HEALTH CARE/Joan Retsinas

Housing: A Common-Sense Prescription

“Healthcare” conjures up an arsenal of heavy-duty science: physician-specialists, super-duper medications, brave new world diagnostic imagery. The titles are intimidating: interventional radiologists, serotonin reuptake inhibitors, computerized tomography, bariatric surgery – all befitting complicated diseases. “Healthcare” swoops us into an arcane universe, where “clinical trials” will yield the wonder-interventions that will cure whatever ails our failing bodies.

How simple! How misguided! Even as we swoop into the scientific paradigm of wellness, we abandon commonsense. What ails our bodies may lie in microbes, malformations, and bacteria; but compounding that may be quotidian human misery. And the solutions may lie in such “interventions” as better food, better family dynamics, better shelter – in short, better lives.

An article in the Washington Post (Oct. 6) highlights the value of commonsense. Montefiore Hospital is one of 19 Pioneer Accountable Care Organizations (a pilot under the Affordable Care Act) that broadened their scope of “healthcare” to include community services. One Montefiore patient had undergone a bone marrow transplant, part of treatment for blood cancer. The operation was a success. But this patient was homeless,  living in a shelter an hour away by public transportation from the hospital. Fortunately for him, Montefiore has a “housing unit,” with a skilled social worker, charged with finding apartments for homeless chronic patients.  This case offers up no simple solution: the article makes clear that the patient would have to alter his lifestyle in exchange for the apartment. And a landlord would have to accept this patient. But the article also makes clear the consequence of homelessness: without a stable home, close to the hospital, the patient would probably not survive, even after a successful transplant.

Common sense often doesn’t jibe with bureaucratic officialdom. A lot of people need “social services.” But we deliver social services in silos – food, housing, income, anger management, domestic violence – name the need, find the program, each managed by a cadre of caring (the ubiquitous word in social servicedom) professionals. The money pours out in distinct spigots. The “healthcare” spigot is generous, but not easily linked to others. The needy patient must calculate his list of “needs,” then drink from an array of spigots, all at once. A bit like shuffling from one office to another, each with its own “intake” form, its own “eligibility” requirements, its own modus operandi.

Bureaucrats recognize the link beween health and housing, but linking the two spigots has been hard. Medicaid has always paid for nursing home care; and the federal government has long given states “waivers” to use Medicaid money to move patients into housing. (For example, New York State recently received such a waiver, which will permit payment for supportive housing <https://www.health.ny.gov/health_care/medicaid/redesign>). Similarly, the federal Department of Housing and Urban Development, concerned with homeless populations, has noted that the provision of stable housing can “significantly improve health outcomes for chronically homeless individuals.” Programs in Boston and  Chicago demonstrate the impact of housing on illness. These programs, though, are not the norm. So we should cheer the provision in the Affordable Care Act that gives 19 hospitals flexibility.

Indeed, these programs may even be cost-effective. A trip to the emergency room costs as much as $1,200; paring those visits can save enough money to pay for rent. The Centers for Medicare and Medicaid Services said that those Pioneer ACOs saved $96 million in 2013.

We marvel at the wizardry of modern medicine; we want more wondrous vaccinations, more astounding surgeries, more diagnostic miracles. But I’d also like to see somebody break down those bureaucratic silos, to let the people writing “treatment” plans include safe, affordable housing.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, November 15, 2014