Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing...
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Transcript of Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing...
![Page 1: Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing University of California, San Francisco joshdbamberger@gmail.com.](https://reader036.fdocuments.in/reader036/viewer/2022081514/56649e795503460f94b79316/html5/thumbnails/1.jpg)
Housing as Healthcare
Joshua D. Bamberger, MD, MPHSF Dept. of Public Health & Mercy Housing
University of California, San Francisco
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Poverty—combined with mental illness, substance
abuse or a chronic medical condition—is lethal
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• People in these conditions die 25 years younger than general public
• These premature deaths, often from common diseases like cardiovascular disease or diabetes, are preventable
• Medical treatment is necessary but insufficient alone to improve outcomes
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A.G.
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What does medical success look like?
Avastin: huge financial success, modestly increased survival rates by 15%
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Medical success: housing homelessHousing homeless with AIDS increased survival rates by about
80%
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DAH Portfolio
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Quality is impacted byfive key indicators:
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1.Quality of building/architecture
2.Quality of neighborhood
3.Severity of illness among tenants
4.Homogeneity of the population
5.Quality of the on-site services
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Building Neighbor-hood (1-3)
Housing quality (1-3)
Severity of tenant illness (3-1)
Quality of on-site service (1-4)
Mixed population (1-2)
Total (5-15)
Mission Creek
3 3 1 2 2 11
Kelly Cullen Comm.
1 3 1 2 1 8
Measuring Quality in Affordable Housing
“Magic Number > 9”
1 Point Bonus for Strong Community1 Point Bonus for a Work Program
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Relationship between Housing Quality and Mortality
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Death rate: Le Nain vs. Mission Creek
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Cost
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“It costs less to house homeless people than to leave them on the streets
and in shelters.”—Shaun Donovan
U.S. Secretary of Housing & Urban Development
The Daily Show, March 5, 2012
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Chez Soi/At Home Study
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• 3000 adults with mental illness and chronic medical problems
• Randomly assigned to housing vs. regular care
• For the top 10% of the healthcare users, $10 returned for every $1 in housing
• For next 40%, $1 returned for every $1 in housing
• For bottom 50%, housing did not significantly reduce healthcare utilization
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Saved $19,000 per person
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Saved $23,000 per person
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Saved $29,000 per person
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A.G. is recovering now
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So what now?
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Next steps
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Future Opportunities for Healthcare in Supportive Housing
•New York State
• Investing savings in healthcare into supportive housing
• $600 million in 2015-6
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Future Opportunities for Healthcare in Supportive Housing
•San Mateo
• Managed care- HPSM
• Committed to 120 units of housing
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Future Opportunities for Healthcare in Supportive Housing
•LA County
• DAH on steroids
• Increase in targeting
• Increase in scale
• Diversity of housing stock
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Tasks for Affordable Housing Sector
• Reach out to the providers of healthcare services
• Diversify the capital cost
• Diversify the operating costs
• Replicate to scale
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Future
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Housing as Healthcare
Joshua D. Bamberger, MD, MPHSF Dept. of Public Health & Mercy Housing
University of California, San Francisco