By Marlene Saez
The chronically homeless population often utilize hospitals’ emergency rooms to meet their basic health care needs, not only causing public costs to skyrocket but also doing little to address the other mental and behavioral needs of this very vulnerable population.
The Corporation for Supportive Housing (CSH)’s Social Innovation Fund (SIF) initiative responds directly to one of the most pressing policy problems currently facing states and the nation as a whole: rising public spending on health care with poor health outcomes. In nearly every state, a major contributor to growing public spending on Medicaid is a small subset of individuals who are caught in a “revolving door” of emergency room visits, inpatient hospitalizations, detox stays, and involvement in other costly crisis health services. These men and women have complex and co-occurring physical and behavioral health challenges, limited support networks, and more often than not, experience homelessness or unstable housing situations.
For these individuals, homelessness exacerbates chronic illnesses by increasing exposure to trauma and high-risk behaviors, which in turn results in social isolation and difficulties in accessing coordinated primary and behavioral health services needed to manage and expedite recovery. When substance abusers with physical and mental concerns become homeless, the difficulties they face are aggravated, imposing additional ill-effects on health status as well as on public costs.
Supportive housing – a solution for increasing housing stability, health care access, and health outcomes for this vulnerable population – combines affordable housing with services that help people who face the most complex challenges to live with stability, autonomy and dignity.
CSH advances solutions that use housing as a platform for services to improve the lives of the most vulnerable people, maximize public resources and build healthy communities. With resources from the SIF, CSH is discovering how innovative, data-driven methods can make supportive housing work better for more people – especially the highest-cost, highest-need people, like Sam.
With its SIF grant, CSH is leading a five-year national initiative to create innovative solutions at the intersection of supportive housing and healthcare by addressing chronic homelessness among individuals with complex health needs. CSH’s goal is to address the growing U.S. problem of rising health care costs by demonstrating a model of supportive housing linked to health care services is an effective solution that pulls people with the most complex issues out of the revolving door of costly crisis health services.
CSH works with selected subgrantees to collaborate with public agencies in identifying frequent users of public health systems and provide supportive housing tied to client-centered, integrated primary and behavioral health services. Coordination of these much needed services and the public systems that serve these frequent users has great potential for impact on the challenges facing a vulnerable population.
The CSH – SIF evaluation is contributing to a growing body of research examining the impact of the combination of affordable housing, care management, and access to health services on important outcomes including health and behavioral health, health care utilization, and public costs.
An evaluation of its Frequent Users of Health Services Initiative showed that homeless clients experienced a 61% decline in ER visits and a 62% drop in inpatient hospital stays over 2 years.
With SIF funding, CSH is piloting its integrated approach in four different communities across the country: Los Angeles and San Francisco, CA; Ann Arbor, Michigan, and Connecticut. With a goal of reaching 549 highest-cost, highest-need individuals and developing evidence that its supportive housing model works, CSH intends to implement lessons learned and expand its model to additional communities. Columbia University tracked its New York City Resident’s Housing Initiative participants and a group of similar nonparticipants, and documented positive outcomes after a year: 91% of tenants remained stably housed; 92% experienced a reduction in shelter stays; and 53% recorded a decline in jail recidivism. A follow-up study one year later showed that 82% of tenants, who had previously undergone many years of homelessness, remained stably housed.
A TNDC social worker provides voluntary support services to a tenant. Photo by Jennifer Reiley.
Transforming Lives and Strengthening Communities
A rare genetic disorder landed Sam in the hospital consistently during childhood, and plagued his adult life in the form of seizures and blackouts that made it impossible to hold a steady job. His chronic unemployment made health insurance unaffordable, and left him unable to manage his medical condition. As a result, Sam remained chronically homeless, struggled with a drug addiction that aggravated his medical issues, and lost touch with his children and family over the years. Sam’s story is not unique. Through the services of the 10th Decile Project, a CSH – SIF-funded pilot project being implemented through the Los Angeles Economic Roundtable and Ocean Park Community Center, Sam’s life has improved drastically. He obtained supportive housing, received help to manage his medical condition, and began the process of stabilizing his life. Sam is no longer a frequent user of public health systems. In fact, over the past year, Sam reduced his hospital visits from 52 down to just three.