Housing is Healthcare
The push for a merging of the social service and healthcare industries to improve health by fighting homelessness and the current state of homelessness in New Brunswick, New Jersey.
The social services industry has been arguing that housing stability and safety largely influence the health of an individual for years and are continuing to fight for the merging of the healthcare system and theirs. Local organization, Coming Home of Middlesex County, works to create a system to end homelessness in the county. They work to help people find permanent housing, connect homeless individuals with case workers, and build affordable housing.
Eileen O’Donnell, Executive Director, of Coming Home told me that safe housing “improves health, reduces unnecessary visits to the ER, reduces unnecessary costs, and improves people’s health outcomes. When I applied for a grant for funding [for Coming Home] I was told, at that time, that that didn’t really fit into their mantra of building a culture of health. Really? Having a kitchen isn’t important to your health? Access to non-GMO foods?”
But, the healthcare industry is slowly coming around and O’Donnell explained that there now is a larger population of persons in the healthcare industry that are realizing much more influences a person’s health than what happens in the doctor’s office.
In the most recent Point-in-Time count of Middlesex County, a census of all homeless persons, conducted January 22, 2019, 620 individuals reported themselves homeless in Middlesex County, a rise from the 597 reported in January of 2018. Of this, 485 persons, 158 of them children, were being sheltered in an Emergency Shelter, Transitional Housing, or a Hotel Placement. The number of homeless people has been rising since 2016, according to the Point-In-Time count.
One statistic that sticks out is that New Brunswick was shown to be the highest reported city within Middlesex County as a homeless person’s last permanent address. There was also a 19% increase from 2018 in households reporting New Brunswick as their last permanent address on the night of the PIT.
With this many individuals homeless, or housing-insecure, that means that the entire population is also facing a health crisis through not receiving healthcare for recent studies confirm that housing does improve long-term physical health, especially mental health as well as bring down money spent on health-related issues.
Los Angeles County in California had more than 53,000 people experiencing homelessness, 40,000 of those shelterless, living in cars, camps, or on the street in 2018, making it a useful case study for other counties across the country to see the most effective ways to improve health by combating homelessness. Starting in 2012, they have run a program titled “Housing for Health” where they work to end homelessness through placing homeless individuals and families into permanent and safe housing, along with providing health care and social services.
In a 2017 study conducted by RAND their key findings are outlined as such on the report:
- Clients’ use of public services, especially medical and mental health services, dropped substantially, including emergency room visits and inpatient care. Costs, correspondingly, also decreased.
- Across all the services examined, the associated costs for public services consumed in the year after receipt of supportive housing declined by close to 60 percent.
- Participants’ self-reported mental health functioning improved after receiving housing, though self-reported physical health was largely unchanged.
- Although the number of individuals arrested and the number of jailed arrests decreased during the year after receiving housing, the number of jail days increased following PSH entry by an average of 2.76 days.
These results show that stable housing reduced the necessity of medical and mental health services, cut down on the reliance of expensive emergency room visits, reduced public services consumption, improved mental health (physical health largely remained unchanged), and decreased the number of individuals arrested as well as arrested and then jailed. If programs like Housing for Health in Los Angeles County are showing that their services improve mental health, long-term physical health, and decrease the cost of emergency room visits, the only form of health care homeless individuals without insurance will be accepted for immediate care, then it is clear that housing is healthcare. Thus, social service industries should be connected with the healthcare industry.
One of the largest inhibitors to the social services industry being able to provide all the services that are needed for a community is funding, something the healthcare industry is less inhibited by.
“Right now, nobody funds the social services, we fund ourselves. We try to get grants and maybe we get some public assistance, we do fundraisers, we fund ourselves,” O’Donnell says. “Whereas with the healthcare system they have a steady stream of income through Medicare, Medicaid, and Private Insurance, so their services are all funded.”
Coming Home has a program where they catalyze the construction of affordable housing by partnering with housing developers. “That takes a long time though,” O’Donnell says. “We have only built one 12-unit complex starting in 2014 and ending a couple years ago.” They are currently working on a couple more but aren’t the only organization building affordable housing. They also have a landlord-engagement initiative where they encourage landlords to work with their clients and meet them where they’re at from a business-perspective through supplying them with clients so they’ll spend less time and money on advertising.
“Even Medicare put out an RFP in 2016 that said, ‘You’ve got the social services system operating over here and the health care system operating here and you need a bridge,’” O’Donnell said, “They’ve been studying it for several years, seeing how social services actually did improve peoples’ health and reduce unnecessary cost.”
In regards to what she sees for the future of these industries, she said, “I think maybe down the line there might be payment for the social services that address the healthcare related social needs through Medicare, Medicaid, and Insurance. The work of social services has gone relatively unnoticed by industries that are correlative and not cash-strapped. Now there is hope for us.”
Currently, Robert Wood Johnson University Hospital and Saint Peter’s University Hospital in New Brunswick are funding two Coming Home case managers to address the health-related social needs of the highest utilizers of their emergency rooms.
“This is the future,” O’Donnell said.
If you’d like to support the homeless of Middlesex County through Coming Home, please visit their Get-Involved page where you can give money, become a volunteer, or even donate household items and furniture for individuals gaining permanent housing.
