Housing Programs Improve Stability and Health of Homeless Families

A home is an invaluable space, providing not only physical shelter but also psychological sanctuary and security. In January 2017, the National Alliance to End Homelessness identified 553,742 homeless individuals living in the U.S. Housing instability causes numerous challenges for the homeless, including negative health consequences. For example, homelessness increases the risk of communicable disease (such as sexually transmitted diseases and tuberculosis) and physical, sexual and emotional violence due to crowded living conditions and a lack of privacy and security.

Governments have adopted housing programs that provide homeless people with temporary shelters or permanent residence, among other support services. In 2005, New York City and New York State launched a supportive housing system called the New York/New York III (NY/NY III) Supportive Housing Program. It provides both congregate and scatter-site supportive housing models for homeless single adults or families in which the head of household suffers from a substance abuse disorder, serious mental illness, physical disability, or HIV/AIDS. These families are considered to be at serious risk of becoming chronically homeless.

A recent study by Sungwoo Lim et al. analyzed the impact of this program on housing stability and emergency department visits and hospitalizations. Building on previous research that revealed that supportive housing can result in reduced hospital usage, the authors identified an additional association between supportive housing and preventable emergency department visits. Their methods include a sequence analysis which studies trends in outcomes over specific time periods following a treatment and an inverse probability of treatment weighting (IPTW) regression model, which adjusts a study sample’s probabilities of being placed in treatment or control groups. The researchers selected a sample of 926 families from the 966 families eligible for NY/NY III from 2007 to 2012; they excluded 40 families that already received government-subsidized housing. They then categorized the families into treatment and control groups. The treatment group was placed in NY/NY III housing for more than 7 days while the control group was either not placed in NY/NY III or placed in NY/NY III for seven days or fewer.

The researchers’ IPTW model revealed that 87 percent of the treatment group experienced housing stability two years after the date they were determined to be eligible for NY/NY III. The remaining 13 percent experienced one of three other less desirable housing patterns: non-institutional stays, unstable housing, or transitions to non-institutional stays, with non-institutional stays defined as independent housing, street homelessness, or residence outside NYC. By contrast, only 1 percent of the control group exhibited stable housing patterns, and the weighted rate of preventable emergency department visits among the treatment group was 0.6 times that of the control group. Moreover, the study’s sequence analysis found that the rate of preventable emergency department visits decreased each year for the treatment group, while there was no decreasing trend for the control group.

The authors concluded that NY/NY III had a positive impact on housing stability among homeless families whose heads of household exhibit serious mental illness, substance use disorders, physical disabilities, or HIV/AIDS. In addition, improved housing stability was associated with a reduction in preventable emergency department visits. Moreover, stable housing can bring homeless families additional mental and physical health and economic benefits through employment outcomes that were outside the scope of this study. Additional cost-benefit analyses on this topic may provide further evidence of the value of similar housing programs.

A large number of homeless people still live on the streets. In September 2018, the number of homeless people in New York City reached its highest level since the 1930s: 63,025. Policymakers should consider expanding housing programs for homeless families to prevent serious health consequences both in the short and long term.

Article source: Sungwoo Lim, Tejinder P. Singh, Gerod Hall, Sarah Walters, and L. Hannah Gould “Impact of a New York City Supportive Housing Program on Housing Stability and Preventable Health Care among Homeless Families.” Health Service Research, Vol. 53 (5), (2018): 3437-3454.

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