Effectively Allocating Homeless Assistance Resources to End Homelessness
HEALTHCARE FOR THE HOMELESS AND ENDING HOMELESSNESS · HEALTHCARE FOR THE HOMELESS AND ENDING...
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HEALTHCARE FOR THE HOMELESS AND ENDING HOMELESSNESS Joshua D. Bamberger, MD, MPH [email protected] Sarah Dobbins, MPH San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine
Transcript of HEALTHCARE FOR THE HOMELESS AND ENDING HOMELESSNESS · HEALTHCARE FOR THE HOMELESS AND ENDING...
HEALTHCARE FOR THE HOMELESS AND ENDING HOMELESSNESS
Joshua D. Bamberger, MD, MPH [email protected]
Sarah Dobbins, MPH
San Francisco Department of Public Health University of California, San Francisco, Dept. of
Family and Community Medicine
Outline • Housing reduces mortality for homeless people with
AIDS • For high users of healthcare system, it is cheaper to
be housed than homeless • Not all housing is the same • Characteristics of communities on track to end
homelessness • Leadership role of HCH clinics
Plaza High Utilizer Study
• 106 Chronically homeless adults • Cost year before housing: $3,132,856 • Cost year after housing: $906,228 • Reduction in healthcare costs: $2,226,568 • Cost of program: $1.1million/year • Reduction in public cost in first year: $1.1 million • More than 90% of reduction
among 15 tenants who cost more than $50,000/year prior to being housed
The more beautiful the housing the better the outcome
The more beautiful the housing the better the outcome- Windsor
The more beautiful the housing the better the outcome- Plaza
The more beautiful the housing the better the outcome- Mission Creek
The more beautiful the housing the better the outcome- Richardson
The more beautiful the housing the better the outcome- Kelly Cullen Community
The more beautiful the housing the better the outcome- Kelly Cullen Community
The more beautiful the housing the better the outcome- Kelly Cullen Community
R² = 0.76418
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Windsor Empress LeNain PBI CCR West Folsom Dore
Plaza 149 Mason
990 Polk Mission Creek
Move-out not death
Move-out not death
Linear (Move-out not death)
7.6
3.5
6.8
3.9
5.3
2.7
5.0
3.5
2.5
4.0
3.1
R² = 0.38889
Windsor Empress LeNain PBI CCR West Folsom Dore Plaza 149 Mason 990 Polk Mission Creek
Death by Quality of Housing %death
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Death Rate/year
Death rate Le Nain vs. Mission Creek 2006-2011
Le Nain death %
MCSC death %
Case #1 • 48 y/o man w/ many year h/o homelessness • Experience rectal trauma in 2011 • Colostomy and colostomy repair, complications • H/o alcoholism and cocaine use • Multiple stays in medical respite • Placed in supportive housing in 2012 • Chronic back and leg pain with radiographic abnormalities • First visit to me in 2013 after switching from another clinic • Reports cocaine use at first visit, “just for my birthday.” • Refuses utox next visit: “I am not on parole.” • Denies cocaine use, makes threats to staff
Case #2 • 67 y/o depression, speed use, alcoholism, afib. • Evicted from supportive housing in 2010 • Unrelenting stimulant use and alcoholism • Repeated hospitalization for A. Fib and CHF • Conserved as gravely disabled • Placed in locked facility. Released from locked facility • Drunk and in A. Fib on second day out • 1 year of being on streets, in and out of hospital • Hospitalized and held for grave disability
POSITIVE OUTLIERS Characteristics of communities on track to end homelessness
POPULATION SNAPSHOT
Veteran PIT Counts, 2009-2012
* CoCs only required to conduct a new count of unsheltered homelessness in odd numbered years; in 2012, only 32% of CoCs opted not to do a new unsheltered count, providing an incomplete picture of trends in the number of unsheltered homeless Veterans Source: PIT data, 2009 - 2012
75,609 76,329
67,495 62,619
43,409 43,437 40,033
35,143
32,200 32,892 27,462 27,476
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
2009 2010 2011 2012
Num
ber o
f Vet
eran
s
Total Veterans
Sheltered Veterans
Unsheltered Veterans *
Number of Homeless Veterans in 5 Communities with Greater than 40% reduction 2010-2012
256
174 223
310
512
0
100
200
300
400
500
600
2010 2011 2012 2013 2014 2015
Hennepin Lexington Tacoma Fort Worth Birmingham
-------Projected
13,690 13,362
11,970
14,375
15,525 15,642
14,351
16,522
5,565 5,910
5,000
6,785 7,100 7,105
6,440
7,390
1,932 1,914 1,530 1,470 1,400
812 601 542
0.60%
0.52%
0.46%
0.53%
0.57% 0.56%
0.52%
0.60%
0.00%
0.10%
0.20%
0.30%
0.40%
0.50%
0.60%
0.70%
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
2005 2006 2007 2008 2009 2010 2011 2012
Source: 2012 Annualized Utah Homeless Point-‐In-‐Time Count
Utah Homeless Point-‐In-‐Time Count: 2005-‐2012
Annualized Total Count Number of Persons in Families Number of Chronically Homeless Persons Total Homeless Persons as % of Total PopulaNon
1,932 1,914
1,530 1,470 1,400
812 601
542
14% 14%
13%
10%
9%
5% 4%
3%
0%
2%
4%
6%
8%
10%
12%
14%
16%
0
500
1,000
1,500
2,000
2,500
2005 2006 2007 2008 2009 2010 2011 2012
Source: 2012 Utah Homeless Point-In-Time Count
Utah Annualized Chronic Homeless Count: 2005-2012
Chronic Count
267
224
177
126
0
50
100
150
200
250
300
2009 2010 2011 2012
Veterans in Minneapolis/Hennepin County 2009 - 2011
total veterans
775 779
566
351
2009 2010 2011 2012
Point-in-time count for Minneapolis/Hennepin County Continuum total chronic homeless
21.84 24.26
17.59
10.36
total chronic homeless (perecnt of
Characteristics of Positive Outliers
• High level of communication and collaboration across different pillars of homeless services • Continuum of care • Healthcare for the homeless • Housing Authority • VA
• Strong and dynamic leadership • Commitment to similar philosophy
• Housing First and Harm Reduction
Characteristics of Positive Outliers
• Use of data to inform policy • SMART (Specific, Measurable, Attainable, Relevant,
Time-sensitive) • Targeted intervention
• Chronically homeless = Permanent supportive housing
• Episodic homeless = Rapid re-housing, homeless prevention
Role of HRSA in Leading HCH Towards Ending Homelessness
• Limited by congressional mandate • Performance measures already burdensome and
difficult to change • HCH as part of Community Health Centers
• Healthcare for homeless should be held to same standards as other health centers
• Opportunity for HCH to take lead
Recommendations
• Establish connections across the sectors • Position HCH as necessary to evaluate who goes into housing.
• Position HCH as necessary to serve people in supportive housing • Opportunities for revenue with ACA
• Establish measureable goals, provide real time feedback
• Take credit for success • Repeat…..
HEALTHCARE FOR THE HOMELESS AND ENDING HOMELESSNESS
Joshua D. Bamberger, MD, MPH [email protected]
Sarah Dobbins, MPH
San Francisco Department of Public Health University of California, San Francisco, Dept. of
Family and Community Medicine
