Hospitals incorporate affordable housing models to better serve patients
Health Care Report: Hospitals are spending money on housing to save money overall
A patient at Denver’s Stout Street Health Center, which is operated by the Colorado Coalition for the Homeless, tries on glasses as part of the integrated health-care model used to support people experiencing, or at risk of, homelessness. Photo courtesy of Mercy Regional Medical Center.
One Durango resident suffering from uncontrolled alcoholism spent 10 years as a homeless person in the small city and utilized the emergency room at Durango’s Mercy Regional Medical Center seven times during a four-month span in early 2018.
Now, assisted by the local LINK program, or Life Interruptions Need Kindness, the man lives in an apartment, is managing his health issues through a medical clinic in La Plata County, continues progress on his sobriety and has restored family relations with his daughter and two grandchildren.
Prioritized housing vouchers for frequent users of emergency rooms is one example of how hospital systems in Colorado and across the county are helping to fund more robust social service programs, including housing support, to improve health outcomes for Medicaid patients. Hospitals are spending money on housing to save money overall.
“Housing is health care,” says Elsa Inman, LINK program coordinator and lead of the Hospital Transformation Program at not-for-profit Mercy Regional. “We know the health care system saves money when we can provide housing to patients who are homeless. More and more hospitals are realizing that and are partnering with housing agencies to support housing services.”
LINK started in September 2016 with a $572,000 grant from Catholic Health Initiatives’ Mission and Ministry Fund. In the first 27 months, LINK helped to save nearly $500,000 in community health care costs while improving the life situations for 128 patients enrolled in Medicaid, Inman says. With the success of LINK after almost three years, Mercy Regional assumed the program funding in July.
LINK employs a full-time social worker along with program coordinator Inman, who has a master’s degree in social work. Although only 20% of LINK clients are considered homeless or at risk of being homeless, Inman says, all the clients typically have a substance use disorder; mental illness issues such as anxiety, depression, PTSD and personality disorders; or end-stage renal disease due to poor management of hypertension and diabetes.
Elsa Inman, (left) LINK program coordinator, and Christie Schler, inpatient hospital social worker, discuss a LINK participant’s case near the emergency room at Mercy Regional Medical Center in Durango. Photo courtesy of Mercy Regional Medical Center.
“They live rather chaotic lives, living in and out of homelessness for years before they’re housed and can stabilize,” Inman says.
The program coordinator credits the five-year initiative Hospital Transformation Program (HTP) in Colorado, which kicks off later this year after several years of planning, as helping move the needle toward better housing for poor patients. HTP is a care delivery and payment reform effort involving general acute care hospitals participating in Health First Colorado, the state’s Medicaid program.
Another noteworthy hospital and housing partnership in Colorado is underway with Denver Housing Authority and Denver Health Medical Center, where a former 10-story administrative building on the campus is being transformed into affordable senior housing, including 15 apartments designated to help homeless patients transition out of the hospital. Hospitals cannot legally discharge patients to recuperate at home who have no safe place to go. Patients who are not suitably housed can lead to more return ER visits.
Peg Burnette, Denver Health’s chief financial officer, says hospitalization costs can be $2,700 per night per person, while hospital-supported housing would be $10,000 per year per person.
“At any given time, we have between 25 and 30 patients in the hospital who could be somewhere else,” Burnette says. “I estimate that in 2018, we incurred costs of about $28 million related to these folks.”
Cooperative hospital and housing efforts are taking place across the country in areas ranging from Boise to Baltimore, from Oakland to Kansas City. According to the 2017 report “Housing and the Role of Hospitals” (aha.org/housing) by the Health Research & Educational Trust, up to 40% of health outcomes may be attributed to nonmedical factors such as income, housing status and access to sufficient healthy food.
In the Durango program, recurrent ER visitors talk with a social worker to answer 34 yes or no questions to determine the severity of their housing situation. Prioritized patients can receive a housing voucher administered through organizations such as the nonprofit Housing Solutions for the Southwest.
“Point-in-time surveys of homeless individuals around the county and locally show statistics that a significant portion of the population of homeless faces serious health issues,” says Elizabeth Salkind, executive director of Housing Solutions for the Southwest. “Without safe and affordable housing, it is difficult for a person to address health concerns.”