The Source forHousing Solutions

NASCSP Conference

Charlene M. FlahertyDirector, SouthwestSeptember 11, 2013

Our Mission

Improve lives of vulnerable

people

Maximize public

resources

Build strong, healthy

communities

Advancing housing solutions that:

Building Strong, Healthy Communities

Locations where CSH has staff stationed

Locations where CSH has helped build strong communities

High Utilization of Hospitals & EDs

A subset of individuals are caught on a revolving door of emergency department visits, inpatient hospitalizations, and use of other crisis health services

These individuals typically have complex needs, with multiple co-occurring chronic conditions and social challenges including extreme poverty, limited social supports, and homelessness

Failing to address the needs of these individuals not only contributes to their worsening health status, but also poor use of public and institutional resources

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A Small Number of Very High Risk Homeless Persons

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Probation

Sheriff mental healthjail

Sheriff medical jail

Sheriff general jail

LAHSA homelessservices

GR HousingVouchers

General Relief

Food Stamps

Paramedics

Public Health

Mental Health

Private hospitals-ER

Health Srv - ER

Health Srvoutpatient clinic

Private hospitals-inpatient

Health Srv hospital-inpatient

•The most expensive 10% of homeless persons have average monthly costs $6,529

•LA County linked service and cost records across county departments for a representative sample of recipients to produce this exceptionally valuable data

Source: 2,907 homeless recipients in LA County with DHS ER or inpatient records Deciles based on costs in all months

Housing Instability Contributes to Frequent ED Use

Growing understanding of role that homelessness and housing instability plays in contributing to frequent use

“The recognition of the complex care needs and fragile social circumstances of these especially high-need patients has stimulated fresh thinking about aggressive outreach, intense coordination of services by integrated care teams, and the need for nonmedical resources such as supportive housing, all of which could likely help curb the cost of health care.” – M. Raven and D. Gould

Housing Is Health Care

Impacts on Health Denver study found 50% of

tenants placed into SH experienced improved health, 43% had improved mental health outcomes, and 15% reduced substance use

Seattle study found 30% reduction in alcohol use among chronic alcohol users in supportive housing

SH in San Francisco and Chicago had higher survival rates for persons with HIV/AIDS compared to control groups

Impact on Health Costs

• 24% to 34% fewer emergency room visits

• 27% to 29% fewer inpatient admissions and hospital days

• 87% fewer days in detox and fewer psychiatric inpatient admissions

• 41% to 67% decrease in Medicaid costs

Supportive Housing Solution

Communities across the country are pursuing initiatives that use supportive housing to reduce ED and hospital use among frequent users Using data matches to identify homeless

frequent users Assertive outreach and recruitment in crisis

health settings Stronger links to coordinated, patient-centered

healthcare

What is Supportive Housing?

Supportive housing is permanent,

affordable housing combined with

a range of supportive services that help

people with special needs

live stable and independent lives

Characteristics of Supportive Housing

HOUSING PERMANENT: Not time limited,

not transitional AFFORDABLE: For people

coming out of homelessness INDEPENDENT: Tenant holds

lease with normal rights and responsibilities.

SERVICES FLEXIBLE: Designed to be

responsive to tenants’ needs VOLUNTARY: Participation is

not a condition of tenancy INDEPENDENT: Focus of

services is on maintaining housing stability.

Who Lives in Supportive Housing?

Long-term homeless Veterans Domestic violence

victims Unaccompanied Youth People with mental

illness and/or chemical dependency

People coming home from correctional facilities, treatment, jail, hospitals, detox

HUD Focus on Performance

HUD Continuum of Care on Homelessness/ HEARTH Outcomes Reduce new episodes of homelessness Reduce length of homeless episodes Reduce returns to homelessness(Note: CoC includes ALL homeless programs including those not funded by Continuum of Care)

Coordinated Assessment and Entry Rapid Rehousing Permanent Housing

Common Ground – Housing & Health

High Cost Health Care

Utilizers

High Cost At-Risk/

Homeless

Supportive Housing

SJHMC FUSE Pilot

15 Frequent and high cost utilizers of SJHMC ER

Chronically homeless individuals Long-term homeless Disability

Care Navigator/Case Manager Permanent Supportive Housing Evaluation

SJHMC FUSE Pilot

Dignity Health/St. Joseph’s Hospital and Medical Center

Corporation for Supportive Housing Circle the City Medical Respite Native American Connections Arizona Housing Inc. Arizona Behavioral Health Corporation Native American Community Health Center Valley of the Sun United Way St. Luke’s Health Initiative

Success Story – “Mr. 280”

280 visits to SJHMC ER Traumatic Brain Injury and seizures Chronically homeless Criminal history History of failed housing attempts

Success Story – “Mr. 280”

Seizures under control Housed at 209 W. Jackson Employed No additional ER visits Reconnected with family

Stakeholders & Community Partners

HUD Continuum of Care Hospitals Public Housing Authorities State Department of Housing Local Government Homeless Housing and Service

Providers United Way CAP Agencies

Considerations/Questions

What are my organization/clients needs? How do our goals align with the goals of the

ACA? Are we engaged in the discussion and

decision making processes in our community?

Are we open to realigning our priorities and resource allocation to participate in initiatives?

What resources do we have to bring to the table?

Charlene FlahertyDirector, Southwest480-203.8131Charlene.flaherty@csh.org