The University of Illinois Hospital Provides Housing for Individuals Experiencing Chronic Homelessness in Chicago
Persons experiencing chronic homelessness, who often have a serious mental health disorder or physical disability, are frequently banned from shelters that lack the resources to manage those conditions. For many of those experiencing chronic homelessness, the only alternative to escaping the street is to visit a hospital’s emergency department, where they incur disproportionately large healthcare costs. In 2015, the University of Illinois Hospital and Health Sciences System (UI Health), part of the University of Illinois at Chicago, partnered with the Center for Housing and Health (CHH) to address this issue in Chicago by launching Better Health Through Housing (BHH). UI Health committed $250,000 to the pilot program to reduce healthcare costs by identifying emergency department patients who experience chronic homelessness and transitioning them to permanent supportive housing. BHH brings together 28 housing organizations, 4 hospitals (including UI Health), and a managed care organization to provide a holistic support system of services including mental health, substance abuse treatment, education, and employment training. Based on the success of the pilot, UI Health committed an additional $250,000 to help expand the BHH program in 2018.
Better Health Through Housing
To achieve BHH’s main goal of housing emergency department patients, the program first identifies which patients are homeless, a task that can be quite difficult. According to Stephen Brown, UI Health’s director of preventive emergency medicine, the identification process has improved over the past several years largely through new analytical methods, including using addresses provided by patients. UI Health discovered that many homeless patients provide the address of a shelter, church, or another hospital. Using these new methods, the number of homeless patients identified by UI Health grew from 48 to more than 1,500 between 2015 and 2018.
From the list of homeless patients, a BHH referral panel selects potential participants for the program. Most patients chosen for the program are “super-utilizers” who have visited the emergency department more than eight times in a year. The panel also considers patients’ current health status, prioritizing those with chronic illnesses. One important group that the program does not currently serve is patients with severe mental illnesses because BHH does not have access to supportive housing with around-the-clock care — a problem the program is looking to rectify. Outreach workers locate patients selected for the program and offer them a temporary housing unit in one of three single room occupancy hotels participating in the BHH program. These bridge units allow patients to get off the street as quickly as possible, and patients typically stay in these temporary housing units for two to four weeks. To accommodate the growing number of patients, BHH is searching for an additional hotel which, at the request of current program participants, will include Spanish-speaking staff.
During their stay in a bridge unit, BHH patients work with a caseworker to find permanent housing. BHH’s 28 partner housing organizations represent approximately 4,000 scattered-site units that typically have between 125 and 150 vacancies spread throughout the city. Patients can select a unit that best suits their preferences. According to Brown, this is only one of numerous opportunities in the BHH program in which patients are encouraged to exercise their right to self-determination. UI Health provides CHH $1,000 per month for each permanently housed patient for up to 12 months to cover the costs of housing. BHH staff periodically meet with caseworkers to identify and manage any problems patients may have encountered in their transition to independent living. A BHH Systems Integration Team also meets regularly to coordinate service provision.
BHH Program Results
BHH began accepting patients in November 2015 and filled its quota for the first cohort of 26 patients by August 2016. Illustrating the severe negative health effects of homelessness, 9 people from that group passed away before the 12-month pilot ended. Those who survived saw a 45 percent decrease in their healthcare costs, and excluding 1 outlier patient, the remaining 16 patients saw a 67 percent decrease in costs. In its 2018 annual report, BHH noted that 91 people had thus far been assisted through the program and that 72 were currently in supportive housing. Of those current residents, 29 have been successfully housed for at least a year, with 16 remaining in BHH housing for more than 2 years. In addition, UI Health reported a 48 percent decline in hospital and emergency room utilization by program participants by 2019.
Expanding Housing Options for Those Experiencing Homelessness
UI Health is a leader in addressing chronic homelessness in Chicago, and its recent commitment of an additional $250,000 demonstrates its dedication to expanding the BHH program. As Brown points out, BHH hopes to offer additional kinds of supportive housing to meet patients’ needs. For example, individuals with severe mental illnesses or substance use disorders often need housing with onsite support, a type of housing that is not currently available through the BHH program.
Following the success of the BHH pilot program, UI Health and CHH are currently using a flexible housing pool for supportive housing. The housing pool was created by a public-private partnership led by the Chicago Department of Public Health, the Chicago Department of Family and Support Services, and the Corporation for Supportive Housing. Based on a model from Los Angeles County, the housing pool combines subsidies, grants, and investments from various organizations to provide permanent housing for those experiencing chronic homelessness. The Chicago partners are seeking new investments from hospitals, insurance companies, and other entities to expand the housing pool by 750 apartments. UI Health has committed $350,000 to the flexible housing pool program, adding to a recent $1.78 million investment from the city.
A recent featured article in PD&R Edge includes a discussion of the Better Health Through Housing program.