Providence creates “supportive housing” to help patients live healthier lives

Douglas A KoekkoekDoug Koekkoek, M.D., chief executive of clinical services and Providence Medical Group
Pam Mariea-Nason, RN, MBA, executive, Community Health Division, Providence - Oregon

When Providence’s Community Health Division surveyed front-line caregivers in 2016 as part of a community needs assessment, a dominant theme emerged – caregivers felt strongly that patients who lacked safe, secure housing often struggled to lead healthy lives. These patients faced significant obstacles as they attempted to follow provider instructions about how to stay healthy. 

Although housing isn’t the only barrier for these patients, a lack of stable housing magnifies other barriers. Just as one example, it’s hard to eat fresh, healthy food without reliable access to a refrigerator and stove. Homelessness especially complicates chronic medical illnesses such as COPD, diabetes, depression and substance abuse.

Providence began working with Central City Concern, Adventist Health Portland, CareOregon, Kaiser Permanente Northwest, Legacy Health, and Oregon Health & Science University to address this complex issue.

Unique partnership addresses homelessness

Last September, these seven organizations announced a $21.5 million investment in affordable housing and medical services to address the Portland homeless crisis. 

Central City Concern – a nonprofit that serves adults and families in the Portland area experiencing homelessness, poverty and addictions – will own and operate the project’s 385 new affordable housing units.

The new units will be located in three sites across the city, and they'll serve the very poor, those who are medically fragile, people with mental illness and substance use disorders, and those displaced by gentrification.

But the program isn’t about just housing.

What is “supportive housing?”

While providing access to safe, affordable housing is a major component of supporting healthier communities, other services are needed as well. Features of the Portland area’s new supportive housing program will include medical, behavioral health and care management services such as: medical stabilization beds, addiction treatment, behavioral health services, palliative and advanced illness care, an integrated persistent pain program and more.

We call this supportive housing since it provides a wide range of supportive health services that, combined with a secure place to live, offers the best opportunity for improving the health of this vulnerable population. It also reduces unnecessary trips to the ED and helps providers achieve better health outcomes with this at-risk population.

Research supports strong link between housing security and better health

Providence’s investment in housing is evidence-based and was researched locally – but has national implications. The Center for Outcomes Research and Education (CORE) has emerged as a national leader in conducting research that connects the dots between housing and health care. CORE is based at Providence in Oregon but is an independent research hub that conducts research to improve population health. CORE partners with health systems, state agencies and community groups to help them meet the Triple Aim of better health, better care and lower costs.

In 2016 CORE conducted a study (“Health in Housing: Exploring the Intersection Between Housing & Health Care”) in partnership with Enterprise Community Partners, Inc., and with support from the Meyer Memorial Trust. It is one of the first studies to directly assess the impact on health care costs when low-income people move into affordable housing. The study included 145 housing properties of three different types: family housing, permanent supportive housing, and housing for seniors and people with disabilities. The impact of integrated services within housing also was considered.

There were four key findings in the study:

  1. Costs to health care systems were lower after people moved into affordable housing.
  2. Primary care visits went up after move-in; emergency department visits went down.
  3. Residents reported that access to care and quality of care improved after moving into housing.
  4. Integrated health services were a key driver of health care outcomes.

What’s next?

CORE currently is conducting another housing study, funded by a Robert Wood Johnson Foundation grant, which examines the effect of Section 8 housing vouchers on community health, including on health care outcomes and on educational outcomes for school-age children. 

Planning and design for the Portland area’s 385 new affordable housing units and related health services is underway, with construction scheduled to begin in summer 2017. The units are scheduled to begin opening in 2018.