Cost-Benefit and Utilization Evaluation of Onsite Medical Services in Supportive Housing for the Chronically Homeless

Executive Summary Background and Significance Chronic homelessness is associated with increased public expenditures and utilization of hospital services (National Alliance to End Homelessness, 2019). In 2017 there were more than 2,000 chronically homeless individuals in the Seattle area. Chronically homeless individuals report high prevalence of alcohol and/or substance abuse and mental illness and 38% indicate that one or both is responsible for their homelessness(Applied Survey Research, 2019). Chronically homeless people with mental health and/or substance abuse illnesses are often unsuccessful in traditional housing programs due to requirements such as abstinence from substances and participation in treatment (National Alliance to End Homelessness, 2019). Due to these unique circumstances and challenges, chronically homeless individuals require carefully tailored programs to assist residents to successfully exit homelessness. Supportive housing programs (SHPs) are effective in reducing public expenditure by providing stable housing with services such as social support, case management, and medical care (Lim et al., 2018). However, there is little consensus on which model of supportive housing is most cost-effective in improving health outcomes for chronically homeless individuals while reducing public expenditures. Problem and Purpose Statements SHPs vary in design and onsite medical care is a newer addition to the traditional services of supportive housing programs. The hospital program responsible for operating onsite medical services in the supportive housing programs lacked evaluation of onsite medical care and the role of these services in reducing costs and utilization of hospital services. This project detailed hospital utilization patterns of supportive housing residents and provided a cost-benefit analysis comparing operational costs with charges associated with hospital utilization of the residents of two supportive housing facilities with onsite medical services. An evaluation of the efficacy and value of onsite medical services was needed to inform design and allocation of funds for current and future SHPs, impact public and organizational policy, and provide recommendations for expanded evaluation of onsite medical services in SHPs. Results/outcomes Hospital charges of supportive housing residents from 12 months before move-in compared to 12 months after move-in revealed a reduction of $11,096,000.00. After subtraction of the cost of onsite medical services, there remained a savings of $10,826,010.00 – nearly a 58% reduction. Emergency department visits declined by 30%, number of hospitalizations dropped by 47%, and lengths of hospital stay were shortened by 61%. These results demonstrate that SHPs with onsite medical services provide significant savings of public funds, relief to overburdened emergency departments, and prevent lengthy hospital stays. The evaluation results garnered interest from multiple stakeholders for expanded evaluation of supportive housing programs. Discussion with an individual stakeholder resulted in an anticipated future collaboration to complete a comparison of supportive housing programs with and without onsite medical services to better understand the value of these services to save public funds. Sustainability Next steps include a comparison of supportive housing programs with different levels of onsite services. Further evaluation should be expanded to include other benefits of supportive housing, such as reduced emergency medical and law enforcement encounters to more fully understand the savings to the public and the improvement of supportive housing resident’s lives. It is also recommended to consider a multidisciplinary team approach for future evaluation projects Implications Given the efficacy of SHPs to address public health issues, leaders should support rigorous evaluations to fully capture benefits. Increased knowledge of the value of onsite medical and other services of supportive housing is imperative in designing current and future programs, as well as informing policies regarding fund allocation. This project demonstrates the role of APRNs to drive change at organizational and governmental levels. References Applied Survey Research. (2019). Seattle/King County Point-In-Time Count Of Persons Experiencing Homelessness. www.appliedsurveyresearch.org Lim, S., Gao, Q., Stazesky, E., Singh, T. P., Harris, T. G., & Seligson, A. L. (2018). Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness. https://doi.org/10.1186/s12913-017-2816-9. National Alliance to End Homelessness. (2019). https://endhomelessness.org/homelessness-in-america/who-experiences-homelessness/chronically-homeless