HOUSING AS HEALTHCARE Joshua D. Bamberger, MD, MPH [email protected] San Francisco Department...
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HOUSING AS HEALTHCARE Joshua D. Bamberger, MD, MPH [email protected] San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine
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Transcript of HOUSING AS HEALTHCARE Joshua D. Bamberger, MD, MPH [email protected] San Francisco Department...
HOUSING AS HEALTHCARE
Joshua D. Bamberger, MD, MPH
San Francisco Department of Public Health
University of California, San Francisco, Dept. of Family and Community Medicine
Direct Access to Housing- 1500 units in 33 buildingsTailor housing to needs of individual
Initially SRO, now new buildingsPriority to people with multiple disabilities93% with Axis I mental illnessAt least 18% HIV+
SF Health Dept’s Housing
Must have longitudinal professional relationshipClinical Referral FormPrioritized to house highest usersMatch services to need50% of income towards rent- 3rd party payeeGreater demand than supply
25 new applicants/wk20 vacancies/month700 people in wait pool
Wait times unpredictable
Referring to DAH
DAH Portfolio
•
253 286604 678 704 704
8780 0
177 247 339
689
0200
400600
8001000
12001400
16001800
99-00 2001-2 2003-4 2005-6 2007-8 2009-10
2011-2015
NewMaster-lease
The more beautiful the housing the better the outcome
The more beautiful the housing the better the outcome- Windsor
The more beautiful the housing the better the outcome- Plaza
The more beautiful the housing the better the outcome- Mission Creek
The more beautiful the housing the better the outcome- Richardson
The more beautiful the housing the better the outcome- Kelly Cullen Community
The more beautiful the housing the better the outcome- Kelly Cullen Community
The more beautiful the housing the better the outcome- Kelly Cullen Community
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 reduction
among 15 tenants who cost more than $50,000/year prior to being housed
• 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
EvaluationQuality of Housing and Outcome
Windsor Empress LeNain PBI CCR West Folsom Dore
Plaza 149 Mason
990 Polk Mission Creek
0.0
5.0
10.0
15.0
20.0
25.0
30.0
R² = 0.76418262009445
Move-out not death
Move-out not deathLinear (Move-out not death)Linear (Move-out not death)
Windsor Empress LeNain PBI CCR West Folsom Dore Plaza 149 Mason 990 Polk Mission Creek
7.6
3.5
6.8
3.9
5.3
2.7
5.0
3.5
2.5
4.0
3.1
R² = 0.388887624467414
Death by Quality of Housing%death
Death Rate/year0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Death rate Le Nain vs. Mission Creek 2006-2011
Le Nain death %
MCSC death %
The more beautiful the housing the better the outcome
NYC: 90,000 in locked institutions in1955Homeless advocates focused on economic conditions, not illness
Episodic vs. Chronically homelessTiming of offering PSH?
Impact of trauma
Homelessness in US
POPULATION SNAPSHOT
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
2009 2010 2011 2012 -
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
75,609 76,329
67,495 62,619
43,409 43,437 40,033
35,143
32,200 32,892 27,462 27,476
Total VeteransSheltered VeteransUnsheltered Veterans
Nu
mb
er
of
Ve
tera
ns
*
2010 2011 2012 2013 2014 20150
100
200
300
400
500
600
HennepinLexingtonTacomaFort WorthBirmingham
Measured
-------Projected
______
Number of Homeless Veterans in 5 Communities with Greater than 40% reduction 2010-2012
2005 2006 2007 2008 2009 2010 2011 20120
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
0.00%
0.10%
0.20%
0.30%
0.40%
0.50%
0.60%
0.70%
13,69013,362
11,970
14,375
15,525 15,642
14,351
16,522
5,5655,910
5,000
6,7857,100 7,105
6,440
7,390
1,932 1,9141,530 1,470 1,400
812 601 542
0.60%
0.52%
0.46%
0.53%
0.57%0.56%
0.52%
0.60%
Utah Homeless Point-In-Time Count: 2005-2012
Annualized Total Count Number of Persons in Families Number of Chronically Homeless Persons Total Homeless Persons as % of Total Population
Source: 2012 Annualized Utah Homeless Point-In-Time Count
2005 2006 2007 2008 2009 2010 2011 20120
500
1,000
1,500
2,000
2,500
0%
2%
4%
6%
8%
10%
12%
14%
16%
1,932
1,9141,530
1,470 1,400
812
601542
14%14%
13%
10%
9%
5%4%
3%
Utah Annualized Chronic Homeless Count: 2005-2012
Chronic Count% Chronic of Total Homeless Persons
Source: 2012 Utah Homeless Point-In-Time Count
2009 2010 2011 20120
50
100
150
200
250
300267
224
177
126
Veterans in Minneapolis/Hennepin County 2009 - 2011
total veterans
2009 2010 2011 2012
775 779
566
351
Point-in-time count for Minneapolis/Hennepin County Con-tinuum
total chronic homeless
21.8424.26
17.59
10.36
Common values and philosophy of practice, strong leadership, housing first
TargetingHigh level of communication (HIPPA busters)Use of data to inform policy and measure success
Common aspects of “positive outliers”
Common values and philosophy of practice, strong leadership, housing first
TargetingHigh level of communication (HIPPA busters)Use of data to inform policy and measure success
Common aspects of “positive outliers”
Overcoming “wrong pocket” problemProving value of supportive housingMoving forward from data to expansionReplicating positive outliers in non-VA populations
Next steps in movement
HOUSING AS HEALTHCARE
Joshua D. Bamberger, MD, MPH
San Francisco Department of Public Health
University of California, San Francisco, Dept. of Family and Community Medicine
