Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing...

Housing as Healthcare

Joshua D. Bamberger, MD, MPHSF Dept. of Public Health & Mercy Housing

University of California, San Francisco

[email protected]

Poverty—combined with mental illness, substance

abuse or a chronic medical condition—is lethal

• People in these conditions die 25 years younger than general public

• These premature deaths, often from common diseases like cardiovascular disease or diabetes, are preventable

• Medical treatment is necessary but insufficient alone to improve outcomes

What does medical success look like?

Avastin: huge financial success, modestly increased survival rates by 15%

Medical success: housing homelessHousing homeless with AIDS increased survival rates by about

80%

DAH Portfolio

Nathaniel Kerksick

This slide needs more context; the chart is hard to understand

Quality is impacted byfive key indicators:

1.Quality of building/architecture

2.Quality of neighborhood

3.Severity of illness among tenants

4.Homogeneity of the population

5.Quality of the on-site services

Building Neighbor-hood (1-3)

Housing quality (1-3)

Severity of tenant illness (3-1)

Quality of on-site service (1-4)

Mixed population (1-2)

Total (5-15)

Mission Creek

3 3 1 2 2 11

Kelly Cullen Comm.

1 3 1 2 1 8

Measuring Quality in Affordable Housing

“Magic Number > 9”

1 Point Bonus for Strong Community1 Point Bonus for a Work Program

Nathaniel Kerksick

Can improve this table later but fairly readable for now

Relationship between Housing Quality and Mortality

Death rate: Le Nain vs. Mission Creek

“It costs less to house homeless people than to leave them on the streets

and in shelters.”—Shaun Donovan

U.S. Secretary of Housing & Urban Development

The Daily Show, March 5, 2012

Chez Soi/At Home Study

• 3000 adults with mental illness and chronic medical problems

• Randomly assigned to housing vs. regular care

• For the top 10% of the healthcare users, $10 returned for every $1 in housing

• For next 40%, $1 returned for every $1 in housing

• For bottom 50%, housing did not significantly reduce healthcare utilization

Saved $19,000 per person

A.G. is recovering now

So what now?

Next steps

Nathaniel Kerksick

Ill tidy these visuals later

Future Opportunities for Healthcare in Supportive Housing

•New York State

• Investing savings in healthcare into supportive housing

• $600 million in 2015-6


•San Mateo

• Managed care- HPSM

• Committed to 120 units of housing


•LA County

• DAH on steroids

• Increase in targeting

• Increase in scale

• Diversity of housing stock

Tasks for Affordable Housing Sector

• Reach out to the providers of healthcare services

• Diversify the capital cost

• Diversify the operating costs

• Replicate to scale

Future

Housing as Healthcare

Joshua D. Bamberger, MD, MPHSF Dept. of Public Health & Mercy Housing

University of California, San Francisco

[email protected]

Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing...

Documents

Transcript of Housing as Healthcare Joshua D. Bamberger, MD, MPH SF Dept. of Public Health & Mercy Housing...