Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.
As social determinants of health are being more intensely researched, one determinant that is already well understood and has a number of interventions in place and being studied is housing. Here are 5 things about housing in healthcare.
As social determinants of health are being more intensely researched, one determinant that is already well understood and has a number of interventions in place and being studied is housing. A recent issue brief in Health Affairs has shown that housing stability plays an important role in health outcomes.
Here are 5 things about housing in healthcare.
1. The importance of housing in HIV/AIDS
During the early years of the AIDS epidemic, researchers noticed that people living with AIDS who had housing fared better than those without housing. More recent research published in Social Science & Medicine showed that unstable housing among the HIV population adversely impacted viral suppression and CD4 cell count.
The study also showed that unstable housing lowered the likelihood of receiving mental health/counseling, visiting a healthcare provider, and engaging in continuity of care.
2. Housing can reduce hospital use among seniors
When seniors have access to affordable housing with supportive services, they are less likely to use the hospital than seniors who live in the same neighborhood but who don’t have access to housing with the same amenities.
Some of the supportive services included at the facilities were personal, functional status, and psychological assessments; counseling and advocacy; health education; wellness programs; socialization; educational programs to control chronic disease; and evaluation and referral for mental health concerns.
3. Supportive housing reduces health spending for the homeless
Individuals who are faced with homelessness use the emergency department and are hospitalized at higher rates than the average person. A pilot in Portland, Oregon, that provided supportive housing for 98 homeless and high healthcare utilizers was able to significantly lower overall healthcare spending. Not only did the patients reduce their use of the emergency department and inpatient care, but they also reported improved access to care, stronger primary care connections, and better subjective health outcomes.
4. Some health systems are putting up the money for this
Health systems and hospitals realize the benefits of increasing access to affordable housing. One benefit is that high utilizers now have a safe place to return to when they are discharged, which may help prevent future hospital visits. The Center for Community Investment recently launched a new initiative to help health systems and hospitals get the resources to increase affordable housing in their communities.
Kaiser Permanente announced in May 2018 that it would invest $200 million to address housing instability. It is working with mayors and chief executive officers across the country to identify opportunities to invest in projects that support affordable housing.
5. Housing First, but not housing only
As more housing programs are implemented, the approach of Housing First has taken hold. This is the concept that people need to get into a housing stable situation first by lowering barriers to get into housing, and then other issues are taken care of. However, that does not mean a person is put into stable, quality housing and then left to their own devices. Housing First works when people are provided with supports to address their needs. These supports could be formal services, like access to healthcare providers or social workers who are nearby or are in the building, or informal services, like providing opportunities to socialize and meet with family, friends, and faith groups.