Housing for homeless critical for health care

Chicago Tribune Letter to the Editor

During the debate on health reform in Washington, much as has been made of the need to "bend the curve"--to significantly and permanently reduce the seemly unstoppable growth in health care costs ("Centrist plan on table," News, Sept. 17).

Much of the policy discussion has focused on reducing unnecessary tests, increasing the use of technology such as electronic medical records and expanding access to preventative care.
While these changes are critical, a study recently completed here in Chicago shows the role that the most basic non-medical intervention--providing housing for homeless people--must play in reducing health care spending for an extremely expensive population: homeless people with
chronic health conditions.

A ground-breaking demonstration in Chicago showed that providing housing and supportive
services to chronically ill homeless people could reduce health care use by one-third. The study, published in the Journal of the American Medical Association, suggests that housing and social services could more than pay for themselves in reduced medical costs.

There is ample evidence to show that seriously ill homeless people are a significant driver of
health care costs for public hospital systems in major urban centers. One in every three Stroger
Hospital patients is homeless or at high risk of homelessness. In San Francisco, homeless adults make up less than 2 percent of the city's population, but account for one in four emergency room visits and hospital stays at the city's public hospitals.

The study, called Chicago Housing and Health Partnership, followed for four years 405
chronically ill homeless people, including 146 living with HIV, who had been hospitalized at
Stroger and Mount Sinai hospitals. The homeless patients were randomly assigned to two
groups. Half were offered immediate housing and intensive support from a case manager. The
other half was released into the customary dysfunctional web of emergency shelters, family and
under-financed recovery programs.

Remarkably, homeless people who were housed were admitted to the hospital one-third fewer
times than people in the control group. They also spent one-third fewer days in the hospital and
went to the emergency room one-fourth fewer times.

For every 100 homeless adults offered the program intervention, there would be 49 fewer
hospitalizations, 273 less days spent in the hospital, and 116 fewer emergency department visits.

Health reform proposals advanced by Democrats in Congress all include an expansion of
Medicaid to very low-income, childless adults. It is a policy change that will provide health care
coverage for the first time to the group of homeless people in the Chicago study.
But this research demonstrates that it will be difficult to control the costs and care of this
population unless they are also provided housing. Policymakers in Congress should consider
expanding Housing First vouchers to long-term homeless individuals. They should also explore
allowing states to use Medicaid funding to pay for housing for high-cost, homeless Medicaid
patients.

Ultimately, the Chicago demonstration project shows that the most dignified solution to
homelessness is also the most affordable to taxpayers.

--Mark Ishaug
President & CEO
AIDS Foundation of Chicago