A growing number of healthcare organizations are finding that tackling healthcare access and coordination requires addressing housing insecurity.
• Housing vulnerability often must come first before at-risk patients can address their chronic illnesses and other health concerns.
• One model, Housing for Health, is an idea based on the understanding that homeless individuals are very expensive to care for and often have poor outcomes.
• The Housing First model focuses on providing housing as a catalyst to healthcare changes.
Case management often focuses on patients’ social determinants of health as a part of the bigger health picture. Now, there’s a small but growing number of organizations that are making one social determinant — housing — an integral part of all healthcare coordination.
“We are still learning how to integrate housing and healthcare,” says Monica McCurdy, PA-C, vice president of healthcare services for Project Home in Philadelphia.
“We’re a large organization, and we started out focusing on ending chronic homelessness,” McCurdy says. “Permanent support of housing has been one of the strongest focuses of our work.”
Now, Project Home is trying to end chronic homelessness by providing healthcare, as well as focusing on education and employment.
“Forty percent of our young adults living in our program are living with chronic medical conditions,” says Kate Gormley, LSW, young adult program manager at Project Home.
Before coming to Project Home, Gormley worked for eight years in a targeted case management program, overseeing HIV-positive patients in Philadelphia. She says she learned through that experience how intrinsically housing and health are linked. “When you are insecurely housed and couch-surfing, you don’t know when your next meal is coming, and preventive care is not on your list of priorities,” she says. “When young people come into our program, we double down on the healthcare piece because that’s often been long neglected.”
In Salt Lake City, an innovative program uses technology to identify housing vulnerability among a healthcare population.
“A lot of clients are provided homeless case management,” says Sam Taylor, director of solutions and health and human services at Eccovia Solutions in Salt Lake City.
“We quantify the client situation to see if they’re a good fit for Housing First,” Taylor says. “One notion in the Housing First perspective is to find low-barrier, permanent housing solutions for the most vulnerable clients in the community.”
Another new model, Housing for Health, is based on the understanding that homeless individuals are very expensive to care for and often experience poor outcomes, says Laurel Rodriguez, director of marketing for Eccovia Solutions.
“If organizations provide housing as part of the overall healthcare, they can improve the individual’s health and save money,” Rodriguez explains.
Housing First and Housing for Health are a step up from the Housing Ready model, which was based on improving health — mostly through alcohol and drug treatment — before providing housing. The new models focus not on making people change their lives first, but rather on providing housing that may lead to their making positive healthcare changes.
“How easy is it to manage your medications if you’re living on the street?” Taylor says.
Housing First and Housing for Health programs put people in supportive housing, and one goal is to improve their health. Housing for Health programs coordinate supportive housing with case management, medical care, and behavioral healthcare among vulnerable populations. The overarching goal is to improve health outcomes.
Project Home’s clients often experience the combination of housing insecurity and poor health. “When we see folks in the clinic, the presentation often times is — whether they’re living in the community or unstable in housing — we can’t get too far in helping them manage chronic illnesses without addressing the quality of their housing, safety in housing, or whether they have any housing at all,” McCurdy says.
Housing, like food, is a basic need. If someone is hungry or homeless, it’s challenging for him or her to take medication on time, she adds.
People with housing vulnerability are helped with that basic need first, and it’s integrated with support services to help them with their behavioral and physical health issues, as well as workforce services and other needs, Rodriguez says.
“Let’s get them into housing first, and then provide support services,” she says. “This started in Canada and is now across the United States.”
Various organizations, communities, and states have found they are able to keep people housed more effectively if they start with housing and then move to healthcare and support services, she adds.
“We developed the software solution to support our clients who fill this need,” Taylor says.
At Project Home, new private funding has made it possible for the organization to plan a new building for young LGBT (lesbian, gay, bisexual, and transgender) homeless clients. It will include 31 bedrooms, and preventive health measures built into its programming, Gormley says.
Residents will receive preventive care appointments, dental visits, pre-exposure prophylaxis for HIV, vaccinations, and other healthcare.
“There are a lot of medical considerations that happen and get rolled into case management goals when someone comes into care with us,” Gormley says.
These LGBT youth typically would use EDs for their basic health needs, so the housing/case management/preventive care model will serve as a less costly and better quality method for helping them improve their health.
“We made a leap three years ago to become a federally qualified health center,” McCurdy says. “We’re learning to better integrate housing and healthcare and to track our outcomes, too.”
McCurdy says the Affordable Care Act’s push for community-based population health could help organizations like Project Home evolve into safety net health centers. “The ACA changed our lives, and we were able to serve people a lot better.”
The U.S. Department of Housing and Urban Development (HUD) adopted the Housing First philosophy within the last few years. (For more information, visit: http://bit.ly/2BvDUNw.) Health systems nationwide have moved closer to a model that views healthcare from a housing access perspective, Taylor notes.
“In isolating superusers [of healthcare], they’ve found that many of them are homeless,” Taylor says.
Housing for Health, care coordination, and Housing First models all approach the problems of people in housing crisis, who often have healthcare comorbidities, from the perspective of holistic health.
“You can’t treat the whole person with only part of the data,” Rodriguez says. “Does this person have substance use issues? Is he homeless? Is he employed? Social services and healthcare come together in housing: They’re trying to solve the same issue of how to help these people become healthier and reduce the cost.”