Housing Is Healthcare:
Improving Health Outcomes
for Homeless People Living
with HIV/AIDS
Laura Grund
New York State Supportive Housing Conference
June 9, 2011
Overview of Presentation
Presentation Overview
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Harlem United
Housing= HIV/AIDS Healthcare
Foundation House West
NY/NY III
Client Profile
Questions
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Harlem United
• “One-stop shop” with integrated medical, housing,
prevention, and supportive services for PLWHA
• Our mission: to provide 100% access to care and to obtain
zero disparity in health outcomes caused by socioeconomic
barriers
• 558 units of housing for adults and families living with
HIV/AIDS (plus HIV primary medical and dental care [FQHCs],
psychiatry, mental health, substance use, adult day health
care, intensive case management, Voc Ed employment
services and prevention services)
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HOUSING = HIV HEALTHCARE
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Studies show strong correlations between improved housing status and…
– Reduction in HIV/AIDS risk behaviors
– Access to education and prevention
– Improved health outcomes
– Savings in taxpayer dollars
• Reduced utilization of emergency & inpatient services, lower overhead
costs compared to shelters and other emergency housing services
• Savings have been found to offset up to 95% of the cost of supportive
housing (findings from “National Housing & HIV/AIDS Research Summit
Series” – The Johns Hopkins Bloomberg School of Public Health)
•
Harm reduction-based housing services increase routine utilization of medical
care, improve medication adherence and health outcomes, and increase rates of
employment among our clients
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Foundation House West
• 25 congregate units, single adults living
with HIV/AIDS, histories of homelessness,
chronic health diagnoses
• Program mission: to assist residents in
attaining personal medical and housing
stability and independent living skills
• Supportive case management; life skills
services; vocational, employment and
educational services; primary medical and
home care referrals; entitlement
assistance and advocacy; substance use
assessment and Harm Reduction
education and counseling; mental health
assessment and counseling; etc
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Demographics of FHW
Demographics:
Residents are predominantly male (88% male; 12% female)
African American (63%); 33% Latin, and 4% white
Median age of 46.3
All residents are triply-diagnosed with a history of substance
use, 85% with a psychiatric diagnosis, 90% with another nonHIV related co-morbid condition such as diabetes, asthma,
heart or lung disease
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Hospital Utilization, Foundation House West
Hospital Utilization
Prior to and After Placement at Foundation House West
70%
60%
50%
40%
63%
54%
46%
42%
30%
20%
10%
0%
ER V isit s 6 M o nt hs
Pio r t o Placement
ER V isit s 6 M o nt hs
af t er Placement
Ho sp it aliz at io ns 6
M o nt hs Prio r t o
Placement
Ho sp it aliz at io ns 6
M o nt hs af t er Placement
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Hospital Utilization, Foundation House West
Number of ER Visits
Frequency of ER Visits
Prior to and After Placement
7
6
5
4
3
2
1
0
5.87
1.46
Number of visits to the ER 6 Months Prior to
Placement
Number of visits to the ER 6 Months After
Placement
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Cost Benefit Analysis of Foundation House West
The cost benefit of supportive housing for PLWH/A has been
demonstrated by the decreased dependence and need for
inpatient hospital care.
Likewise, the decrease in FHW clients’ frequency of inpatient
hospitalizations yielded overwhelming savings in
comparison to the overall cost of this congregate program.
Cost
Cost Benefit
Benefit of
of
Supportive
Housing
Supportive Housing
Cost
Cost of
of
Hospitaliza
Hospitaliza
tion
tion
Per
Day
Per Day
Cost
Cost of
of
Hospitalizations
Hospitalizations
Six
Six Months
Months Prior
Prior
to
Placement
to Placement at
at
FHW
FHW
Cost
Cost of
of
Hospitalizations
Hospitalizations
Six
Six Months
Months After
After
to
Placement
to Placement at
at
FHW
FHW
Saving
Saving
offered
offered by
by
Harlem
Harlem
United
United FHW
FHW
Estimated
Cost
Estimated Cost
$775
$775
$28,520
$28,520
$5,277
$5,277
$23,242
$23,242
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FHW
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NY/NY III Scattered Site Housing
• 70 units of housing coupled with supportive services to chronically
homeless single adults who are living with HIV/AIDS and cooccurring serious mental illness, substance use, or both
• NY/NY III works with residents to stay healthy using a multidisciplinary team approach. The team includes Case Managers, a
Nurse, a Vocational/Educational Specialist, and a Mental Health
Specialist. All members of the team provide services to residents
within their homes or in other community settings at least twice a
month
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NY/NY III Population Overview
Demographics:
Gender:
69% Male
24% Female
7% Transgender
Race:
66% Black/African
American
19% White
1% American Indian/Alaska
Native
1% Multi-racial
13% unknown
Ethnicity:
27% Latino/a
Gender
Male
Female
Transgender
Race
Black/African American
White
American Indian
Multi-racial
Unknown
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NY/NY III
Services include medical monitoring and medication adherence; mental
health counseling and referral; substance use counseling and referral;
life skills training including vocational, employment and educational
services; apartment care and maintenance ; advocacy and case
management; linking/referrals for legal assistance and other
entitlements; escorts to medical, mental health, entitlements, and all
other appointments; etc
Utilizes multi-disciplinary model
that incorporates aspects of an
ACT team
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NY/NY III
70% of clients classified as high risk and have some other serious illness or
diagnosis; more than half (55%) present multiple risk factors requiring
increasingly individualized multidisciplinary HIV/AIDS services
Classification of High Risk Due to One or More of the Following
n=150
16%
Multiple Factors
8%
Med-Psych
31%
Med-Behavioral Substance
7%
Psychiatric Illness
16%
Behavioral SubstanceIssue
22%
Medical Status
0%
5%
10%
15%
20%
25%
30%
35%
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NY/NY III
Substance Use & Adherence to Mental Health Treatment
Comparison Between High and Low Risk Clients
n=216
60%
50%
40%
30%
20%
10%
0%
50%
38%
27%
Substance Use
Not in care for MH Issue
19%
10%
1%
% of High Risk % of Low Risk
Clients
Clients
% of total
Sample
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Hospital Utilization, NY/NYIII Clients
Assessment of NY/NYIII
Utilization
Emergency Room Visits (n=64)
 Average # of visits
 ER visits resulting in
hospitalization
Hospitalizations (n=64)
 Frequency of hospitalization
 Average length of stay
Six Months Prior Six Months
to Move-in
After
Placement
42%
27%
1.81 visits
1.12 visits
48%
53%
38%
25%
1.67
1.33
hospitalizations 7.13 days
9.42 days
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[1]
Cost of emergency room visits $832 hospital stay $1,891.
Source of Emergency Room Cost based 2003 cost data from Medical Expenditures Panel Survey. Research and Quality January 2006.
Source of Hospitalization Cost based on 2007 numbers from Agency for Healthc
[2] ER Cost $832 x 49 ER visits = $40,768. Hospital $1891 x 226 days spend hospitalized = $427,366
[3] ER Cost $832 x 19 ER visits = $15,808 Hospital $1891 x 114 days spend hospitalized = $215,547
[4] Unit of Analysis is the total number of emergency room visits and the total number of days spent in the hospital prior to and then after program intervention.
Analysis of NY/NY III
Cost Benefit of A. Cost of Hospital B. Cost of Hospital
NY/NYIII
Visits Six Months
Visits Six Months
Prior to Placement After to Placement
(ER Visits + Days in (ER Visits + Days in
Hospital)
Hospital)
Estimated Cost $468,134
$231,355
C. Saving in
reduced
Hospital Visits
by Program
(Column A-B)
$236,779
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Client Profile
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CH was referred to HU Supportive Housing in July 2010 by his Case Manager at
HU’s Adult Day Health Care West due to inadequate housing.
At the time of intake, CH was four months sober and focused on remaining sober,
returning to the work force and improving his relationship with his 12 year old
daughter.
CH was housed in September 2010 and immediately began to seek employment.
Although the client is legally blind and uses a walking stick, he obtained full time
employment as a Service Coordinator at a non-profit organization working with
individuals with a history of substance use and homelessness. The client has a
current goal of working towards his CASAC.
Since obtaining his own apartment, the client has been able to take advantage of
every other weekend visits with his daughter and have a home he feels comfortable
sharing with her. He remains sober and says he is very happy with his job and looks
forward to a future of employment and greater independence.
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Policy Implications
Take Aways…
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Supportive Housing for PLWHA is Healthcare -- increases
access to medical care, decreases acute care, improves
health
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Supportive housing as form of Prevention for those at risk
(HIV negative, unstably housed); homelessness/eviction
prevention
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HU housing clients healthier, leading full and productive
lives; emphasis on employment and ultimately moving on
from supportive housing
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Contact Information
Questions?
Laura Grund
Vice President of Supportive Housing
HIV/AIDS Treatment Support Services
Harlem United Community AIDS Center, Inc.
306 Lenox Avenue, 3rd floor
New York, NY 10027
(212) 803-2850
lgrund@harlemunited.org
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