Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States

Abstract

In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital utilisation who were housed as part of a scattered‐site Housing First program in a mid‐size city in the northeastern United States. 26 individual, semi‐structured interviews were conducted with Housing First clients in their homes or day program sites between March and July 2017. Interviews were digitally recorded and transcripts were analysed using a qualitative descriptive methodology until thematic saturation was reached. Findings suggest that housing provided the physical location to manage the logistical aspects of care for these clients, and an environment where they were better able to focus on their health and wellness. Study participants reported less frequent use of emergency services and more regular interaction with primary care providers. Additionally, case managers' role in connecting clients to behavioural health services removed barriers to care that clients had previously faced. Housing also facilitated reconnection with family and friends whose relationships with participants had become strained or distant. Changes to physical and social communities sometimes resulted in experiences of stigmatisation and exclusion, especially for clients who moved to areas with less racial and socioeconomic diversity, but participation in the program promoted an increased sense of safety and security for many clients.

A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services

“…These results differ from those reported in studies of PSH that used uncontrolled designs. These found large reductions in service use 12,19,20 . Without controls, these findings are susceptible to regression to the mean 20,21 .…”

Indicadores de boas práticas em saúde para a população de rua: revisão de escopo

“…(2020) (40) Investigar como a estabilidade da moradia afetou a gestão de doenças crônicas e as relações sociais e comunitárias.…”

“…Sentimento de esperança (22) Incapacidade intelectual (32) Modelo comportamental (33) Recuperação clínica, existencial, funcional, física e social (35) Gestão das condições agudas e crônicas (40) Indicadores de boas práticas em saúde para a população de rua: revisão de escopo…”

Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada

“…In general, psychosocial interventions or counseling have been shown to improve housing stability for people residing in PH (Hwang & Burns, 2014;Kreindler & Coodin, 2010;Stergiopoulos et al, 2019). Given that consulting a psychologist in private practice would be financially However, it may also be argued that housing stability may facilitate better health outcomes, especially for those with chronic physical illnesses, by providing an environment more conducive to focus on personal health and well-being, even in terms of simply having an adequate physical space to manage the logistics of personal care (Chhabra et al, 2020;Jaworsky et al, 2016). Since housed individuals are spared the relentless daily struggle of seeking shelter and food, health needs can take more immediate priority for those formerly homeless who obtain more stable housing (O'Connell, 2004).…”