How Housing With Supportive Services Can Cut Hospital Utilization

Medicare-eligible people living in housing with supportive services use less hospital services, new research shows.

Evidence is mounting that housing is a highly significant factor in population health.

A study released this week found that Medicare-eligible residents of housing with supportive services had lower hospital utilization than a comparable group of seniors living in housing without supportive services.

Michael Gusmano, PhD, the lead author of the research and an associate professor of health policy at Rutgers University in New Brunswick, New Jersey, says the utilization finding is the key takeaway of the study.

"Our research supports the hypothesis that stable housing with supportive services can reduce the use of expensive medical care. In particular, it can have a significant effect on hospitalizations for ambulatory care sensitive conditions because social work staff are able to identify people who require community-based services and facilitate their use," he told HealthLeaders last week.

The researchers studied 1,248 Medicare beneficiaries in a housing program operated by Selfhelp Community Services in New York City. In the same zip codes, 15,947 other Medicare beneficiaries who did not live in housing with supportive services functioned as the study's control group.

Supportive services included psychological assessments, counseling and advocacy, health education, wellness programs, socialization, referral to public benefits and entitlements, and educational programs to control chronic disease. The housing also had technology features such as telehealth systems for checking vital signs and a virtual senior center.

Three primary findings demonstrated healthcare utilization benefits of living in housing with supportive services:

• Hospital utilization was measured by discharge rate. The researchers found the hospital discharge rate for the intervention group was 32% lower than the control group.
   
• Hospital length-of-stay was one day shorter for the intervention group.
   
• The rate of hospital discharges for ambulatory care sensitive conditions was 30% lower for the intervention group.

Earlier research has shown that tying affordable housing to supportive services allows the elderly to remain in their homes as they age with an improved ability to access healthcare and social services.

How healthcare providers can invest in housing
 

Government programs and community partnerships are being established to help health systems and hospitals invest in housing, Gusmano says.

"There are now 13 states with Delivery System Reform Incentive Payment waivers, which are designed to encourage hospitals to address social and economic determinants of health and healthcare services and reduce avoidable hospitalizations. Several other states have or are pursuing waivers to use Medicaid money to facilitate housing services for people who are homeless or at risk of homelessness," he says.

Partnerships between housing organizations and healthcare providers can address social determinants of health such as housing, Gusmano says. "Encouraging hospitals to work with community partners for the purpose of addressing the housing needs of their patients is consistent with that goal."

For health systems and hospitals, investing in housing is a component of the shift to value-based care, he says.

"Although hospital bottom lines may still be helped when patients use more hospital services, efforts to develop and implement 'value-based' payments are trying to change these incentives. If these efforts are successful, hospitals will need to understand and address the social factors that lead to avoiding the use of hospital services."