Tony Price frequently visited the emergency department (ED) at Sacramento, Calif.-based Dignity Health while he was living on the streets. At that time, his diabetes was out of control and he drank heavily.
His life didn’t begin to turn around until he tried to commit suicide and spent a week recovering at Dignity Health nearly three years ago. He qualified for services offered by the then-fledgling “Housing with Dignity” program, which put him into a one-bedroom apartment. Housing with Dignity later helped him move into an apartment in a federally funded permanent housing program.
“I definitely would be dead by now” without Housing with Dignity, the 50-year-old Price says. He says stable housing put him on the path to sobriety. His diabetes is under control and he has been to the hospital only once since he enrolled in the program.
“I don’t need to be in survival mode,” he says.
“Housing with Dignity” is a partnership of Dignity Health and Lutheran Social Services (LSS) of Northern California, a provider of supportive housing services. The partnership believes the best prescription for a chronically homeless patient, like Price, is permanent supportive housing.
The program is designed to give chronically homeless patients the stability they need to achieve better health. These are patients who have been homeless for at least a year and live in spaces deemed unfit for habitation.
Dignity Health and LSS launched the program on a modest scale in 2014. They placed five formerly homeless patients in one-bedroom apartments in a complex near LSS’ North Sacramento office. Today, the program provides temporary housing for up to six months for 12 clients at any given time, and helps them become eligible for permanent housing.
“Stable housing plays a critical role in a person’s health and well-being,” says Ashley Brand, Dignity Health’s director of community health and outreach. The health system reached out to LSS to create the program, because “we needed to find a better way to care for this highly vulnerable population and there was no better partner in the community in understanding this population than LSS.”
The program is patterned on the “Housing First” policy endorsed by the Department of Housing and Urban Development in 2002. Under the Housing First model, residents are given regular leases without their housing hinging on attending therapy or other conditions.
With an estimated 3,600 homeless residents in Sacramento, Housing with Dignity can’t address the magnitude of the problem on its own. But its partners want to show that providing free housing – even when clients are under no obligation to stay sober or find a job – will improve their health so much that they will be less of a burden on the health care system and society.
“Housing is good medicine,” says Kate Hutchinson, LSS deputy director in Sacramento. “Just the fact of having a roof over their heads, a warm place to sleep and knowing they have a place to go seems to be the most effective medicine.”
Dignity Health refers patients to the program. They are typically so-called “super users” of hospital services or those struggling with chronic disabilities, like substance use disorders. The program’s goal is to find permanent housing for its clients, reduce hospitalizations and help them get the wraparound social services they need to help achieve a better quality of life and long-term stability.
Dignity Health provides financial support for the apartments, with assistance from Medicaid insurer Health Net. LSS coordinates clients’ case management and supportive services. That can include teaching clients about eating and cooking healthier foods, helping them with transportation to a doctor’s appointment or picking up medications from the pharmacist, and connecting them to community resources.
Staff work with clients on issues like effective budgeting, anger management, cooking, nutrition and problem solving, says LSS Executive Director Carol Roberts. “We look at the social determinants of health,” she says. “Our goal is to make people house healthy.”
Roberts says clients who enroll in the program eventually find and maintain permanent housing. “We have amazing stories of transformation,” she says. “We meet people where they are and walk with them to where they would like to be going, and help them build a foundation for a new life.”
Roberts and Hutchinson credit Dignity Health for addressing the social determinants of health and treating chronic homelessness much like it would treat a chronic illness.
“We have the same goals and this is one of the best ways we can invest in the community,” Roberts says.
Hutchinson adds that housing for the homeless makes sense when you factor in the costs of attending to chronically homeless residents at places like hospitals, psychiatric facilities, food pantries, shelters and jails. “Put together housing and wraparound services, and hospitals will see amazing results in terms of decreasing these patients’ hospital utilization,” she says. “It is not complicated stuff, but it makes a difference.”
The results are impressive. Dignity Health’s hospitalization and ED use for clients enrolled in Housing with Dignity have dropped by 52% and 55%, respectively. But Dignity Health’s Brand points out that the biggest reward is seeing the transformation in the lives of the health system’s onetime chronically homeless patients.
“Knowing where they came from and knowing they were ready for this step, and then seeing the outcome is something you can’t quantify,” she says.