In the Future We Won't Be Able to Separate Housing and Health Care

We are entering a new era where there is a distinct, understood marriage between housing and healthcare. The design of the home and the surrounding community are known to have a strong impact on the habitants' well-being. This change will impact building code and legislation.

Here, Open Minds explores the impacts of healthy housing on a homeless population with themes that extend beyond homeless to the general population.

The overlap between housing and health care continues to blur. The reason is clear—people with housing insecurity are likely to use more health care resources, particularly hospitalization. A recent report looking at hospitalizations among the homeless population in three states found hospitalizations increased by an average of 38.4% from 2007 to 2013. The increase over this period varied by state. In California, the increase was from 133 to 164 per 1,000 homeless people (23.3%); in Florida, the increase was from 161 to 240 per 1,000 homeless people (49.4%); and in Massachusetts, the increase was from 294 to 420 hospitalizations per 1,000 homeless people (42.9%). Approximately 52% of these 185,292 hospitalizations were for mental illness or addiction disorder (see Hospitalization Among Homeless Adults Rose 38.4% Between 2007 & 2013; Over Half Were For Behavioral Disorders).

As I read this, I started to wonder about the math. We know that on any given night, there are over 553,000 homeless individuals in the United States (see How Many Shelter Beds Are Enough?). And, according to the study referenced previously, there are 240 hospitalizations each year per 1,000 homeless people, with an average cost per stay of $10,391. Using that rough math, we’re talking about $1.4 billion per year in hospitalization expense for this population.

The immediate question for any organization that is looking to control health care costs in general and hospital admissions is—how many of the admissions for homeless people are preventable? There is no definitive answer to that question, but we do know that when a consumer who is a high utilizer of health care services gains supportive housing, average hospital cost savings are $3,022 per person per month (see Is Housing Health Care?). Over the past few years, health insurers have started paying more attention to issues of homelessness. Health plans like Kaiser Permanente, Blue Shield, and UPMC are making investment in housing (see The Future Of Housing Support).