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Better Health Through Housing

Man smiling for a headshot

Homelessness is a health equity issue. It is a social condition that should be taken as seriously as any life-threatening illness.  It carries mortality risks similar to some forms of cancer and many other chronic conditions.

“Although homelessness has profound effects on health outcomes, it is largely invisible in the healthcare system,” says Stephen Brown, Director of Preventive Emergency Medicine and Program Director for Better Health Through Housing. “These realities are leading health systems, especially those with health equity missions like the University of Illinois Hospital and Health Sciences System, to ask why healthcare isn’t doing more for the homeless.”

It’s estimated there are 80,000 homeless individuals in Chicago annually, resulting from a myriad of circumstances including job loss, substance abuse, eviction and mental health issues. Approximately 10 percent are “super users” who cycle through criminal justice and healthcare systems and have high rates of severe mental illness. It’s estimated each of these individuals incur costs over $1 million.

“Housing is a fundamental building block to do anything in your life,” says Brown. “The data we have shows it’s less expensive to invest in a homeless patient’s housing up front than it is to leave him or her on the streets to incur further illness or trauma, which ultimately drives up healthcare costs. National studies indicate aggregated public costs decrease by 48 percent when a homeless person is placed into housing.”

When Better Health through Housing (BHH) was piloted in 2015 by the University of Illinois Hospital and Health Sciences System (UI Health) to provide supportive housing for homeless patients, it was the first to operate such a program based out of an emergency room (ER). Hospitals across Chicago are following suit.

People tend to focus on the overt acts of racism and bigotry, but often overlooked are the intractable systems of structural discrimination. Citizens who rely on public aid benefits and services, which are based on these systems, face incredible difficulty and have to forego their dignity to do so. To access the services they need to live, they face contempt, long lines and paper-based systems that many of us would never tolerate.

Stephen Brown, Director of Preventive Emergency Medicine and Program Director for BHH

Homelessness is not only a pressing health condition, but also a complex social issue that requires alignment among other public sector systems to address.  While BHH’s model aims to refer homeless patients into supportive housing, the real work for Brown is partnering with city officials, politicians, police and others to find common ground and shared priorities, and to build cooperation around serving the population of homeless super-users on which they’re all focused.

BHH follows an interdisciplinary, interagency process to transition a patient from the emergency room into a home. After homeless patients are identified, a panel of emergency room attendings, social workers and psychiatrists determine which patients’ health would be most helped by supportive housing.  Once a patient is selected, the Center for Housing and Health, UI Health’s partner agency, uses outreach workers to find him or her in encampments and shelters and then assigns a case worker to help the patient find an apartment, coordinate care and ensure they receive needed services.

UI Health initially committed $250,000 to help launch the initiative. To date, UI Health has contributed $1.1M. The housing where patients are placed is funded by the Flexible Housing Pool (FHP), a fund to which hospital, insurance company, government agency and private funding can be directed. This collective impact approach will result in 750 more available housing units.

The program has provided permanent housing and supportive services to 75 patients since it began in 2015 and this fiscal year will add roughly 20 more patients. Without the support provided by BHH, experts expected housing retention to be around 20 percent.  With the supportive services the program provides, the retention rate has been 59 percent.  There has been a 41 percent and 52 percent drop in ER and inpatient utilization, respectively.

“Homelessness is a reflection of our society’s values, and of how we’ve chosen to do things in the past,” says Brown. “Here is a vulnerable population of individuals who don’t have access to services or care. Therefore, we have to address this as a health equity issue.”

34% of homeless people report a suicide attempt
21% of homeless women report being sexually assaulted
72% of chronically homeless have neurocognitive deficits
Nearly 50% have evidence of severe traumatic brain injury
Homeless individuals live up to 15 years less than the average American