- Housing insecurity is a critical social determinant of health, demanding the attention of healthcare industry professionals, according to a new guidebook from the American Hospital Association (AHA).
The report specifically focuses on housing as it affects various components of patient health, including liability for certain diseases, ability to access clinicians, exposure to and threat of violence, quality educational attainment, and other social factors.
Over 1.48 million individuals experience homelessness annually, AHA said. Another 7.72 million households live outside of their financial means, meaning that their rent or housing costs exceed far beyond their income, the organization added.
Housing instability encompasses a number of different challenges, including:
- Acceptable housing conditions, such as clean environment and adequate heating and cooling
- Safety and structural soundness
- Exposure to allergens and pests
- Homelessness, living on the streets, or in homeless shelters
- Extreme rent burden
Meeting any of those criteria categorizes an individual as homeless, and put a patient at high-risk of living an unhealthy life.
These patients are more susceptible to infectious diseases such as HIV/AIDS, pneumonia, and tuberculosis because of their living conditions. They are also more liable for mental illness and substance abuse disorder because of their living conditions.
The homeless population is also aging, AHA said. As individuals age, they naturally fall into a series of chronic illness, such as COPD, diabetes, cardiovascular disease, and some cognitive conditions such as Alzheimer’s and dementia. Patients experiencing homelessness also suffer from increased stress, depression, and anxiety levels.
Patients often can’t do anything about these conditions, making matters worse, according to the AHA. These patients usually can’t afford primary and preventive care or chronic care management tools.
Individuals experiencing homelessness or housing instability account for some, but not necessarily all, of the five percent of individuals contributing to 50 percent of all healthcare spending.
Patients with housing instability are more likely to be admitted to an acute care hospital for an average of one to four days, costing up to $4,000 per stay, AHA reported. In 2015, children under four living with housing instability cost the industry $238 million, the organization added.
However, strong patient and community health outreach can begin to cut away at these costs. Hospitals that partner with community and federal housing organizations can work to chip away at housing insecurity issues by offering transitional housing and safer housing experiences for patients.
To be clear, hospitals in these situations are not responsible for fully funding a homeless patient’s housing. They are not creating shelters or building subsidized homes. Instead, hospitals must forge mutually beneficial community health partnerships with interested stakeholders, in this case, housing authorities.
Hospitals can help identify goals with these partners that will create relevant and ideally effective solutions to housing and health-related issues.
Doing so can drive hospitals’ cost savings. Patients who are homeless account for a majority of preventable 30-day hospital readmissions. Readmissions are costly for hospitals and hospitals can incur reimbursement penalties when they exceed a certain benchmark for readmissions.
Ultimately, supporting housing and social needs of patients can result in cost savings ranging from $9,000 and $30,000 per person per year, depending upon the level of outreach and severity of need, AHA said.
In addition to making the case for community health partnerships dedicated to housing support, AHA offered some advice for creating those supports.
“Once hospitals decide to get involved in promoting housing stability, they need to identify their targets and approach, based on their capacity and specific goals,” AHA wrote in the guidebook.
Goals can include neighborhood revitalization, home assessments and repairs, medical care for the homeless, medical respite care (providing short-term care for patients well enough for hospital discharge but not well enough to return to a shelter), and transitional or permanent supportive housing.
From there, hospitals and community partners can follow six steps:
- Identify issues, opportunities, and risks
- Build strategic partnerships
- Research possible interventions
- Consider funding needs
- Educate patients, providers, and community
- Evaluate progress and adapt
“The links between housing and health are clear: Individuals struggling with unsafe or unstable housing experience worse health outcomes and higher health care costs,” the guide concluded. “Evidence is equally strong for the benefits of interventions to promote housing stability. Spending more time in more stable housing and eliminating housing-related stressors lead to improved health and fewer, shorter hospitalizations.”
This most recent guidebook is a part of AHA and the Health Education & Research Trust’s (HRET) guides for hospitals to address the social determinants of health.
Earlier this month, AHA and HRET published a playbook on how to forge community health partnerships that are critical for patient outreach. AHA plans to publish other related guides in coming weeks.