This part of the year is particularly harsh for people who lack housing.

If not employed, the days are often spent looking for a warm place to rest, nutritious and warm food to nourish the body, and above all, a place to stay for the night.

Many communities have arranged for emergency shelters to remain open during the day and homeless outreach workers work hard to bring people into shelters at night.

Despite these efforts, a number of people remain on the streets during extremely cold nights. Exposed to the elements, people who lack housing may seek safety in a hospital emergency room while others may seek assistance at hospitals for exposure related injuries and illness.

So the question remains: does your hospital have policies in place to assist homeless individuals seeking shelter and care during extremely cold weather?

Point-in-Time Count

To get an idea of how many people are experiencing homelessness during any given year, the U.S. Department of Housing and Urban Development (HUD) conducts an annual "point-in-time count." The initiative occurs during the last week of January and involves service providers and groups of volunteers across the United States who go out in the middle of the night and count the number of people staying in homeless shelters, enrolled in transitional housing programs and sleeping on the streets. Being in January, the count also gives us an estimate of how many people are sleeping outdoors on cold nights. After the 2010 count, HUD reported that 38 percent of homeless Americans were sleeping outside.

Out in the Cold

Exposure to cold weather can create a number of health complications, including hypothermia and frostbite. These exposure-related conditions are among the most critical and preventable types of injury for people experiencing homelessness. These conditions are not acquired exclusively during extremely cold weather, either; many occur when the days are warm (between 40 and 50 degrees) and the nighttime temperatures drop into the mid-30s. Humidity and wind play a factor as well.

Hospitals are accustomed to treating exposure-related conditions in their emergency rooms, particularly as they affect people experiencing homelessness. The cost of caring for a homeless patient with an exposure-related condition is likely to be significantly higher than the cost of caring for a person with established residency. For people who have housing, the condition is treated, and after a couple of days they are sent home for recuperation.

People who lack housing require longer inpatient stays if access to a medical respite program is unavailable; these longer stays will be monitored more closely as new quality-of-care standards established by the Patient Protection and Affordable Care Act are carried out.

What You Can Do

Hospitals can take steps to help their homeless patients avoid cold-weather conditions and future readmissions. These simple steps not only improve quality of care for people experiencing homelessness but also could reduce hospital costs:

• Ask your local emergency management agency for flyers outlining your community's cold-weather emergency plan. Make these flyers available in your emergency room for people experiencing homelessness or living in unstable housing situations. If your community does not have a plan in place, ask your local emergency management agency about establishing a plan. This could prevent a number of emergency room visits for exposure-related conditions.

• Make sure housing status is determined at intake. Document lack of housing using ICD-9 code V60 or ICD-10 code Z59 in order to identify individuals at risk of injuries related to lack of housing.

• Make sure clinicians and discharge workers talk to homeless patients about symptoms of exposure-related conditions, how to retain body heat and factors that increase risk of exposure-related conditions (such as drinking alcohol). Click here for clinical information about exposure-related conditions.

• Be familiar with symptoms of hypothermia, including difficulty walking, slurred speech and impaired judgment, among others. These symptoms easily can be mistaken for symptoms of alcohol or drug intoxication. Hospitals can make sure that front-line staff are trained to identify these symptoms as potentially related to hypothermia.

• Partner with a medical respite program that can admit homeless patients who have been treated for exposure-related conditions. Such programs can provide clinical oversight to ensure proper healing; additionally, they will work with patients to help them access housing, or at minimum help patients improve their ability to prevent reoccurrence. Click here for a directory of medical respite programs in the United States.