Where we live influences our health. In the U.S., approximately three million people experience an episode of homelessness in a given year and many more experience housing instability, unsafe living conditions, or lack of social support that makes medical recoveries more difficult. Each of these scenarios can lead to poor health outcomes, increased high-cost health care utilization, and gaps in care.
In an effort to tackle the increasing number of patients stuck in the cycle of readmission to the emergency department due to non-optimal housing conditions, hospitals and health systems across the country are partnering with local government, housing authorities, and nonprofits to provide more upstream interventions. The range of innovation in this space is tremendous, but three specific hospital-led trends stand out.
Sending providers out to practice "street medicine"
In order to facilitate the provision of health care to homeless individuals where they live and to minimize avoidable emergency department visits, many health systems send providers out into the community to provide immediate assistance.
At Lehigh Valley Health Network in Pennsylvania, advance practice providers deliver primary and preventive care services and facilitate referrals for about 100 homeless individuals a month through their street medicine program.
Similarly, at Mount Carmel Health System in Ohio, a team comprised of an RN, EMT, and physician or NP set out once a week to provide treatment, education, resources, and referrals to individuals at homeless camps.
Vanderbilt University Medical Center's "street rounds" focus specifically on providing follow-up care to people who have been treated at the hospital for mental health and substance abuse.
Street medicine programs have been shown to reduce avoidable emergency department utilization and 30-day readmissions, and in many cases reduce the rate of uninsured individuals.
Providing short-term housing to support psychiatric patients post-discharge
Just as a patient may require rehabilitation services after a hip replacement, many adults with psychiatric illness may need additional therapy between discharge and returning home.
Recognizing this often unmet need for transitional assistance, many hospitals are leading the charge in funding "recovery homes" or temporary housing. Mayo Clinic, Hennepin County Medical Center, and Regions Hospital in Minnesota are currently pursuing such plans.
NYC Health + Hospitals has also backed construction and future management of a housing project for low-income mental health patients on one of its campuses. In partnership with local nonprofit Comunilife, 89 studio apartments will be constructed for low-income residents; 54 of which will be designated for income-eligible residents with mental illness. The building will provide social services and skills training as well as case management.
Partnering with other organizations to build longer-term housing for patients
Other organizations have determined that providing longer-term housing to frequent fliers or super-utilizers is more cost effective than continuing to treat them in high-cost sites like the emergency department and hospital. ($1,000 a month for an apartment versus $3,000 a day for hospital care.)
University of Illinois Hospital in Chicago is piloting a project to get 25 super-utilizers into "housing first" style housing in partnership with Chicago's Center for Housing and Health. In addition to an apartment, patients are paired with a care manager who helps with scheduling medical appointments and coordinating care. For the individuals housed by the hospital so far, health care costs are down 42 percent.
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