Health and Homelessness Challenges & Opportunities at the Intersection of Health & Homelessness

Purpose: Provide an overview of the unique health-related challenges of persons who are homeless and highlight opportunities to improve health care and health outcomes for this population.

- National Alliance to End Homelessness Housing is a key component of health and health care. Access to stable housing and supportive services are critical for the recovery of people experiencing homelessness. - National Alliance to End Homelessness

2009 Nationwide Health Center Patient Survey conducted by the Health Resources and Services Administration Bureau of Primary Health Care Health Resources and Services Administration (HRSA)’s Bureau of Primary Health Care periodically collects information on a nationally representative sample of health center patients, through its Health Center Patient Survey. Key points: poorer health outcomes across the board, 3x more likely to have a liver condition, more than 1 in 3 report multiple chronic conditions, 1 in 4 report a serious mental illness

Effects of Homelessness on Health Homeless individuals are twice as likely to have had an Emergency Room visit within the last year than their housed counterparts. More than 1 in 3 people experiencing homelessness report multiple chronic health conditions. Average life span of a person who is chronically homeless is 15 years less than their housed counterparts. - Life Expectancy of homeless individuals vs. non-homeless: 64 years vs. 79 years - 64 years life expectancy= same as Sudan, Syria, and Congo - UCSF study: 50 year olds who are homeless were developing geriatric conditions expected 20 years later (failing eyesight, incontinence) Sources: National Health Care for the Homeless Council 2009 Health Center Survey

Effects of Homelessness on Children’s Health Children who experience post-natal homelessness are 22% more likely to have been hospitalized since birth than their housed counterparts. Compared to their peers, children who are homeless are 4x more likely to develop asthma, have 5x more gastrointestinal problems and 2x more ear infections. Sources: Children’s HeathWatch Seattle University’s Project on Family Homelessness

$$ The Cost of Homelessness $$ In MA, healthcare expenditures of homeless individuals on Medicaid are 3.8 times the rate of an average Medicaid recipient People struggling with homelessness spend, on average, 3 nights per visit in the hospital which can cost over $9,000. People experiencing homelessness are much more frequent users of health care and emergency departments, stay longer and are more likely to be re-admitted $9,000: 3 nights in the hospital, or the same cost to house a person for a year Sources: “Health care utilization patterns of homeless individuals in Boston: preparing for Medicaid expansion under the Affordable Care Act.” Green Doors

Opportunities Case Study: Harbor Place

Opportunities Case Study: Harbor Place Champlain Housing Trust purchased the 59-room motel in 2013 The UVM Medical Center contributed $25,000 in seed capital and $15,000 to CHT to pay in advance for 550 nights for its patients over the course of the next year Other contributors include the State, United Way, Fanny Allen Foundation: $300,000 operating reserve Discount rate contracts with State, UVM Medical Center and local services agencies Onsite case management services available through local partners 1,397 unduplicated guest households in first three years - Comes out to about $27 per night for UVM Med to provide shelter at Harbor Place vs. $100/night at other motels/hotels for patients who need ongoing care after discharge but are without shelter - On-site case management through the Howard Center and Steps to End Domestic Violence at Harbor Place to supports folks find permanent housing & provide supportive services

Cost Savings Statewide average motel voucher room = $73/night Average discount Harbor Place cost = $38/night

Harbor Place Patient Intervention Study What is the impact of discharge to Harbor Place on health care cost and utilization? UVM Medical Center Study: 120 Patients who were discharged to Harbor Place who stayed an average of 11 nights each, Data through November 2016

UVM Medical Center Study: 120 Patients who were discharged to Harbor Place who stayed an average of 11 nights each, Data through November 2016

UVM Medical Center Study: 120 Patients who were discharged to Harbor Place who stayed an average of 11 nights each, Data through November 2016

Opportunities Case Study: Rutland County Housing Specialist from the Homeless Prevention Center provides services to patients in the Emergency Department who are experiencing housing issues Rutland Regional Medical Center as a key supporter of the creation of a family homeless shelter Community Health Team participation in the Rutland County Continuum of Care - Housing Specialist: on an as needed basis - Family Shelter: currently in the works - Rutland County Continuum of Care: a partnership of service & resource providers that works to address and preventing issues of housing and homelessness in the County

Opportunities Case Study: Better Health Through Housing Initial investment: $250,000 Initiative began in 2015 Move straight from emergency room to permanent housing and provide intensive case management and support services through partnership with service providers

Opportunities Case Study: Better Health Through Housing After one year, average monthly cost for patients in the program decreased by 42 percent Cost per month to pay for individual’s apartment: $1,000 vs. Cost per day to hospitalize that same patient: $3,000

"A stable environment is the first step toward establishing long-term health. Better Health Through Housing is taking proven steps to positively impact the health and lives of Chicago's most vulnerable individuals.“ – Dr. Avijit Ghosh, CEO of the UI Health Hospital & Clinics

Sources https://www.nhchc.org/wp-content/uploads/2011/09/Hln_health_factsheet_Jan10.pdf https://www.ncbi.nlm.nih.gov/pubmed/23134588 http://hospital.uillinois.edu/Documents/Service%20Lines/BetterHealthThroughHousing/housingFirst_Final2.jpg http://www.endhomelessness.org/pages/cost_of_homelessness Children’s HealthWatch Sheward Presentation “Improving Health Through Housing: Collaborative Approaches to Combat Homelessness,” by Margaret Bozik, Erin Ahearn & Jason Williams “Health care utilization patterns of homeless individuals in Boston: preparing for Medicaid expansion under the Affordable Care Act.” http://www.greendoors.org/facts/cost.php http://www.npr.org/sections/health-shots/2016/06/29/482994000/a-hospital-offers-frequent-er-patients-an-out-free- housing http://hospital.uillinois.edu/about-ui-health/community-commitment/better-health-through-housing