According to the Centers for Disease Control (CDC), the average life expectancy for an American is 78.8 years and is expected to continue climbing. However, there is an entire sub-population of citizens that have a life expectancy of almost half of that. The National Health Care for the Homeless Council cites the life expectancy for the homeless population as just 41 years. Homelessness and access to quality healthcare are strongly connected, and many believe that quality shelter and healthcare are basic human rights.
For many homeless Americans, the problem originates with an injury or illness that leads to a loss of employment. A study in 2007 found that 62% of personal bankruptcies were caused by medical debt. Some of these people fall through safety nets and end up living on the streets. This is when physical health declines and behavioral and substance abuse problems develop or worsen. Without the safety that a home provides, minor health issues can be exacerbated into larger problems that lead to chronic disease. Not only does this lead to an early death, but also it puts a financial strain on the healthcare system with frequent unpaid emergency room visits.
Image Source: Spencer Platt
The traditional model of homeless outreach requires the homeless to become “housing–ready” before being allowed in a home. Mandatory sobriety, medical stability, and mental illness stability are examples of these “housing-ready” requirements that are often unattainable for homeless individuals. These requirements are blocking a large portion of chronic homeless individuals from achieving the stability needed to address their healthcare issues.
Permanent supportive housing is a recent solution to homelessness and its troubling healthcare outcomes. By creating programs called “Housing First programs,” cities are providing their homeless with housing without the requirements of being “housing-ready.” The only initial requirement is that the individual must meet with a case manager at least once a month for help with accessing quality health care and government safety net benefits.
A study on the Housing First program in Columbia, South Carolina found that providing housing first is an effective way to spur access to quality health care. A six-month follow–up found that many of the formerly homeless individuals were able to access a primary care physician instead of relying on emergency room visits. Many also gained access to federal benefits and assistance at their new addresses.
The Housing First program is far more effective in improving medical outcomes for the homeless and has a lower associated cost than the traditional model. This cost-saving effectiveness should spur more cities across America to adopt the Housing First strategy to improve medical outcomes for their homeless population.