Hospitals leverage affordable housing to reduce avoidable visits

Health systems investing in affordable community housing have seen significant decreases in inpatient and emergency department visits among patients experiencing homelessness.

Hospitals are creating housing programs and partnering with local building developers, health departments and governments to connect patients to stable housing options.

In fiscal 2023, nearly 25 health systems reported investing more than $550 million in affordable housing projects, according to the Healthcare Anchor Network, a health equity advocacy organization that partners with providers. Other systems are leveraging government finances through a 2022 Medicaid 1115 waiver project that allows states to use federal funding to cover rent and temporary housing costs for up to six months.

Health systems are uniquely positioned to tackle housing issues because they regularly interact with and treat community members experiencing homelessness and can connect them with a variety of resources, said Healthcare Anchor Network founder and President David Zuckerman.

Between 2020 and 2023, the number of people experiencing chronic homelessness increased by nearly 30%, according to data from the Housing and Urban Development Department. One-fifth of these individuals reported having a serious mental illness and 16% reported having a substance use disorder, HUD found. People without housing are also more likely to have chronic conditions including hypertension, pulmonary disease, diabetes, liver disease and hepatitis.

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Ten states have been granted section 1115 demonstration waivers under the Biden administration to cover health-related social needs, including evidence-based housing costs and rental navigation services, according to the Centers for Medicare and Medicaid Services.

California Gov. Gavin Newsom (D) approved the $12 billion California Advancing and Innovating Medi-Cal, or CalAIM, initiative in 2022 to help homeless patients find and pay for housing. Medicaid is known as Medi-Cal in California.

Some health systems are leveraging their long-term financial reserves to invest in housing services, while others have leased or given land to affordable housing developers, Zuckerman said.

Kaiser Permanente's Housing for Health Fund puts the Oakland, California-based health system's dollars toward avoiding rent increases and making sure affordable housing properties aren't acquired by market-rate developers.

The health system has invested $50 million into the fund since it was created in 2019, preserved more than 1,200 units in 13 properties and prevented potential displacement among low-income populations, said John Vu, vice president for community health strategy at Kaiser Permanente.

“Housing is health, and a secure, stable place to live is key to a person’s ability to thrive,” Vu said. “Increasing the availability of affordable housing through construction or preservation of affordable units advances the economic, social and environmental conditions for health.”

The University of Illinois Hospital and Health Sciences System's Stephen Brown, director of preventive emergency medicine, said more healthcare providers need to realize that people must have a place to live before their health issues can be properly managed. UI Health has been helping house people in Chicago for nearly a decade, resulting in less frequent hospitalizations for those individuals.

Since 2015, UI Health has housed 130 individuals by giving about $350,000 annually from the system's general operating fund to Chicago’s Flexible Housing Pool, according to Brown. Through that pool, UI Health also provides individuals with housing navigation resources, care coordination services and rental subsidies to pay for up to three years of stable housing.

UI Health uses social workers and a case management panel to determine who qualifies for the program. Those individuals are able to choose from various one-bedroom apartments across the city, Brown said.

The health system has been fairly successful in stabilizing the health of chronically homeless people that participate in the program, with 80% to 90% able to retain their housing for more than one year, and a 35% reduction in emergency department use, Brown said.

Health systems in New York City have also invested in housing for their patients. The public NYC Health + Hospitals system treats around 72,000 patients experiencing homelessness or housing insecurity annually, many of whom have comorbidities and chronic health conditions.

“We also want to address the whole person and that is really hard to do if they don't have their social needs met,” said Leora Jontef, assistant vice president for housing and real estate at NYC Health + Hospitals. “If we can help navigate someone to housing so that they can live a stable life and be healthier, that is our goal.”

The health system’s Housing For Health initiative, launched in 2022 and has helped more than 1,200 people find housing through navigation services, including transitions into permanent housing. People are paired with local housing agencies and placed in affordable or supportive housing where they pay no more than 30% of their income towards rent, Jontef said.

Those placed in such housing receive periodic check-ins over the next few months with health system staff to ensure they stay connected to healthcare, she said.

NYC Health + Hospitals also is working with developers and city housing agencies to construct residential buildings on its land and create 650 affordable homes over the next five years, according to a news release. The system is ground leasing its land under the condition that some units be set aside as affordable housing for its patients.

“We are a public hospital system and we believe public land should be used for public good,” Jontef said.

Montefiore Medical Center, also based in New York City, is making sure frontline healthcare workers can help patients navigate its housing program, said Deirdre Sekulic, the system’s associate director of social work.

The health system’s Housing at Risk program was created in 2009 and includes three full-time employees who help patients with housing paperwork, reach out to landlords, identify community resources and, in some instances, deal with housing court cases. Program leaders have also secured New York City housing vouchers to help certain patients receive supplemental income, search for an apartment and apply for housing.

All employees at the health system are educated on housing resources, which has led workers to report feeling more comfortable discussing patients' housing situations, Sekulic said.

The system has helped more than 1,000 people secure stable housing in the Bronx, prevented 40 evictions and decreased hospital inpatient visits by 60% among its patients with unstable housing, Sekulic said.