Permanent Supportive Housing Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness (2018) / Chapter Skim
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3 Evidence of Effect of Permanent Supportive Housing on Health
3 Evidence of Effect of Permanent Supportive Housing on Health
Pages 38-57
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From page 38... ...
. The leading causes of death for individuals experiencing homelessness are drug overdoses, HIV, and common chronic diseases such as heart disease and cancer, as was found in retrospective data from more than 28,000 adults experiencing homelessness in Boston (Baggett et al., 2013)
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From page 39... ...
. Thus, evidence is presented on the degree to which PSH increases the likelihood of individuals experiencing chronic homelessness remaining housed; increases or decreases health care utilization; and affects physical health, mental 3Gray literature is "the unpublished, non-commercial, hard-to-find information that organizations such as professional associations, research institutes, think tanks, and government departments produce" (University of Michigan Library, 2018)
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From page 40... ...
EVIDENCE OF THE IMPACT OF PERMANENT SUPPORTIVE HOUSING FOR HEALTH OUTCOMES Sustained Housing Permanent supportive housing can decrease the harms of homelessness only to the extent that people stay housed. Several studies have demonstrated that individuals experiencing homelessness who are also chronically ill who are randomized to PSH spend significantly fewer days homeless than those who receive usual care.
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Health Care Utilization Individuals experiencing chronic homelessness are often frequent users of health care services, including high-cost services. They may have longer hospital stays or be infrequent users of primary care services (Martin, 2015; Bowen, 2016)
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From page 42... ...
However, as expected by the authors, the intervention group had higher costs in outpatient visits, housing, and case management when compared to the control group. In the original experimental evaluation of the Pathways Housing First program in New York, 225 individuals experiencing both chronic homelessness and mental illnesses were randomized to Housing First or to usual care.
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From page 43... ...
. This study, using retrospective survey responses and Medicaid administrative claims data, showed that placing individuals experiencing homelessness and high medical costs into supportive housing significantly reduced Medicaid expenditures for inpatient hospital and emergency department services for physical health issues, with an average annual reduction
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. Impact on Physical Health Outcomes Reductions in the use of ambulance transport, emergency department use, and hospitalization are important but imprecise process indicators of the impact of PSH on the health of individuals experiencing chronic homelessness.
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From page 45... ...
on individuals experiencing homelessness and living with HIV/AIDS in Chicago. In this study, which is a subsample of the larger Chicago Housing for Health Partnership (CHHP)
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In a subsample of 676 individuals living with HIV who were also experiencing homelessness, 49 case-controlled pairs were analyzed. Of the individuals experiencing homelessness, 67 percent survived 5 years compared with 81 percent of those who received supportive housing.
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improves health to individuals experiencing outcomes for people homelessness and living with living with HIV and HIV/AIDS in Chicago. experiencing homelessness, based on improved health measures related to mortality, immunity, and viral load.
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From page 48... ...
and the usual care group on a number of secondary variables. Impact on Mental Health Outcomes and Substance Abuse Multiple surveys of people experiencing chronic homelessness indicate that the prevalence of serious mental health conditions is much higher than in the general population (Aubry et al., 2015)
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From page 49... ...
In a previously described study in New York City, mentally ill, substanceusing individuals experiencing homelessness were assigned to two conditions, a Pathways Housing First 9 program and an approach where receipt of housing was contingent on treatment and sobriety (Tsemberis et al., 2004)
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More research will be needed to elucidate the role of permanent supportive housing on mental health and substance abuse outcomes. Impact on General Well-Being Along with physical and mental health, social well-being is a component of the WHO (1946)
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Social integration was a factor derived from measures of social support and the number of social ties from one's neighborhood. Data from randomized controlled trials of the Pathways Housing First model therefore provide some evidence of improvements in social integration and several specific domains of quality of life.
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An observational study examined individuals experiencing chronic homelessness also with serious mental illness who received permanent supportive housing across 11 U.S. sites.
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Yet randomized studies of individuals experiencing homelessness along with mental illness and/or substance abuse did not show statistically significant health benefits between the housed group and the usual-care group, except in the area of well-being. To better understand how and why providers believed PSH was a factor in improving health in this population, the committee examined the concept of medical necessity.
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. CMS states that under this reinterpretation, the agency would "allow supplemental benefits if they are used to diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization." This expansion of benefits signals a move in the agency's thinking toward a more integrative approach to covering services beyond those traditionally held as health-related, which could include housing.
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From page 55... ...
. Health care providers for individuals experiencing homelessness have often used the concept of medical necessity broadly and creatively, to include, for example, the provision of housing as a medical necessity for their patients experiencing homelessness (Wilkins et al., 2014)
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The evidence of the impact of housing on HIV/AIDS in individuals experiencing chronic homelessness may serve as a basis for more fully examining this concept.
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From page 57... ...
Studies also should be undertaken to clarify linkages between the provision of both permanent housing and supportive services and specific health outcomes. Recommendation 3-2: The Department of Health and Human Services, in collaboration with the Department of Housing and Urban Develop ment, should call for and support a convening of subject-matter experts to assess how research and policy could be used to facilitate access to permanent supportive housing and ensure the availability of needed support services, as well as facilitate access to health care services.
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