Glenn Baker received his birthday gift a week early this year. And it might be the best gift he has ever received: After living on the streets of Chicago for several years, he now has an apartment to call his own.
Better Health Through Housing, created by the University of Illinois Hospital & Health Sciences System (UI Health), seeks to help the city’s chronically homeless reach stability and, in turn, reduce health care costs by providing them with permanent homes.
The pilot phase of UI Health’s program kicked off in November 2015 and now houses 22 patients. The hospital is investing $250,000 in the initiative, with hopes to expand it with more funding.
Preliminary data is promising: The average annual cost per month for patients enrolled in the program has decreased 42 percent, and their number of monthly hospital visits has decreased 34 percent.
Before Baker got his apartment in May, he was one of UI Health’s emergency department (ED) “super-users,” patients who have a significantly higher number of ED visits and hospital admissions than the average patient. Like hundreds of other chronically homeless individuals in Chicago, Baker frequented the city’s hospitals 10 to 15 nights a month — sometimes because he was sick, but most often just to have a comfortable place to sleep for the night.
Baker admits that he would often fake an illness — a headache, an injured hand, even an asthma attack — to be admitted to the hospital.
“It took a lot for me to perfect the [act of] being ill,” he says. “I had to make myself sound like I was wheezing or make it seem like whatever they were giving me for pain was not working.”
Moving into his South Side apartment has turned Baker’s life around, he says. He no longer has to think twice about whether he’ll be able to take a hot shower, wash his clothes, or eat a warm meal. He says he can finally focus on establishing his career and looks forward to celebrating the upcoming holiday season in his new home. Since moving in, he has visited the ED only once.
“It’s a remarkable change,” he says. “I think the people at the hospital respect me more. They know when I come through the door now that I’m actually sick.”
A Vulnerable Population
Stephen Brown, director of preventive emergency medicine at UI Health and program manager of Better Health Through Housing, says the program has yielded several surprising findings, including that the homeless constitute almost half of the hospital’s most frequent ED visitors.
Harsh living conditions on the streets make homeless individuals victims of chronic medical problems and mental illnesses. As a result, Brown says, they die 20 to 30 years younger than the average American.
At the start of the project, Brown and his team had a list of 48 known patients who had previously been identified as homeless. Upon collaborating with ED charge nurses, social workers, and community organizations, the list grew to 525 names. Even now, they uncover two to three additional individuals weekly.
“We thought it would be 10 or 20 [individuals],” Brown says. “But a lot of these folks go from ED to ED or are in and out of prison, so they disappear just as rapidly as they come. We constantly have people joining our homeless cohort.”
In addition to an apartment, each patient is paired with a case manager, who helps the patient schedule doctor appointments and get on track to better health. The hospital pays $1,000 a month for the patients’ apartments, whereas hospital care costs for these “super-users” was previously close to $3,000 per day.
UI Health has been approached by several hospitals interested in replicating its program. The aim is to expand the program beyond the city.
“Theoretically, if every hospital did this in the city of Chicago, we would be able to house, at least to the lower amount, what we believe to be the chronically homeless here.”
He adds, “Now that the Affordable Care Act mandates that every nonprofit develop a community health needs assessment and an implementation plan, we think this is a nice fit for hospitals to demonstrate proactive community benefit that has a definite impact on cost, utilization, and improvement in outcomes in very vulnerable populations.”