| Open-ended questions: |
| 1. Tell me more about your housing situation. |
| 2. Do you have any concerns about your housing (safety, affordability, stability)? |
| a. If yes, what concerns do you have? |
| 3. Can you tell me more about how you feel your current housing situation affects your health, and any challenges you face because of it? |
| 4. What is your biggest concern about being cared for in the hospital? |
| 5. What is your biggest concern when you leave the hospital? |
| 6. Do you have any suggestions for improving the care that you received in the hospital or after you leave the hospital? |
| 7. Do you feel that you have been cared for differently because of your current housing situation on this hospitalization? |
| 8. Have your doctors or other members of your medical team asked you about your current housing situation during this hospitalization? If yes, who and what did they ask you? If no, why do you think they didn’t ask? |
| 9. What things do you wish your hospital doctors knew about your housing situation or other challenges you face which you feel could help them take better care of you? |
| 10. What would make you more comfortable discussing housing status with your medical providers? |
| 11. What resources (such as lists of shelters, community centers, etc.) could we offer in the hospital that you think would be helpful? |
| Discrete Questions: |
| 1. How many people do you currently live with, not including yourself? |
| 2. How much of your income do you spend on housing? |
| 3. Over the past year, have you had problems with any of the following at the place where you live: |
| a. No heat or not enough heat to live comfortably |
| b. No electricity or not enough electricity to live comfortably |
| c. No running water or not enough water to live comfortably |
| d. No toilet or a non-functioning toilet |
| 4. How much do you believe your current housing situation affects your health? |
| 5. How comfortable do you feel discussing issues related to your housing situation with your hospital care team? |
| 6. Has anyone during this hospitalization offered you resources such as a list of shelters, community centers, and food banks or other resources? |
| a. If yes - were these resources helpful? |
| 7. How do you get to medical appointments? (e.g., walk, car, bus, bicycle) |
| 8. In the past year, have you missed any medical appointments due to a lack of transportation? |
| 9. Are you currently working? |
| 10. How many jobs have you worked in the past 12 months? |
| 11. In the past year, have you ever run out of food? |
| 12. In the past year, have you ever been unable to fill a prescription because you did not have enough money to fill the prescription? |
| 13. In the past year, have any of your medications been lost or stolen? |
| 14. In the past year, have you had to miss or cancel a medical appointment because you were unable to pay for it? |
| 15. Is there someone you can rely on to help you if you have medical problems or other concerns? |
| 16. Do you have a case manager or another designated person who is not a family member or friend who can help you with problems? If yes, who |
