Housing is the Best Medicine July 2014 - CSH

1 Housing is the best Medicine July 2014. Supportive Housing and the social determinants of health The most appropriate question may not be how we can afford to pay for social determinants of health as a health intervention, but whether we can afford not to pay for social determinants of health as a health intervention.. - Dr. Kelly Doran, Bellevue Hospital, New York BACKGROUND. Every day doctors in America provide treatment to some of our sickest patients who live in shelters, institutional settings or unsafe Housing . These patients often lack access to basic needs like transportation, nutritious food, heat, a steady income and social supports. Medicine and medical interventions alone will never resolve the complexity of issues that these patients face.

2 Most will return to the clinic or hospital, again and again, with more serious and expensive problems. This reality is not lost on our strained health systems or physicians. However, until very recently, providers lacked the organizational framework, capacity and incentives to address the underlying causes of patients' poor health . With the recent implementation of the Affordable Care Act (ACA), the rise of Accountable Care Organizations and the general shift towards more integrated and holistic models of care, the health system is broadening their practices and investments outside the clinical setting to change the tide of health and health care costs in this country.

3 There is a growing recognition among health care professionals and policymakers that in order to achieve the triple aim of improving The social determinants of population health , improving health care delivery and reducing costs, health are the circumstances in the health system must take a broader approach to health care financing which people are born, grow up, and delivery to include certain social services and supports. This new live, work and age, and the vision seeks to shift attention and dollars toward systematically addressing the social determinants of health that collectively have a systems put in place to deal with greater impact on the health of a community than access to or quality of illness.

4 These circumstances are care 1. social determinants of health are the economic and social in turn shaped by a wider set of conditions that affect health outcomes and are the underlying, forces: economics, social policies, contributing factors of health inequities. 2 Examples include Housing , and politics." - World health educational attainment, employment and the environment. Organization Access to safe, quality, affordable Housing - and the supports necessary to maintain that Housing - constitute one of the most basic and powerful social determinants of health . In particular, for individuals and families trapped in a cycle of crisis and Housing instability due to extreme poverty, trauma, violence, mental illness, addiction or other chronic health conditions, Housing can entirely dictate their health and health trajectory.

5 For these populations, Housing is a necessary precursor of health . Supportive Housing , an evidence-based practice that combines permanent affordable Housing with comprehensive and flexible support services, is increasingly recognized as a cost-effective health intervention for homeless and other extremely vulnerable populations. 1. Magnan S, Fisher E, Kindig D, Isham G, Wood D, Eustis M, Backstrom C and Leitz S, 2012. Achieving Accountability for health and health Care. Minnesota Medicine . Available at: 2. World health Organization, Commission on social determinants of health 2008. Closing the gap in a generation: health equity through action on the social determinants of health .

6 Final report of the Commission on social determinants of health . Available at: SUPPORTIVE Housing . A FOUNDATION FOR H EALTH What is Supportive Housing ? Supportive Housing targets the most vulnerable people who need Improving health and health Care Delivery Housing and service supports to remain stably housed and live Supportive Housing provides an essential platform healthy lives. In addition to individuals experiencing chronic for the delivery of services that lead to improved homelessness, this includes people that are inappropriately placed health and stability. First, at the most basic level, in institutional care settings (nursing homes, state hospitals) due to Housing provides physical safety, protection and a lack of affordable Housing options and/or inadequate access to basic needs.

7 A clean, dry, safe home community-based care. Integrated models of supportive Housing and reduces exposure to harsh weather, health services, which have been proven effective in improving Housing communicable diseases, infections, injury, and health outcomes for this population, share a common set of guiding harassment and violence; it provides a secure principles and Dimensions of Quality. place to sleep and store food, clothing and Quality permanent and affordable Housing : Supportive medications; and it is essential to promoting Housing is affordable rental Housing with no artificial time limits on personal hygiene and recuperation from illness. residency.

8 Rent is adequately subsidized such that extremely low- income tenants can pay no more than 30% of their gross monthly Second, supportive Housing improves access to income for rent. quality health care both by providing a physical space for service delivery ( , in-home case Housing First: Supportive Housing provides individuals access to management, nursing, ADL supports) as well as immediate, permanent, quality affordable Housing in their own access to support staff that link tenants to apartments or homes without any preconditions or requirements for sobriety or treatment compliance to maintain Housing . Supportive community-based social , mental health , substance Housing tenants hold their own leases and have the same rights and abuse and primary/specialty medical care responsibilities as any other tenant.

9 Programs assertively engage services. In many communities, supportive tenants and offer services to maximize Housing stability, including Housing serves as the locus of integrated health regularly communicating with property managers, advocating on care efforts where providers have partnered with behalf of tenants and mediating conflicts with landlords. hospitals, clinics and community mental health Comprehensive, Person-Centered Services: Individuals in centers to create multi-disciplinary care teams to supportive Housing have access to a comprehensive array of flexible deliver the full continuum of care for tenants with services including Housing stability supports, income and benefits complex needs3.

10 Several studies demonstrate that support, coordinated health and behavioral health services, 24-hour linking care management to supportive Housing crisis intervention, employment services, diet/nutrition counselors, leads to improved health outcomes. A Denver and recovery/wellness peer support specialists. Services are study found that 50 percent of supportive Housing provided as needed to ensure successful tenancy and to support the residents experienced improved health status, 43 person's recovery and engagement in community life. Participation percent had better mental health outcomes and 15 in support services is voluntary. percent reduced substance use 4.