Amid a housing crisis, hospitals offer a dose of relief

From providing life-saving surgeries to diagnostic testing and lab work, hospitals work relentlessly to protect the health and well-being of everyone, including society’s most vulnerable members like those experiencing homelessness. But what happens in the hospital, oftentimes stays in the hospital. And for individuals without a stable home, managing their health conditions outside of a medical setting can be difficult. So hospitals are adding a new line of care to their services: housing the unhoused. 

Over the last decade, more medical facilities have tapped into the housing market as they recognize that a lack of secure housing contributes to poor health outcomes and higher spending for hospitals and state and local governments, said Barbara DiPietro, senior director of policy at the National Health Care for the Homeless Council. A 2020 study found, for instance, that Medicaid spending on individuals enrolled in the Boston Health Care for the Homeless Program averaged $18,764 per person per year compared with $7,561 for those who were not enrolled, according to claims data. 

It’s not just the current population of unhoused individuals that should concern policymakers and health care providers. DiPietro pointed to the fact that 1 in 4 households that qualify for housing assistance do not receive the aid they need. That leaves about 75% of families with an unmet need—and an increased risk of homelessness—as housing costs continue to swiftly outpace residents’ income. Individuals experiencing homelessness, for instance, are at a higher risk of health complications but often lack the capacity to manage their health. 

“That’s why we see a lot of hospital admissions, readmissions and longer lengths of stay for people who are homeless who’ve got chronic illnesses. It’s hard to maintain hypertension, asthma and all of that when you’re living on the street,” DiPietro said. “[I]f the community is in a healthier space, then that presumably helps the hospital itself in terms of the number and rates of admissions and the health care status of the people that they're responsible for caring for.” 

To get ahead of gaps in housing and health care access, health care providers are stepping in to offer housing and housing-related services for vulnerable populations. 

One such effort is the Housing for Health program operated by the Bon Secours Mercy Health System in Maryland. Under the program, the system manages more than 800 affordable housing units for low-income families, individuals with disabilities and aging adults across West Baltimore. Tenants have access to wireless internet, a gym, in-unit washers and dryers, and a produce delivery service. The program also links residents with service coordinators to help them schedule medical appointments, apply for public benefits and seek preventative care like health screenings, among other wraparound services.

In 2018, the Bon Secours Mercy Health System invested an additional $5.7 million into Housing for Health to support its operations, and a 2021 report found the hospital system’s efforts were paying off. Researchers said for every dollar that went toward the operating expense, the program yielded a social return on investment of up to $1.92 due to factors like reduced hospitalizations and better medication management among patients. 

In Colorado, a partnership between the Denver Health Medical Center and the Denver Housing Authority to convert a medical office building into 110 affordable housing units began accepting its first few residents late last year. Ninety-six of the apartments will house adults aged 55 or older and residents with disabilities, and the other 14 will serve as transitional housing for unhoused patients leaving the hospital. The complex will include an onsite health and wellness program to help residents find long-term housing solutions. 

“Hospitals are really positioned as strong partners in any community to be the thought leaders on what health and health care looks like in a community," DiPietro said. But that role is threatened, particularly as hospitals across the country are facing increasing financial pressure due to workforce shortages, decreased funding from governments and the rise of private equity.

Policymakers, particularly at the state level, must consider how to support medical systems’ housing efforts, she said. State lawmakers could, for instance, pass policies that address medical debt and how it impacts residents’ credit scores given that medical debt and poor health remains one of the leading causes of homelessness. 

It’s also crucial for states to remove barriers to accessing health care coverage, such as increasing the types of insurance plans offered in insurance marketplaces. When it comes to insurance, DiPietro said Medicaid expansion is a “fundamental” way to increase individuals’ access to quality care, but 10 states have yet to do it. 

While hospitals are able to support increased housing supply and availability in communities, “states are in the driver’s seat … and need to own their role in [mitigating] these problems,” DiPietro said.