A new report in the July issue of Health Affairs looks at a subject of intensifying interest in the healthcare provider world: that of the leaders of patient care organizations plunging directly into providing direct housing to homeless and at-risk patients, along with efforts to reduce drug addiction recidivism. With discussions in the past couple of years turning increasingly to the social determinants of health, the experience of several provider organizations in Portland, Oregon, is revelatory.
As David Tuller reports in his article, “To Improve Outcomes, Health Systems Invest In Affordable Housing,” five multi-hospital systems and one not-for-profit Medicaid health plan joined together three years ago to provide direct housing to homeless and at-risk patients, through their creation of a housing collaborative, Housing Is Health, which continues forward, even as the leaders of the initiative concede that some of the core challenges that they faced at the outset, remain.
As Tuller reports, “In 2016 Providence [Health] and five other Portland health care providers made a headline-grabbing announcement that acknowledged the intimate links between housing and health: They revealed plans to invest a collective $21.5 million in the construction of affordable units. Besides Providence, the participants were three other hospital systems (Adventist Heath Portland, Kaiser Permanente Northwest, and Legacy Health); Oregon Health & Science University, which includes a major hospital facility; and CareOregon, a nonprofit health care plan for Medicaid patients. The initiative, called Housing Is Health, involved three buildings with a total of almost 400 living units for people who were homeless or at risk for homelessness. Besides the six large health care organizations, other state and local agencies and groups also contributed funds. CCC [Central City Concern, a local social service agency] owns the buildings and is developing and managing the project.”
Meanwhile, Tuller notes, “The three buildings in Portland’s Housing Is Health project were designed with specific populations in mind. One includes 51 units for families displaced by gentrification. A second has 153 units of permanent housing for people leaving transitional units. The largest building, called the Ed Blackburn Center after the former CCC executive who spearheaded the project, is scheduled to open this summer with 175 units for people in recovery. It will house additional on-site services, such as a primary care health clinic, treatment for substance abuse and mental health issues, and an employment office.”
What’s more, Tuller reports, “Addressing substance abuse by helping clients stabilize their living situations has long been a key focus of CCC’s work. The agency’s motto is Homes, Health, Jobs.”
“You simply can’t be attendant to someone’s health without housing that is grounded in community, particularly for people who are low income, have trauma, have substance abuse disorders,” said Rachel Solotaroff, a physician who ran the agency’s medical services before being appointed CEO two years ago. “We can say ‘housing’ and put someone in an apartment five miles away, where they’re disconnected from anyone. If you’re in a process of recovery from any number of things, to live in an environment where there is social connectedness is a good thing.”
The challenges continue, even on a basic level, and the leaders of the initiative concede that. Despite efforts across the state and city to address the issue of homelessness, making what appears to be progress has been difficult. “It’s not any better,” said [Pam Mariea-Nason, the executive of the community health division at Providence Health and Services]. “We know it certainly has not been solved in the Portland area. I think that we are a long way from seeing this problem solved.” And that, she worried, has long-term consequences for the health of the people served by Providence and other providers. “We are in a situation where a lot more people that we’re treating and caring for don’t have secure places to live, so how are they going to recover?” she said.
Still, all the leaders of this housing initiative are determined to work forward, continuing to address the challenges that their patients and plan members face outside the strict confines of the formal healthcare delivery system.
