Tim_HeadshotIt was an honest, eye-opening remark during the Alliance for Health Reform panel on Friday, when speaker Barbara DiPietro talked about a common obstacle for patients when they receive a prescription for an illness: many drugs have side effects, some of which may lead to a few more visits to the restroom. For most people with a permanent home or workspace, especially when it comes to making a recovery from an illness or condition, this is an inconvenient, but necessary, reality.

However, for homeless people who do not have access to bathroom facilities 24/7, they do not have the luxury of taking a treatment with such side effects; otherwise they risk a legal citation or worse, arrest, for public indecency. As a result, they choose to not use their medications to avoid going to jail, and thus, they do not get better and have a hard time improving their prospects of finding more permanent housing and employment.

There are other barriers for people who are homeless: medications may get stolen or lack a place for safe or proper storage, such as a refrigerator. For those who do receive care, their treatment may be compromised once they are discharged to the streets.

“Lack of housing complicates treatment,” DiPietro said.

The forum, The Intersection of Health and Housing: Opportunities and Challenges, featured presentations from DiPietro and speakers Jennifer Ho, senior advisor for housing and services, U.S. Department of Housing and Urban Development (HUD); Gretchen Hammer, director, Colorado Department of Health Care Policy and Financing; and Sister Adele O’Sullivan, founder and physician, Circle the City.

Each speaker was tasked with outlining the connection between housing and health.

DiPietro noted an important juxtaposition: poor health can cause homelessness and homelessness can cause poor health. For example, someone with an illness or injury may be unable to work and can’t afford to live in their homes. They ultimately end up in a shelter or on the streets if they have nowhere else to turn. On the flip side, people who are homeless are exposed to extremes, such as weather, and may experience high blood pressure from stress and the occurrence or re-occurrence of mental health and substance abuse issues.

“If you didn’t have issues before, you tend to develop issues when you are homeless,” said DiPietro, who noted that homeless people have rates of acute and chronic disease at three to six times the normal rate.

Ho provided a federal perspective on the relationship between HUD and the U.S. Department of Health and Human Services, which are seeing an unprecedented level of collaboration to ensure that needs of patients, individuals and families are being met. Ho noted that an aging population, which is more likely to live alone, have chronic illnesses and less mobility, will increasingly need rental assistance, placing a bigger burden on the need for more subsidized housing units.

“How do we have a strategy for aging in place if people will not be able to afford or navigate the place that they call home today?” Ho said, who added that Medicaid has a role in paying for critical housing services. “The health care system, I would argue, has a huge stake in meeting the housing, affordability and accessibility needs of an aging America, yet there is not consensus that this is an investment the federal government should be making.”

Hammer provided a local perspective from her work trying to make Colorado the healthiest state in the nation, and a dual platform focusing on health and housing has keyed the state’s approach. She said she is helping providers on both the housing and health care side be cognizant of the opportunities they have to work together and to bring synergy to all of the funding that is available.

“We invest a lot of money across the nation in our health care system, and I think we have some opportunities to get better value for the dollars that we invest, and some of that requires infrastructure investments,” said Hammer, adding that investments could be in things like health care capacity, primary care medical homes and integrated care, spanning physical, behavioral and oral health care services.

Dr. O’Sullivan shared insights into her practice caring for an exclusively homeless population in Arizona and detailed projects they have implemented and are testing to stabilize, assess and move those in need to supportive housing.  She said her organization’s pilot project with a local medical center saw a significant reduction in emergency room visits and a reduction of in-patient utilization, after patients were moved into permanent supportive housing.

“The diagnosis is homelessness,” said O’Sullivan, who added that most of the people in her pilot program had three-plus chronic illnesses.

She added, “We have pretty good data to show that persons with chronic illnesses who are medically vulnerable will not survive, and yet our systems, our electronic systems – our silos, if you will – we have to how learn to cross them to prioritize those limited supportive housing resources that we have to the persons who need them the most.”

To view an archived video of the briefing, visit: http://www.c-span.org/video/?327536-1/discussion-healthcare-homeless.

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