A program to improve the health and lives of homeless populations in Chicago follows a quarterback-style team approach.
The Center for Housing and Health (CHH) serves as the quarterback for the Better Health Through Housing program, established in 2014. The collaborative includes an alliance of 28 supportive housing agencies across Chicago and Cook County and has a contract with the University of Illinois Hospital and Health Sciences System. (For more on the Center for Housing Health, visit: http://bit.ly/2uwbBwj.)
In New Jersey, the collaborative centers around the Bergen County Housing, Health, and Human Services Center in Hackensack. The lead players provide infrastructure and outreach.
For the University of Illinois Hospital homeless program, collaboration with the local housing center was crucial, says Stephen Brown, MSW, LCSW, director of preventive emergency medicine at the University of Illinois Hospital and Health Sciences System.
The hospital also established memorandums of understanding with more than 25 supportive housing agencies and three single-room occupancy (SRO) hotels, Brown says.
“With those relationships, it gave us access to over 4,000 scattered site units — one-bedroom apartments throughout the city,” he says. “At any given time, there would be 125 to 150 vacant units.”
It was highly variable. As the program’s strategies to reduce homelessness became successful, there were fewer vacancies; people stayed in housing longer, so some homeless clients had to wait 60 days to get a unit.
“We got them off the street and put them in SROs,” Brown says. “Once we voted on helping an individual, there was paperwork and intake we needed to do, and then we engaged with an outreach worker.”
Once homeless patients — usually already discharged from the ED or hospital — were selected for housing assistance, workers had to find them.
The referral panel learned that most of the homeless individuals lived within a four-to-six-block range. This section had restaurants that might give them food and provided convenient locations for panhandling, he says.
“So the outreach worker would go out and find them,” he adds.
If that didn’t work, they knew the person would sooner or later return to the hospital because they were frequent visitors, Brown says.
Outreach workers take the homeless clients to SROs, usually within a couple of days of finding them and telling them about the program.
“Once they were stabilized there and we got to know them a little better, then the outreach worker would introduce them to a permanent housing case manager, who would start a housing search for them,” Brown says. “They’d show them apartments.”
Some homeless individuals would share preferences for where they wanted to live. Once they approved a housing choice, they moved in and the program would pay the monthly rental fee on their behalf.
“We do troubleshooting and talk over the difficult cases and challenges case managers are having,” Brown says. “A social worker brings in a list of appointments for each patient and gives them to each of the case managers.”
The homeless patients helped by the hospital’s program are particularly vulnerable healthwise — and this has led to a high mortality rate and more turnover, he notes.
“There was one woman in permanent housing for 30 days, and then she passed away,” Brown says.
In one particularly sad case, a woman re-established in housing and reunited with her daughter and grandchild had maintained housing stability for a year. But then she was admitted into hospice care because of cancer. “To me, that was just tragic,” Brown says.
The program is evolving into a collective impact model, Brown says.
“We’ve done things to help our patients, and there is a greater possibility if all the hospitals are doing similar work,” he adds. “Four additional hospitals have replicated our program.”
Together, the hospitals can help more homeless people than any one of them can do separately. They can provide their own funding and individually apply for grants and subsidies to help pay for affordable housing.
“If we ask every hospital to just provide housing for 10 chronically homeless individuals, then that would have collective impact,” Brown explains. “We could reduce the number of chronically homeless individuals by about 25%.”
In addition to the four hospitals already involved in the project, additional hospitals and even some payers might also help out, he says.
“There is a direct benefit for insurers to pay for housing,” he says. “Payers are finding that homeless people cost them money because of emergency department and inpatient visits.”
Many of the homeless people in Illinois have some form of insurance, including coverage due to Medicaid expansion, he adds.