In a perfect world, a hospital discharge is followed by restful, healing convalescence at home. But not everyone has that option. The truth is an alarming number of patients cannot be safely released from hospital care … because they lack a home or decent conditions at home to return to.
The causes are many: homelessness, lack of affordable housing or poor housing conditions, dementia, substance misuse and a range of reasons in between. As a matter of compassion and doing the best to support the health of patients, caregivers cannot release patients to the conditions that make them sick. Yet the expense of keeping people long past an appropriate stay has forced already-stretched hospital budgets to absorb the costs, not to mention tying up precious bed space. The bottom line: Housing instability is a significant driver of higher health care costs, poor outcomes and poor health overall.
When facing serious challenges, however, hospitals and health systems have a long tradition of answering with innovative and effective solutions. Rather than build new offices or a wing with more beds, hospitals in cities including Denver, Baltimore, St. Louis and Sacramento are starting to invest in housing — often in community partnerships — to control costs while ensuring that discharged patients have a safe and clean place to sleep each night.
"Hospitals investing in real estate may be surprising at first, but its implications for improved patient care are compelling."
For example, Denver Health, a safety-net hospital that cares for a large number of people who are not insured or under-insured, is working to convert a closed building on its campus into affordable housing. This growing trend not only better serves the health of patients and families, but also supports value-based care by reducing the demand for emergency room access.
Hospitals investing in real estate may be surprising at first, but its implications for improved patient care are compelling. Consider: The average life expectancy for a person without stable housing is 27.3 years less than the average housed person. Patients lacking stable housing are far more likely to suffer from such conditions as asthma, low weight, developmental delays and an increased lifetime risk of depression. They also are far more likely to overuse ED services, significantly driving up costs for care providers. So investing in housing is a win-win for vulnerable patients and the hospitals and health systems that care for them.
The growing role of hospitals in addressing the housing instability problem takes time, resources, partnerships and money. But progress is underway. Hospital and community alliances are being formed. And new solutions are being tested.
In collaboration with fellow organizations in health care, as well as other fields, the AHA has taken a leading role in encouraging and fostering new hospital-community partnerships that lead to an increase in safe and affordable housing.
For example, in collaboration with NORC at the University of Chicago, AHA helps evaluate investments in affordable housing by hospitals and health systems in their communities to improve the health of the population. This initiative is led by the Center for Community Investment and funded by the Robert Wood Johnson Foundation.
For their part, hospitals and communities nationwide are creating some innovative and highly-successful examples to assess.
- Hospitals and health systems in Missouri, Georgia and New Mexico are piloting model housing projects that provide on-site, wraparound services that support residents’ mental, physical and economic well-being.
- 14 large national and regional health systems recently announced over $700 million in investments to address health, housing and economic inequities through community wealth building.
- Kaiser Permanente invested more than $2.8 billion in just one year to support and respond to community-health needs. That includes $200 million for fighting homelessness and building affordable housing in eight states and the District of Columbia.
- University of Illinois Hospital & Health Sciences System partnered with the Center for Housing and Health in Chicago to provide stable housing and supportive services to homeless people through the Better Health through Housing (BHH) program. The system saw a 42% drop in participants’ health care costs almost immediately. In addition, among BHH participants, inpatient stays declined 57%, and ED utilization decreased 67%.
There are many such partnerships underway and more to come. You can find more examples and work in progress on the AHA Center for Health Innovation section of AHA.org, including the Hospital Community Cooperative and Population Health: Community Health & Well-being pages.
Hospitals are listening, learning and collaborating to make a positive difference. These exciting efforts will help ensure than when a discharged patient exits the hospital door, he or she can quickly step through another: to a safe, stable and welcoming home.
Jay Bhatt, D.O., is senior vice president and chief medical officer for the American Hospital Association.