Feb 1 2012
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New Study Points the Way to Better Care, Improved Outcomes and Lower Costs for Homeless People with Chronic Conditions

By Laura Sadowski, MD, MPH, and Romina Kee, MD, Robert Wood Johnson Foundation (RWJF) Clinical Scholar alumnae

Becoming homeless is distressing for anyone, and it is especially challenging for people with chronic health problems who need ongoing care.

The face of America’s homeless population is changing. When the job market collapsed a few years ago, millions of families were forced out of their homes. A 2009 national survey of organizations providing services to the homeless found that an estimated 10 to 19 percent had become homeless in the past year due to foreclosure. Nearly one percent of the U.S. population experiences homelessness each year.

Previous research on the health/medical, legal, housing and social services costs accrued by people who are homeless has focused on subsets of the population—those with mental illnesses, substance abuse problems, or the “chronic homeless” (those who have been without stable housing for 24 or more months). But they comprise a small portion of America’s homeless population. The chronic homeless, for instance, represent just 18 percent.

So how do we ensure that all homeless patients – regardless of their individual circumstances – get the care they need, while reducing costs?

In our study published in a special edition of Health Services Research: Bridging the Gap Between Research and Health Policy, we looked at a novel, broader sample: homeless adults with chronic conditions. Unlike previous studies, the majority of our study subjects were not mentally ill, substance abusers, HIV infected, veterans, or frequent users of the health care system.

We followed more than 400 patients over an 18-month period, tracking their use of medical/health, legal, housing and social services. Half of our participants received the usual "haphazard" care homeless individuals receive in most U.S. cities. The other half were enrolled in a case management program that provided them with additional support: interim housing at a respite center after hospital discharge, stable housing after recovery from hospitalization, and case management based in hospital, respite and housing sites.

We found that providing case management and housing to homeless adults with chronic illnesses after hospitalization has the potential to save more than $6,000 per homeless adult annually and more than $5 billion over the next 10 years. The savings come from decreased hospitalizations, emergency room visits, nursing home care and stays in residential substance abuse programs. The savings can be realized despite the higher costs of housing and case management under the intervention, as the homeless adults had 74 more days in stable housing and respite care annually, as well as used more case management services.

We hope that policy-makers and leaders from the housing and health care sectors take note of these findings. Incorporating these kinds of supports can improve the health of our patients and communities.

As the face of America’s homeless population changes, so should our response to the problem and our supports for those who are experiencing it.

Tags: Chronic disease management, Clinical Scholars, Health & Health Care Policy, Health care delivery system, Health plans, Homeless, Human Capital, Research & Analysis, Voices from the Field