Without a home, where would you seek shelter from bad weather? Where would you sleep? Where would you bathe and eat? Where would you go for safety? We take for granted the many benefits of living in a home.
Without permanent shelter, many homeless individuals find themselves turning to hospitals to fulfill their basic needs. With the financial challenges facing our health system already, caring for the homeless is an additional burden it struggles to address.
Homelessness is often described as a harmful cycle from hospitalization to homelessness and back. It is no surprise that homeless individuals are often characterized as “super utilizers” of hospitals, seeking care far more often than the general public. In fact, a 2010 study found there were approximately 23 hospitalizations for every 100 homeless people in a year, compared with five hospitalizations for every 100 people in the general population.
Community Based Approaches to Homelessness
To combat challenges for caring with the homeless, many hospitals and health insurers are partnering with government agencies and non-profit organizations to find solutions.
One such solution is medical respite programs, which aim to care for homeless who are too ill to recover on the streets, but not sick enough to be treated in emergency rooms. With more than 65 locations nationally, the programs operate at a variety of locations, including motels, nursing facilities, and homeless shelters. To convalesce, homeless individauls are allowed to stay at the facility all day, are provided meals, and held accountable in their recovery by staff. Some programs even have social workers available to help secure health benefits, find a permanent housing solution, and attain employment.
These programs have been successful in keeping homeless patients out of the ER following an acute care episode. One study found that patients who were in medical respite programs were 50% less likely to be readmitted within 90 days after discharge compared to the homeless ones who returned directly to the street.
Housing First's Impact on Population Health
Some health systems are taking it a step further giving those in need and who are frequent visitors to the ER their own place to call home. Housing First is an approach that has been embraced in nearly 20 cities across the country since being endorsed by the Department of Housing and Urban Development in 2002, and now additional facilities are getting on board. The programs take those who are chronically homeless and give them housing with no strings attached. The apartments come furnished and often with supportive resources, including a case worker who can help ensure patients schedule and make their health appointments and stay on top of any chronic issues.
Giving homeless a place to call home is paying off. Salt Lake City reduced homelessness by 72% with the Housing First strategy. Another housing initiative in Oregon decreased Medicaid spending by 55% among those who were newly housed. And Los Angeles found that every dollar spent on housing led to $6 saved on medical costs.
As the health providers focus on population health, we need to care for those who are most at risk of requiring chronic and costly care. Those without the basic necessities that a home can provide are a good place to start in achieving this goal.