Housing as Healthcare
Issues : Housing First models across the country have demonstrated that providing supportive housing to persons experiencing homelessness results in cost savings to communities in the form of reductions to emergency room visits and medical service utilization overall.
Description : The Better Health through Housing (BHH) Collaborative is an alliance of 28 supportive housing agencies dedicated to expanding and improving permanent supportive housing across Chicago and Suburban Cook County in Illinois. In October 2015, a partnership between with the University of Illinois Hospital & Health Sciences System (UI Health) and the Center for Housing and Health (CHH), a supporting organization of the AIDS Foundation of Chicago (AFC), an initial 18 month pilot demonstration project was conducted to identify and house up to 25 of UI Health’s patients experiencing chronic homelessness who are frequent, costly users of their emergency room and hospital services. UI Health contracted with CHH to fund a fixed amount per patient per month to supplement the cost of providing clients permanent supportive housing. The ultimate goals of the project were to provide clients with long-term stable housing, improve their health outcomes, and achieve a reduction in medical costs in the 18-month demonstration period.
The BHH Collaborative partnered with the AFC’s Research, Evaluation, and Data Services (REDS) Department to analyze the project outcomes. REDS team members analyzed participant utilization and cost data. Data on client demographics was obtained via ClientTrack, an advanced electronic data collection tool, designed for longitudinal client-level data collection for persons accessing a variety of housing and homeless prevention services. Medical cost data was obtained directly from UI Health, along with health measures across time. Data was abstracted from the various sources and entered into SPSS. Descriptive statistics and frequencies were then run on SPSS and STATA.
Lessons learned : A total of 27 participants were referred to the BHH Demonstration Pilot Program, with 21 participants obtaining permanent housing. The median age of participants was 48, with participants ranging from 26 to 68 years of age. Race and Ethnicity data was obtained from 25 of the participants, with 56% of clients identifying as Black or African American, 20% Hispanic and 12% White. The pilot demonstrated that homelessness is a serious health condition with high mortality rates. Four of the participants passed away over the course of the project.
Participants represent a vulnerable subset of Chicago’s homeless population, and transitioning participants to permanent supportive housing proved difficult. The program’s goal was to transition those referred to the program into bridge housing within 5 – 10 days. Results indicated that the average time from referral to bridge was 25 days; the average from bridge to permanent housing was 100 days and the average from referral to permanent housing was 130 days.
An exploration of inpatient stays revealed a 60% reduction in inpatient stays, with 102 pre-program stays, compared with 41 post-program inpatient stays. Likewise, total emergency room visits decreased 62% from 416 pre-program to 160 post-program. Finally, total costs per participant pre and post program were analyzed. Total hospital costs pre –program were $1,298,107. Total costs for all participants post-program were $979,815, a decrease of 26%.
Recommendations : Creating a sustainable model is essential to ensuring the continuation of the BHH project. Building on the success of the pilot project, additional hospital systems are partnering with CHH to provide supportive housing to patients experiencing homelessness. A comprehensive process and outcome evaluation of the expanded BHH project is needed to assess the effectiveness of this collaborative model in achieving housing stability and positive health outcomes for patients and cost reductions for different hospital systems.