Peter Bowser hasn’t been hospitalized in the past month. While that may not sound like a major accomplishment, it is for the 51-year-old Maple Shade resident – and it may be an early indication of the impact of a major change in how New Jersey treats some of its sickest and most disadvantaged residents.
Bowser was homeless until recently, making frequent trips to local hospital emergency departments as he struggled with his uncontrolled asthma and other chronic conditions, including high blood pressure, acid reflux, and pre-diabetes.
But in November he became one of the first three Camden County residents to receive a voucher for a permanent apartment through the Housing First program.
Housing First allows homeless people to move into a home before they receive healthcare and social services, rather than the traditional approach of delaying permanent housing while the homeless received healthcare services in a piecemeal fashion.
That model has had success in other states, as well as in Mercer and Bergen counties in New Jersey, but the pilot program in Camden County could be especially significant. That’s because state officials have committed to expanding the program once the initial 50 vouchers are used, and to consider expanding it statewide if it’s a success in Camden.
Jennifer Ho, senior advisor for the U.S. Department of Housing and Urban Development, praised the Camden County program.
While housing advocates drove support for Housing First in other states, healthcare providers generated ignited interest in New Jersey, spearheaded by the Camden Coalition of Healthcare Providers led by Dr. Jeffrey Brenner.
Homeless people are among the most frequent visitors to hospital emergency rooms in Camden and elsewhere. Peter Bowser’s case illustrates one of the reasons why.
Since shelters require occupants to leave during daytime hours, and open their doors on a first-come, first-served basis, Bowser’s days were spent trying to figure out where to be next, and how to deal with hot summer days and cold winter days. This disjointed schedule left him poorly equipped to stay on top of his asthma.
Camden County Freeholder Freeholder Carmen G. Rodriguez described the dilemma for a homeless person with diabetes this way: “When are you going to find the time to check your glucose levels to take care of yourself and your health? That’s not the priority at that point.”
Since moving to his new apartment, Bowser has been using his asthma medication regularly and has been able to make needed medical appointments, reducing the risk of hospital stays.
In the past, hospitals may have seen regularly treating homeless people as part of their job. But Ho said hospitals have had to rethink that approach because of a provision of the Affordable Care Act, which penalizes hospitals if they have excessive numbers of patients being readmitted after they’ve been treated.
“You can’t solve for health if you don’t go into people’s lives and solve for housing,” as well dealing with transportation issues, access to healthy food, and other social factors that affect people’s health, Ho said.
Alfred Campanella, Virtua Health’s executive vice president of strategic business growth and analytics, said hospitals are eager to see Housing First grow. Virtua operates four hospitals in South Jersey.
“We find that the social determinants of health are just as impactful as medical determinants,” he said.
Department of Community Affairs Commissioner Charles A. Richman is enthusiastic about Housing First’s potential.
“This is a wonderful start, and it’s a cultural change,” Richman said. “I’ve spent much of my career trying to figure out how to get housing people and social-service providers – two terribly different cultures – to figure out how to work together. And frankly, I’ve grown old trying to do it, and maybe we’re finally starting to see some success out of it.”
Richman said Housing First is part of a web of state programs aimed at reducing homelessness. They include providing housing vouchers to 18-year-olds who are aging out of the foster-care system; a federally supported effort to end homelessness among veterans; and an effort to increase the number of housing vouchers to enable families of children with special needs to move into communities with few low-income residents.
Richman said there’s been a high turnover rate in the use of federally funded housing vouchers, as well as more funding as a result of a relaxation of federal spending limits from the 2013 budget sequestration. The combination of the two factors has put the state in position to commit to at least 1,000 vouchers for special-needs families. He solicited a crowd of housing and healthcare providers and advocates at an event marking the launch of Housing First for suggestions on how to use the additional vouchers.
Campanella applauded Richman’s commitment to Housing First.
“It’s a sign of the state focusing on this issue, and it’s a step toward multiple agencies and departments working together,” he said.
Brenner said trying to foster coordination between different local and state agencies that aren’t used to working together has helped make Housing First “one of the hardest projects that I’ve ever” helped launch.
“We’re dealing with very complicated patients, and we’re all learning as we go,” he said. “This is new skill sets for everyone involved.”
But Brenner believes the initial hard work will pay off. He’s hoping to have all of the first 50 residents in permanent housing by the spring.
“The first three are the hardest, the next five are challenging, the next 10 are less hard, and the next 50 are going to be even easier,” he said. “On all different levels, from our frontline staff, to our legal team, to our data team, everyone’s had to work together.”
Senate President Stephen M. Sweeney (D-Cumberland, Gloucester, and Salem) said Housing First has changed the way he views the large amount of state healthcare spending going toward homeless residents’ hospital stays.
“We never looked at it differently” until now, Sweeney said, who expressed hope that the state will be able to replicate the program elsewhere.
Ho said President Barack Obama’s administration would like to increase funding for programs like Housing First, but needs Congress to agree to it.
Kristin Miller of the Corporation for Supportive Housing said Housing First definitely has statewide potential.
“The future of this project is, almost, less about Camden and it’s about Paterson and Elizabeth and Atlantic City, et cetera,” Miller told the crowd in Camden. “You here are going to prove to the rest of Jersey that it can and should be done.”
If the program does expand, it would help many more people like Bowser, who said he’s “where I’m supposed to be.”
“I love where I’m at right now,” he said. “You know, I go back to my routine of cooking, cleaning, doing laundry, come and go as I please. Don’t have to worry about, you know, the shelter, about the cold, or the heat, because I’m always in a home now, and it feels really good.”