Medicare beneficiaries who live in housing that offers supportive social services use the hospital less than seniors who live in the same neighborhoods in housing without such amenities.
Research has demonstrated that seniors’ housing conditions affect health outcomes, but to date, evidence has been limited on the extent to which supportive services delivered in affordable housing settings improve seniors’ well-being. Now, new findings published in Health Affairs demonstrated that Medicare beneficiaries who live in housing that offers supportive social services use the hospital less than seniors who live in the same neighborhoods in housing without such amenities.
The research team, led by Michael Gusmano, PhD, of the Rutgers School of Public Health, sought to examine whether hospital use was reduced among seniors in housing with supportive services than among their peers who lived in other housing in the same neighborhoods.
The researchers examined Selfhelp Community Services, a nonprofit, community-based housing program in Queens, New York. During 2014, the year for which the researchers examined Medicare claims data on hospital use among Medicare beneficiaries living in other housing in the same Queens zip codes, Selfhelp operated programs for adults aged 65 and over in 6 affordable housing sites in Queens.
In these facilities, residents are provided with personal, functional status, and psychological assessments; counseling and advocacy; health education; wellness programs; physical activity programs; socialization; evaluation for and referral to public benefits and entitlements; evaluation and referral for mental health concerns; and educational programs to control chronic disease. Residents can also request in-home safety technologies.
Among the 1248 Selfhelp residents, the total hospital discharge rate was 88.1 per 1000 beneficiaries, which was 32% lower than the rate among the 15,947 beneficiaries living in other housing. Selfhelp residents also typically stayed in the hospital for 6.38 days, or 1 day fewer than their peers.
Furthermore, the rate of hospital discharge for ambulatory care-sensitive conditions (ACSCs) among Selfhelp residents was 15.2 per 1000 beneficiaries, or 30% lower than among the comparison group. After controlling for age, race, sex, ethnicity, and zip code of residence, the odds of being hospitalized for an ACSC were approximately 43% lower among Selfhelp residents than among their peers.
Gusmano and colleagues acknowledged that the study design was limited by the possibility that the quality of housing, healthcare delivery, or other neighborhood characteristics could contrite to the disparities in hospital use observed between Selfhelp residents and seniors who lived in other housing. However, they wrote that their research has important implications. Namely, they said, investment in upstream social determinants of health can reduce the rates of hospital use for conditions that could be managed in an ambulatory setting and can reduce the likelihood of exacerbations that lead to hospital admission.
“These findings are consistent with the claim that housing programs of this sort help people stay healthy and, perhaps more importantly, help them receive health and social services that allow them to manage their chronic conditions,” Gusmano said in a statement. “By receiving timely and appropriate support in the community, this vulnerable population may be able to avoid hospitalization or at least use it less often.”
Gusmano MK, Rodwin VG, Weisz D. Medicare beneficiaries living in housing with supportive services experienced lower hospital use than others. Health Aff (Millwood). 2018;37(10):1562-1569. doi: 10.1377/hlthaff.2018.0070.