Providing a Solid Foundation for Improving the Health of the Homeless
Helping patients find a permanent place to live called crucial part of effective medical care
Health providers are increasingly focusing on ways to reduce the number of costly hospital visits, both by improving outpatient services and by trying to head off health problems before they become crises.
But this is extremely difficult to put into practice for people without stable housing, which is why healthcare advocates are joining with other social-service organizations to support the Housing First program, which focuses on giving people a permanent place to call home before addressing their healthcare needs.
Housing First, which started in Los Angeles in the 1980s, has been used by the federal government to support homeless veterans.
In New Jersey, it’s been active in Bergen and Mercer counties, and officials in other counties in the state are interested in developing Housing First programs.
Serious challenges stand in the way of providing the new affordable housing needed in New Jersey. In Camden, for example, it costs nearly $100,000 to convert the average vacant house into a new affordable unit, according to Felix Torres-Colon, director of operations for St. Joseph’s Carpenter Society, which builds affordable units in that city.
But the cost of not taking action may be greater than the one-time cost of building new units.
The average cost of a two-day hospitalization in New Jersey is higher than an entire year of housing costs, according to Anthony Marchetta, executive director of the New Jersey Housing and Mortgage Finance Agency, which provides financing for affordable housing. The agency works with developers to build new housing and provides mortgages for first-time homebuyers. Its funds are provided by the federal government.
Torres-Colon and Marchetta participated in a public discussion held at Rowan University’s Cooper Medical School in Camden about how housing affects healthcare.
Camden has a shortage of affordable housing, despite more than 300 new units being built in the city with federal subsidies in each of the last five years. Advocates say it will take additional state funding to help make Housing First a reality in the city.
Marchetta noted that the Housing First model has been discussed by state officials and could be included in recommendations by the Interagency Council on Homelessness, a body that Gov. Chris Christie has charged with developing a plan to end homelessness in the state within 10 years. The council, which Christie created in 2012, is scheduled to make its recommendations by the end of this year.
Torres-Colon emphasized that substandard housing can worsen people’s health, noting that rats and mold plague some city dwellings.
Healthcare services have traditionally sought to make sure that homeless people could stay at a shelter or live in short-term housing, according to Taiisa T. Kelly, an associate with Monarch Housing Associates, which develops and operates permanent affordable housing for people with disabilities.
But when people need access to medication – including some medicines for conditions, such as diabetes, that need to be refrigerated – and follow-up appointments, there is no substitute for having a permanent home.
People living in temporary housing “didn’t have the ability to focus on their issues and work through their issues before they could get to the state where they could get (permanent) housing,” Kelly said. “So you had a lot of people who were routinely failing at this process, ending up the streets.”
Kelly said evidence supports the new approach.
“The Housing First method is an approach to working with this population that says, ‘We’re not going to first decide that you have to be ready for housing -- we’re going to say that housing is a right,’ ” said Kelly, adding: “Once we get you into housing, we’re going to figure out what are the things that you need to utilize in your life, what are the things that you need for your healthcare.”
Kelly added that even if healthcare providers do a good job providing services, they still may not be effective if people don’t have stable housing.
That’s why it’s important for doctors and other medical providers to know how to connect patients with housing services, she told the audience, which was largely made up of medical students.
Bill Nice, an intervention specialist with the Camden Coalition of Healthcare Providers, works daily to connect patients with the social services they need.
“Nobody plans to be homeless, but it takes a lot of planning to get somebody out of homelessness,” Nice said. “And it really takes a lot of people working together.”
Nice said many things can make it difficult to help homeless people, including the lack of documents needed to get access to subsidized housing, long waiting lists for subsidized housing, and a lack of transportation.
With a thicket of different state, county, local and nonprofit agencies are responsible for different services, Nice added, coordination can be lacking.
He encouraged the medical students to let their patients know that they care about them and want to help them find housing, instead of handing them off to someone else.
“When they feel that support, they begin to buy into the fact that they can make a change in their life,” which is particularly important for homeless people with mental-health or addiction issues, Nice said.