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Housing has long been a hot topic among healthcare organizations striving to address the complex needs of populations at risk of homelessness. Over half a million people were living on the street during the January 2019 annual point-in-time count, and this number is expected to dramatically rise courtesy of COVID-19.

Housing is a hot-button issue for any organization building programming to address the social determinants of health (SDoH). From 2017-2019, the majority of hospital spending on the SDoH went to housing initiatives, including $1.6 billion for the following:

  • Rental support
  • Leased apartments
  • Transitional housing
  • Purchase of abandoned buildings for conversion to stable housing for homeless patients, and to reduce chronic readmissions of patients with housing instability

A total of 57 health systems have taken this plunge, with high financial return on investment reported, particularly for programs that incorporate staffing in these initiatives, encompassing social workers, community health workers, and case managers. Someone who hasn’t lived in stable housing for years can’t just be given a key to an apartment or room; more is involved.

However, new housing challenges face a society grappling with the pandemic. Eviction protections, plus unemployment assistance provided through the Coronavirus Aid, Relief, and Economic Security (CARES) Act were set to expire last week, though the issue remains up in the air. These valuable resources helped keep those struggling due to job losses in their homes. Eviction rates usually sit at 3.7 million annually, although current unemployment rates of close to 50 million people and loss of protections mean large looming increases. One out of every 20 renters face eviction annually, and for renters of color, that number is one out of 11. Racial inequity is a major challenge for Blacks and Latinx populations, who more frequently rent their homes than whites. As a result, more headaches are expected as hospitals and organizations working to provide safe and appropriate care and discharges find themselves with more patients experiencing housing insufficiency.

Last fall’s report by the California Policy Lab identified significant self-reports of health challenges for homeless adults:

  • 84 percent of unsheltered people and 19 percent of sheltered had health condition;
  • 78 percent of unsheltered and 50 percent of sheltered had mental illness
  • 75 percent of unsheltered and 13 percent of sheltered people had substance abuse challenges
  • 50 percent of unsheltered and 2 percent of sheltered had a “tri-morbidity” (co-occurring physical health, mental health, and substance abuse challenges)

A report from the Homelessness Research Institute identified $11.5 billion needed for new shelter beds to address anyone unsheltered, to ensure appropriate social distancing, and to implement the creation of quarantine sites for those sick and exposed to the virus. With unsheltered homelessness continuing to trend upwards, further rises of up to 25 percent of the population are anticipated, at least.

During last week’s Monitor Mondays survey, we asked if our listeners are caring for more patients who are homeless or at risk of homelessness. The results can be viewed here.


Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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