1. Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing University of California, San Francisco joshdbamberger@gmail.com

2. Poverty—combined with mental illness, substance abuse or a chronic medical condition—is lethal

3. People in these conditions die 25 years younger than general public These premature deaths, often from common diseases like cardiovascular disease or diabetes, are preventable Medical treatment is necessary but insufficient alone to improve outcomes

4. A.G.

5. What does medical success look like? Avastin: huge financial success, modestly increased survival rates by 15%

6. Medical success: housing homeless Housing homeless with AIDS increased survival rates by about 80%

7. DAH Portfolio

11. Quality is impacted by five key indicators:

14. 1.Quality of building/architecture 2.Quality of neighborhood 3.Severity of illness among tenants 4.Homogeneity of the population 5.Quality of the on-site services

15. Building Neighbor- hood (1-3) Housing quality (1-3) Severity of tenant illness (3- 1) Quality of on-site service (1- 4) Mixed populatio n (1-2) Total (5- 15) Mission Creek 3312211 Kelly Cullen Comm. 131218 Measuring Quality in Affordable Housing “Magic Number > 9” 1 Point Bonus for Strong Community 1 Point Bonus for a Work Program

16. Relationship between Housing Quality and Mortality

17. Death rate: Le Nain vs. Mission Creek

18. Cost

19. “It costs less to house homeless people than to leave them on the streets and in shelters.” —Shaun Donovan U.S. Secretary of Housing & Urban Development The Daily Show, March 5, 2012

20. Chez Soi/At Home Study

21. 3000 adults with mental illness and chronic medical problems Randomly assigned to housing vs. regular care For the top 10% of the healthcare users, $10 returned for every $1 in housing For next 40%, $1 returned for every $1 in housing For bottom 50%, housing did not significantly reduce healthcare utilization

22. Saved $19,000 per person

23. Saved $23,000 per person

24. Saved $29,000 per person

25. A.G. is recovering now

26. So what now?

27. Next steps

28. Future Opportunities for Healthcare in Supportive Housing New York State Investing savings in healthcare into supportive housing $600 million in 2015-6

29. Future Opportunities for Healthcare in Supportive Housing San Mateo Managed care- HPSM Committed to 120 units of housing

30. Future Opportunities for Healthcare in Supportive Housing LA County DAH on steroids Increase in targeting Increase in scale Diversity of housing stock

31. Tasks for Affordable Housing Sector Reach out to the providers of healthcare services Diversify the capital cost Diversify the operating costs Replicate to scale

32. Future

33. Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing University of California, San Francisco joshdbamberger@gmail.com