Philly's heroin camps illustrate how housing instability hurts health

A man sleeps alongside the bridge at Kensington and Lehigh in Philadelphia on May 22.

Beneath four underpasses in Kensington, hundreds of people have been encamped for months, and many face a May 30 deadline to clear out. More than a hundred were forced to move there when the city cleared out the Gurney Street encampment, a makeshift home for hundreds of people, the majority of whom have a substance use disorder, including opioid addiction.  Many also have co-occurring mental health conditions.

When the city closed Gurney, it literally pushed the problem to a new location, and now Philadelphia is stuck in a predicament between responding to the safety concerns of area residents and addressing the needs of those who are homeless and have behavioral health issues.

Shutting down encampments and connecting some people to treatment are only temporary fixes.  Bigger ideas are necessary to holistically address this problem.  By looking at this crisis as both a healthcare and a housing issue, policymakers can move toward real solutions that address the root causes of the problem.

What is the connection between housing and healthcare? Simply put, there is no chance for an individual to get or stay healthy without safe, affordable housing.  Let’s look at some of the reasons for this.

People who have housing are more likely to stick to a treatment plan, more likely to self-manage chronic conditions, more likely to be connected to a doctor, and less likely to end up in the emergency room or hospital for things that could have been prevented. When you don’t have a regular, safe place to live, you often don’t stick to your medications. They can either be lost in your daily shuffle or stolen in a shelter.  If you need to take your diabetes medication every day and you don’t have the refrigerator you need to keep your insulin cold, you give up.

In general, it is also harder to stick to a regular schedule if you lack housing. Your daily routine is focused entirely on meeting your most basic needs. You have to choose between making it to your doctor’s appointment or getting a spot in line to get a bed in a shelter or a meal at the soup kitchen.

Because of the daily struggle to survive, it’s likely that something simple like a recurring infection lands you in the hospital because you haven’t taken your antibiotic. Or you may end up, like Greg whom we met at a health center last year, choosing not to take your diabetes medication because you know you’ll end up in the emergency room, and at least you’ll have a warm place to sleep when temperatures are below freezing.

The importance of factors outside the doctor’s office is borne out in the research. Doctors estimate that they can only control about 10 percent of your overall health through the medicine and care they provide. Socioeconomic factors and physical environment have double the impact on health outcomes. This means that, even if we provided every homeless individual world-class healthcare from top-notch doctors, we might not see a huge improvement in their overall health.

This reality doesn’t only impact homeless individuals; it affects us all.  Not only is medical care ineffective in these circumstances; it’s incredibly expensive to provide. A mere 20 percent of healthcare users account for 60 percent of healthcare costs, running up the bill for everyone else. Just one unnecessary day in a hospital in Pennsylvania can cost $2,307.

So what can we do? The clear answer is to help vulnerable people find and keep housing, but moving from homelessness to housing isn’t always simple.  Services that help homeless individuals conduct a housing search, complete the paperwork to qualify, and get everything ready to move in are essential. When you are starting from scratch or are dealing with complex health issues as you search, even simple things can get in the way. Homeless individuals often also need help working with their landlord and becoming a good tenant and neighbor. With additional coaching and support, people can be very successful in finding and keeping safe housing.

Here, we arrive back at the connection between housing and health.  Providing these services reduces days in the hospital, reduces emergency room visits, and reduces days spent in nursing homes.  Ultimately, that saves taxpayers money even after we pay for the costs of these new services. In one study of 1,272 chronically homeless individuals in Pennsylvania, taxpayers were projected to save almost $3 million dollars after providing supportive housing services.  That’s $1.35 saved for every dollar spent on these services.

The Pathways to Housing Program has seen early success with a “housing first” strategy that places people in addiction in stable housing before they start treatment.

As Philadelphia’s City Council and Mayor decide how to address the situation in Kensington and other neighborhoods like it, they should consider how to shift dollars toward supportive housing services. Council could appropriate more money. The Mayor could shift more behavioral health reinvestment dollars to cover the costs. Ultimately, Harrisburg could explore billing Medicaid, the primary insurer for homeless individuals. Medicaid already bears the brunt of the costs of providing unnecessary or higher-cost care and would benefit from such a move.

Housing and health care are not separate issues.  Thinking creatively about how to fund these critical services is necessary in the midst of the opioid crisis, which challenges the way we’ve done things in the past. We must respond in new ways.

____________________

Antoinette Kraus is director of the Pennsylvania Health Access Network, the state’s largest statewide health coalition, and is a member of the Inquirer’s Health Advisory Panel.