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Abstract
A recently developed body of evidence shows that housing chronically homeless adults improves health outcomes and prevents unnecessary, high-cost, institutional-based medical care. In this study, we report changes in the healthcare costs of homeless seniors who were placed in housing from a skilled nursing facility (SNF) and the costs for those placed in housing from the general community. Cost and utilization data from 1 year before move-in were compared with data from the 7 years subsequent to moving into a new permanent, supportive housing facility. During the 7 years after placement, the total hospital-based costs for the 51 seniors who moved into the facility was $1.46 million less than the costs incurred in the year before moving in. Permanent supportive housing may be a cost-effective placement option for homeless seniors exiting SNFs, particularly as they approach the end of life.
Introduction
Past research has found that housing chronically homeless adults can not only reduce homelessness but also may improve health outcomes and reduce healthcare costs (Holtgräve et al., 2013; Larimer et al., 2009; Sadowski et al., 2009). The New York State Medicaid program has proposed to budget more than $100 million in fiscal year 2014/2015 to pay for supportive housing that targets chronically homeless adults with the goal of reducing the overall state healthcare expenditures (Doran, Misa, and Shah, 2013).
Some past studies indicate that supportive housing may reduce costs for homeless adults who are frequent users of the healthcare system, but little attention has been given to how supportive housing might serve homeless adults as they approach the end of life. Gulcur et al. (2003) report that public health expenditures on homeless people before and after placement in permanent housing have fallen significantly (Gulcur et ah, 2003). Few studies reported on the long-term effect on health and healthcare use following placement, however (Stefancic and Tsemberis, 2007). In addition, most studies assessed resource use after housing homeless people from the streets or shelters, whereas permanent supportive housing can also serve as a high-quality and cost-effective option for placing homeless people who have had extended stays in skilled nursing facilities (SNFs).
In 1999, the San Francisco Department of Public Health-through its Direct Access to Housing (DAH) program-began offering locally funded Housing First permanent...