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Why “Housing as Healthcare” Saves Dollars and Makes Sense

Is there some way to turn the vicious cycle of homelessness and mental and physical illness on its head?  Having a home keeps people healthier, which leads to taxpayer savings, which can, in turn, be used to finance affordable housing. 

At the San Diego Housing Federation’s 23rd Annual Affordable Housing and Community Development Conference in October, Joshua Bamberger, MD, MPH, Medical Director of Housing and Urban Health for the San Francisco Department of Public Health, made those points in a presentation called “Housing as Healthcare.”  Dr. Bamberger, who is an associate professor of family and community medicine at UCSF and who served as special adviser to the executive director of the U.S. Interagency Council on Homelessness in 2012 and 2013, explained that studies show that people who live in permanent housing have lower health care costs and are typically insured.  “It costs less to house homeless people than to leave them on the streets and in shelters,” according to Shaun Donovan, U.S. Secretary of Housing & Urban Development on “The Daily Show,” on March 5, 2012.

Sadly, the reverse is true as well.  Poverty, combined with mental illness, substance abuse or a chronic medical condition, is lethal, Dr. Bamberger said.  He added that people in these conditions die 25 years younger than general public.  These premature deaths, often from common diseases like cardiovascular disease or diabetes, are preventable he said.  Medical treatment is necessary but insufficient alone to improve outcomes.  Rather, medical success comes from housing homeless people.  In fact, housing homeless people with AIDS increased their survival rates by about 80 percent.

Quality is impacted by five key indicators, Dr. Bamberger said.  They are: quality of building/architecture; quality of neighborhood; severity of illness among tenants; homogeneityof the population; and quality of the on-site services.

In pilot projects, the return on the investment has been enormous.  Savings from putting taxpayer dollars toward healthcare costs of homeless people can be used toward building affordable housing.  In New York State, savings in healthcare are being invested into supportive housing to the tune of $600 million in 2015-2016.

Dr. Bamberger stressed the need to focus on linking the healthcare industry to community development.  The affordable housing sector must reach out to the providers of healthcare services, diversify the capital cost, diversify the operating costs and replicate to scale, he said.

Thus, according to Dr. Bamberger, the solution for those who have been on the streets for years and are living with mental or physical illness and substance abuse is high-quality, low-threshold, beautiful housing with on-site or mobile services that are tailored to individual needs.  With a system in place that assesses each homeless person’s need for housing through a medical lens, cities can help ensure that people get the medical care they need while containing medical costs.  Providing housing will reduce health care expenditures.  Providing housing for the highest users of the health care system improves their quality of life and reduces the number of people on the street while reducing public health care spending and the overall size of government.

Tara Matthews of Rosenow Spevacek Group Inc. was the moderator of a panel at the supportive housing session at the San Diego Housing Federation 23rd Annual Affordable Housing Conference