HOUSING AS HEALTHCARE Joshua D. Bamberger, MD, MPH San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine

 Direct Access to Housing units in 33 buildings  Tailor housing to needs of individual  Initially SRO, now new buildings  Priority to people with multiple disabilities  93% with Axis I mental illness  At least 18% HIV+ SF Health Dept’s Housing

 Must have longitudinal professional relationship  Clinical Referral Form  Prioritized to house highest users  Match services to need  50% of income towards rent- 3 rd party payee  Greater demand than supply  25 new applicants/wk  20 vacancies/month  700 people in wait pool  Wait times unpredictable Referring to DAH

DAH Portfolio

The more beautiful the housing the better the outcome

The more beautiful the housing the better the outcome- Windsor

The more beautiful the housing the better the outcome- Plaza

The more beautiful the housing the better the outcome- Mission Creek

The more beautiful the housing the better the outcome- Richardson

The more beautiful the housing the better the outcome- Kelly Cullen Community

Plaza High Utilizer Study 106 Chronically homeless adults Cost year before housing: $3,132,856 Cost year after housing: $906,228 Reduction in healthcare costs: $2,226,568 Cost of program: $1.1million/year Reduction in public cost in first year: $1.1 million More than 90% of reduction among 15 tenants who cost more than $50,000/year prior to being housed

Ranking of housing from worst to best housing Private bath better than shared bath New building better than renovated Nursing better than no nursing Senior better than non-senior Evaluation Quality of Housing and Outcome

The more beautiful the housing the better the outcome

 NYC: 90,000 in locked institutions in1955  Homeless advocates focused on economic conditions, not illness  Episodic vs. Chronically homeless  Timing of offering PSH?  Impact of trauma Homelessness in US

POPULATION SNAPSHOT

Veteran PIT Counts, * CoCs only required to conduct a new count of unsheltered homelessness in odd numbered years; in 2012, only 32% of CoCs opted not to do a new unsheltered count, providing an incomplete picture of trends in the number of unsheltered homeless Veterans Source: PIT data, *

Number of Homeless Veterans in 5 Communities with Greater than 40% reduction

 Common values and philosophy of practice, strong leadership, housing first  Targeting  High level of communication (HIPPA busters)  Use of data to inform policy and measure success Common aspects of “positive outliers”

 Common values and philosophy of practice, strong leadership, housing first  Targeting  High level of communication (HIPPA busters)  Use of data to inform policy and measure success Common aspects of “positive outliers”

 Overcoming “wrong pocket” problem  Proving value of supportive housing  Moving forward from data to expansion  Replicating positive outliers in non-VA populations Next steps in movement

HOUSING AS HEALTHCARE Joshua D. Bamberger, MD, MPH San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine