). In the wake of the COVID pandemic, many cities across the United States responded to the public health crises at crowded congregate shelters by quarantining and housing PEH in hotel rooms. This “unplanned innovation” led to noticeable quality of life and health improvements for PEH who utilized these non-congregate shelter options (Colburn et al., 2022; Padgett et al., 2022). The empirical support for non-congregate hotel-based shelters as a meaningful health intervention for PEH in the aftermath of COVID is small but growing.
This study used a mixed methods approach to investigate how shelter type (unsheltered, congregate shelter, and non-congregate hotel shelter) impacts healthcare access, healthcare use, and health outcomes for adults experiencing homelessness in Northern Arizona— with a focus on tribal, rural, and border communities. We collected primary data via surveys with people who are currently experiencing homelessness (n=100), interviews with community stakeholders (n=16), and people with lived homelessness experience (n=15).
The findings demonstrate promising health and social wellbeing benefits for residents. Non-congregate hotel shelter was associated with more favorable health outcomes and risk profiles compared to congregate and unsheltered settings. Individuals in non-congregate shelter had the highest healthcare coverage and substantially lower substance use. While delayed healthcare remained present across groups, the findings suggest non-congregate shelter may function as a stabilizing, harm reducing intervention that improves access to care and reduces behavioral health risks.
In interviews with people staying at a non-congregate hotel shelter, participants reported an increase in their overall quality of life. Participants noted that the hotel shelter provided a dignified, personal, safe, and stable space that countered the routine stigma and exclusion felt in many public spaces. In interviews with community experts who provide direct services to people experiencing homelessness, participants reported on five interrelated themes: systems-level barriers, community context, individual experiences, service delivery, health impacts and challenges specific to hotel/motel shelters. They highlighted structural challenges, particularly the lack of affordable housing, fragmented service systems, insufficient mental health resources and options for referrals, and unstable funding. There was consistent agreement across provider interviews that hotel/motel shelters have meaningful health benefits, including reduced violence, improved well-being, and stronger service engagement, particularly for individuals who struggle in traditional congregate settings.
Due to the lack of permanent supportive housing and affordable housing options, there are challenges in finding long-term housing placements for residents at non-congregate hotel shelters. The results also point to the need for culturally appropriate, Indigenous-led affordable housing initiatives that address the urgent and unmet housing needs for Indigenous people in Northern Arizona. This research has practical implications for housing policy, while also contributing to the literature on alternative shelters and permanent supportive housing solutions.