Abstract
Housing insecurity is a well-recognized social determinant of health, with poverty and homelessness significantly impacting health outcomes. When faced with unstable housing, health often becomes a lower priority for patients. We present the case of a 52-year-old homeless, morbidly obese female who arrived at the emergency department with worsening dyspnea. She required Bilevel Positive Airway Pressure (BiPAP) support for acute-on-chronic hypercapnic respiratory failure. Her discharge planning was complicated by the need for a BiPAP machine, which limited her options for placement in a receiving facility. The patient ultimately left against medical advice (AMA) after a seven-day hospitalization but was readmitted hours later with recurrent symptoms, highlighting the ongoing challenges posed by her chronic conditions and social determinants of health. This case highlights how the requirement for specialized medical equipment can serve as an additional barrier to securing shelter for individuals experiencing homelessness.