The Correlation Between Chronic Illness and Housing Insecurity

Lost jobs and decreased economic activity during the COVID-19 pandemic created financial hardships that exacerbated existing problems with housing insecurity. In late 2021, 16% of adult renters in the United States reported that their households were behind on rent, according to the Center on Budget and Policy Priorities (CBPP). Renters of color were affected more widely, as 28% of Black renters, 20% of Asian renters, and 18% of Latino renters said they were not caught up on rent, compared to 12% of White renters.

The pandemic’s proportionally greater financial impact on communities of color doesn’t stop with housing insecurity—it also widens existing health inequities because people who are housing insecure often deal with serious medical conditions they don’t have the resources to manage. For instance, people without proper housing are 21 times more likely to have congestive heart failure and 4 times more likely to have hypertension. They are 5 times more likely to have diabetes and 8 times more likely to have COPD. They also experience higher rates of chronic kidney disease and end-stage renal failure, according to data Arcadia has collected.

With increased likelihood of serious medical conditions comes increased health care resource utilization and medical expense. For example, people experiencing housing insecurity represent a disproportionate and growing share of emergency department (ED) visits, according to a study in BMC Health Services Research.

Patients who are homeless are more likely to be admitted compared to patients who are not. Homeless patients are more likely to be “frequent users” (4 or more ED visits per year) and “super users” (20 or more ED visits in a year) than other patients. On average, value-based organizations spend $700 per member per month (PMPM) on emergent admissions and $200 PMPM on non-emergent admissions for patients who are housing insecure. Compare this with $78 PMPM for emergent admissions and $43 PMPM for non-emergent admissions for housed patients, according to Arcadia’s data.

Chronic illness can be compounded by behavioral health conditions, which also disproportionately impact patients who are housing insecure. Those who are housing insecure suffer from major depression, substance abuse, and adjustment disorder at higher rates than the housing secure. This points to a correlation between mental health and the need for adequate housing and better coordination across patient services.

To simultaneously reduce housing insecurity and medical overutilization, providers need a deeper understanding of the numerous socioeconomic and environmental factors that impact their patients. It starts with capturing the right data. In addition to collecting social determinants of health (SDoH) information from their patients, providers benefit from greater support in improving care coordination, which often requires joining a broader group of social service organizations. With real-world SDoH data, these collaborating organizations can establish innovative programs to promote greater housing security for homeless patients. Here is a deeper look at 2 success stories:

Central City Concern, Portland, Oregon: Five hospital systems and a nonprofit health plan in Portland donated $21.5 million to support the development of 379 new affordable housing units, including supportive, respite care, and transitional housing. The project serves several distinct populations, including people in recovery for behavioral health disorders, those in need of medical and mental health respite housing, and palliative care for homeless adults at the end of life.

As a result of the project, the participating health systems are increasing their emphasis on addressing broader community health needs by shifting investments away from traditional clinical care and toward SDoH.

Central California Alliance for Health, Salinas, California: Central California Alliance for Health (CCAH), a managed care organization that covers 3 counties in California, partnered with a nonprofit housing developer to assist in the development of a 90-unit mixed-use development in Salinas, California.

Executives with CCAH identified 3 key goals for the project: increasing provider capacity, expanding access to behavioral health and substance use disorder services, and strengthening support resources for the organization’s most medically fragile members.

Those medically fragile members account for about 8% of CCAH’s overall membership but utilize about 75% of its health care resources. An essential strategy to reduce demand on health care resources by these high utilizers was to invest in supportive housing, reducing utilization and improving health for plan members who are placed in the housing facility.

Whole person care requires whole person solutions. We know that housing insecurity, chronic illness, behavioral health conditions, and health inequities are deeply intertwined. To address one, we need to address all. And if we invest in programs to do this, we need a clear picture of patient clinical, behavioral, and SDoH needs, along with analytics, to help engage them in the interventions that will have the biggest impact on their health outcomes.