Housing the sick and homeless seen as a "win-win"
NEW YORK (Reuters Health) - Providing housing to chronically ill, long-term homeless adults reduces hospitalizations and emergency department visits, according to research conducted in Chicago.
Previous studies of such interventions generally produced negative results. However, Dr. Laura S. Sadowsky and others write in this week's Journal of the American Medical Association, "Missing are intervention studies of homeless individuals with any chronic medical illness."
Sadowsky at Stroger Hospital of Cook County and her associates conducted a controlled trial involving 405 patients hospitalized at two centers, who had been homeless for an average of 30 months. All of the subjects were deemed capable of self-care when they left the hospital.
Half of the participants were discharged to transitional housing, then placed in long-term housing. They all had a case manager whom they contacted at least biweekly.
The other subjects in the study were assigned to usual care with standard discharge planning, mainly to overnight shelters.
Over the next 18 months, the housed group had 29 percent fewer hospitalizations, spent 29 percent fewer days in hospital, and had 24 percent fewer visits to an emergency department.
Sadowsky's team estimates that for every 100 homeless adults offered such help, there would be 49 fewer hospitalizations, 270 fewer hospital days, and 116 fewer emergency department visits over the following year.
They note that the active intervention was based on the Housing First model using federal funds, and "represented a city-wide consortium of clinicians, social workers, and housing and other advocacy groups."
Two editorialists comment, "These studies compellingly demonstrate how the provision of secure housing to the most vulnerable members of society -- the sickest of the chronically homeless -- can be a win-win situation for all parties concerned."
However, they also remark that "financial returns are likely to decrease (or disappear) when Housing First is offered to less severely debilitated individuals."
SOURCE: Journal of the American Medical Association, May 6, 2009.
