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Housing as Healthcare

Housing as Healthcare. Joshua D. Bamberger, MD, MPH Josh.bamberger@sfdph.org San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine. SF Health Dept’s Housing. Direct Access to Housing- 1500 units in 33 buildings

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Housing as Healthcare

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  1. Housing as Healthcare Joshua D. Bamberger, MD, MPH Josh.bamberger@sfdph.org San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine

  2. SF Health Dept’s Housing • Direct Access to Housing- 1500 units in 33 buildings • Tailor housing to needs of individual • Initially SRO, now new buildings • Priority to people with multiple disabilities • 93% with Axis I mental illness • At least 18% HIV+

  3. Referring to DAH • Must have longitudinal professional relationship • Clinical Referral Form • Prioritized to house highest users • Match services to need • 50% of income towards rent- 3rd party payee • Greater demand than supply • 25 new applicants/wk • 20 vacancies/month • 700 people in wait pool • Wait times unpredictable

  4. DAH Portfolio

  5. The more beautiful the housing the better the outcome

  6. The more beautiful the housing the better the outcome- Windsor

  7. The more beautiful the housing the better the outcome- Plaza

  8. The more beautiful the housing the better the outcome- Mission Creek

  9. The more beautiful the housing the better the outcome- Richardson

  10. The more beautiful the housing the better the outcome- Kelly Cullen Community

  11. The more beautiful the housing the better the outcome- Kelly Cullen Community

  12. The more beautiful the housing the better the outcome- Kelly Cullen Community

  13. Plaza High Utilizer Study • 106 Chronically homeless adults • Cost year before housing: $3,132,856 • Cost year after housing: $906,228 • Reduction in healthcare costs: $2,226,568 • Cost of program: $1.1million/year • Reduction in public cost in first year: $1.1 million • More than 90% of reductionamong 15 tenants who cost more than $50,000/year prior to being housed

  14. EvaluationQuality of Housing and Outcome • Ranking of housing from worst to best housing • Private bath better than shared bath • New building better than renovated • Nursing better than no nursing • Senior better than non-senior

  15. The more beautiful the housing the better the outcome

  16. Homelessness in US • NYC: 90,000 in locked institutions in1955 • Homeless advocates focused on economic conditions, not illness • Episodic vs. Chronically homeless • Timing of offering PSH? • Impact of trauma

  17. Population Snapshot

  18. Veteran PIT Counts, 2009-2012 * * CoCs only required to conduct a new count of unsheltered homelessness in odd numbered years; in 2012, only 32% of CoCs opted not to do a new unsheltered count, providing an incomplete picture of trends in the number of unsheltered homeless Veterans Source: PIT data, 2009 - 2012

  19. Number of Homeless Veterans in 5 Communities with Greater than 40% reduction 2010-2012

  20. Common aspects of “positive outliers” • Common values and philosophy of practice, strong leadership, housing first • Targeting • High level of communication (HIPPA busters) • Use of data to inform policy and measure success

  21. Common aspects of “positive outliers” • Common values and philosophy of practice, strong leadership, housing first • Targeting • High level of communication (HIPPA busters) • Use of data to inform policy and measure success

  22. Next steps in movement • Overcoming “wrong pocket” problem • Proving value of supportive housing • Moving forward from data to expansion • Replicating positive outliers in non-VA populations

  23. Housing as Healthcare Joshua D. Bamberger, MD, MPH Josh.bamberger@sfdph.org San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine

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