housing is healthcare: improving health outcomes for homeless people living with hiv/aids new york...
TRANSCRIPT
Housing Is Healthcare:
Improving Health Outcomes for
Homeless People Living with HIV/AIDS
New York State Supportive Housing ConferenceJune 9, 2011
Laura Grund
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Overview of PresentationOverview of Presentation
Presentation OverviewPresentation Overview
• Harlem United• Housing= HIV/AIDS Healthcare• Foundation House West• NY/NY III• Client Profile• Questions
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Harlem UnitedHarlem 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
• Studies show strong correlations between improved housing status Studies show strong correlations between improved housing status and…and…– Reduction in HIV/AIDS risk behaviorsReduction in HIV/AIDS risk behaviors– Access to education and preventionAccess to education and prevention– Improved health outcomesImproved health outcomes– Savings in taxpayer dollars Savings in taxpayer dollars
• Reduced utilization of emergency & inpatient services, lower Reduced utilization of emergency & inpatient services, lower overhead costs compared to shelters and other emergency overhead costs compared to shelters and other emergency housing serviceshousing services
• Savings have been found to offset up to 95% of the cost of Savings have been found to offset up to 95% of the cost of supportive housing supportive housing (findings from “National Housing & (findings from “National Housing & HIV/AIDS Research Summit Series” – The Johns Hopkins HIV/AIDS Research Summit Series” – The Johns Hopkins Bloomberg School of Public Health)Bloomberg School of Public Health)
• Harm reduction-based housing services increase routine utilization of Harm reduction-based housing services increase routine utilization of medical care, improve medication adherence and health outcomes, medical care, improve medication adherence and health outcomes, and increase rates of employment among our clientsand increase rates of employment among our clients
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Foundation House WestFoundation 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 FHWDemographics 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 non-HIV related co-morbid condition such as diabetes, asthma, heart or lung disease
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Hospital Utilization, Foundation House WestHospital Utilization, Foundation House West
54%
42%
63%
46%
0%
10%
20%
30%
40%
50%
60%
70%
ER Visits 6 MonthsPior to Placement
ER Visits 6 Monthsafter Placement
Hospitalizations 6Months Prior to
Placement
Hospitalizations 6Months after Placement
Hospital Utilization Prior to and After Placement at Foundation House West
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Hospital Utilization, Foundation House WestHospital Utilization, Foundation House West
Days Spend in the Hospital Prior to and After Placement at FHW
36.8
6.810
10
20
30
40
Number of Days Spent Hospitalized 6 Months Prior toPlacement
Number of Days Spent Hospitalized 6 Months After toPlacement
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Cost Benefit Analysis of Foundation House WestCost 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 Benefit of Cost Benefit of Supportive Supportive Housing Housing
Cost of Cost of HospitaliHospitalizationzationPer DayPer Day
Cost of Cost of HospitalizatioHospitalizatio
nsnsSix Months Six Months
Prior to Prior to Placement at Placement at
FHWFHW
Cost of Cost of HospitalizatioHospitalizatio
nsnsSix Months Six Months
After to After to Placement at Placement at
FHWFHW
Saving Saving offered offered
by by Harlem Harlem United United FHW FHW
Estimated Estimated Cost Cost
$775$775 $28,520$28,520 $5,277$5,277 $23,242$23,242
Cost Benefit of Cost Benefit of Supportive Supportive Housing Housing
Cost of Cost of HospitaliHospitalizationzationPer DayPer Day
Cost of Cost of HospitalizatioHospitalizatio
nsnsSix Months Six Months
Prior to Prior to Placement at Placement at
FHWFHW
Cost of Cost of HospitalizatioHospitalizatio
nsnsSix Months Six Months
After to After to Placement at Placement at
FHWFHW
Saving Saving offered offered
by by Harlem Harlem United United FHW FHW
Estimated Estimated Cost Cost
$775$775 $28,520$28,520 $5,277$5,277 $23,242$23,242
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FHWFHW
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NY/NY III Scattered Site HousingNY/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 co-occurring serious mental illness, substance use, or both
• NY/NY III works with residents to stay healthy using a multi-disciplinary 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 OverviewNY/NY III Population Overview
Demographics:
Gender: 69% Male24% Female7% Transgender
Race: 66% Black/African
American19% White1% American
Indian/Alaska Native1% Multi-racial13% 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 IIINY/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 IIINY/NY III
22%
16%
7%
31%
8%
16%
0% 5% 10% 15% 20% 25% 30% 35%
Medical Status
Behavioral SubstanceIssue
Psychiatric Illness
Med-Behavioral Substance
Med-Psych
Multiple Factors
Classification of High Risk Due to One or More of the Followingn=150
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
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NY/NY IIINY/NY III
50%
10%
38%
27%
1%
19%
0%10%20%30%40%50%60%
% of High Risk Clients
% of Low Risk Clients
% of total Sample
Substance Use & Adherence to Mental Health TreatmentComparison Between High and Low Risk Clients
n=216
Substance Use
Not in care for MH Issue
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Hospital Utilization, NY/NYIII ClientsHospital Utilization, NY/NYIII Clients
Assessment of NY/NYIII Utilization
Six Months Prior to Move-in
Six Months After Placement
Emergency Room Visits (n=64)Average # of visitsER visits resulting in hospitalization
42%1.81 visits48%
27%1.12 visits53%
Hospitalizations (n=64)Frequency of hospitalization Average length of stay
38%1.67 hospitalizations9.42 days
25%1.337.13 days
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Analysis of NY/NY IIIAnalysis of NY/NY III
Cost Benefit of NY/NYIII
A. Cost of Hospital Visits Six Months Prior to Placement(ER Visits + Days in Hospital)
B. Cost of Hospital Visits Six Months After to Placement(ER Visits + Days in Hospital)
C. Saving in reduced Hospital Visits by Program(Column A-B)
Estimated Cost
$468,134 $231,355 $236,779
[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.
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Client ProfileClient Profile
• 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 ImplicationsPolicy Implications
Take Aways…
• Supportive Housing for PLWHA is Healthcare -- increases access to medical care, decreases acute care, improves health
• Supportive housing as form of Prevention for those at risk (HIV negative, unstably housed); homelessness/eviction prevention
• HU housing clients healthier, leading full and productive lives; emphasis on employment and ultimately moving on from supportive housing
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Contact InformationContact Information
Questions?
Laura GrundVice President of Supportive HousingHIV/AIDS Treatment Support ServicesHarlem United Community AIDS Center, Inc.306 Lenox Avenue, 3rd floorNew York, NY 10027(212) [email protected]