PROJECTS

New York City

Homelessness and Healthcare

Integrated, coordinated care that improves lives and saves taxpayer dollars

Sometimes the hospital becomes a home.

Imagine being on the street with asthma, diabetes, an addiction to alcohol or cocaine. You’re sick and can’t take care of yourself. And you have no home base to recover and rest. So, the Emergency Room or a hospital room becomes, at least for a short while, the only place you get fed, get your medicine and get people to pay attention or care.

At Community Solutions, we view street homelessness as a health care issue. Studies and our own experience show that people experiencing homelessness are far more likely to be ill or mentally ill and frequent users of emergency rooms and hospital facilities than those who can count on a roof over their heads.

Keys to a Healthy Life:  A Home—and Regular Care

Take Ms. W, 44, a drug user who suffers from diabetes, asthma, renal insufficiency and severe enough depression to cause several suicide attempts. She was living in a shelter and frequently landed in Bellevue Hospital’s ER for high blood sugar and infections.  Ms W. became one of the first to benefit from Hospital to Home, a program that connects high frequency users of the hospital to housing, if need be, and regular treatment and care.  The program demonstrates that integrated, coordinated care not only improves lives, it also vastly lowers public costs.

Designing Partnerships to Integrate Housing and Health Care

Working through the Institute for Healthcare Improvement’s Triple Aim initiative since 2009, we’ve helped hospitals from Camden, New Jersey to Venice, California design community partnerships that integrate health care, housing and social services—both inside and outside the hospital.  Across the country, teams honed care coordination skills to effectively link people to community health care and housing.

“People experiencing homelessness are far more likely to be ill or mentally ill and frequent users of emergency rooms and hospital facilities than those who can count on a roof over their heads... Integrated, coordinated care not only improves lives, it also vastly lowers public costs.”

Maria Raven, an emergency room doctor at Bellevue who coordinates the NYC Hospital to Home program, has seen tremendous results.  By the second year in their own homes, Dr. Raven calculated that patients’ health care bills decreased an average of $36,000 per patient per year.  Ms. W., once housed and connected to addiction counseling, mental health and home care services, saw her health improve and Medicaid tab drop by $62,335 in the first year. But beyond the dollars, the program is transforming, and in some cases, saving lives.

How is Dr. Raven’s model working? The hospital identifies their most frequent users and invites them to work with a community-based case manager, supervised by a social worker, who coordinates with a primary care physician, mental health professionals and, when the patient is homeless, a housing coordinator. “Even though the team is hospital based,” says Catherine Craig, director of health integration at Community Solutions, “they act like a community team.”

Bellevue Hospital’s frequent user program is just one of the many innovations being shared and replicated through the 100,000 Homes Campaign, a nationwide collaboration of communities, led by Community Solutions, to house 100,000 homeless people by July 2013.  Community Solutions’ technical assistance to campaign communities includes support to hospitals and community clinics to grow their ability to end homelessness.