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Deborah De Santis Headshot

Housing and Health Care Must Come Together to Serve Vulnerable People Better

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Those of us in the supportive housing field have recently become eager students of national health reform efforts. The changes in coverage, access, delivery and quality of care have the potential to significantly improve and lengthen the lives of the vulnerable men and women who live in supportive housing.

Supportive housing is affordable housing used as a platform for services like health care, employment services, substance abuse treatment and case management. Study after study has documented supportive housing's ability to improve health and behavioral health status. And it's also shown to lower emergency room, hospitalization and Medicaid costs among individuals with some of the most complex health problems. Some studies showing Medicaid cost reductions of 41%.

These days, my and my staff's calendars are filled with meetings with health policy experts, Medicaid officials and managed care executives. I've come to appreciate that health care in the United States involves a complex (some would say convoluted) health care delivery system, replete with multiple payers, providers, benefit packages, coverage rules and limitations, and payment rates. After many years working in housing, I well know that affordable housing is no easier to connect to than health care. Our nation's "housing delivery system" is just as difficult to navigate as our health system--especially for the most vulnerable and poorest families and individuals. The terminology may differ, but the housing delivery system has its own equivalent multiple payers, coverage limitations, regulations, eligibility restrictions and payment standards.

By recognizing the complexities and challenges associated with our respective delivery systems, health care and housing professionals see clearly that we need to work better and more closely together. We need to find new ways to do our best by our residents and patients by aligning and integrating health care and housing at the delivery system level.

We must streamline bureaucratic obstacles to increase access to both health care and housing. We must provide the appropriate levels of housing assistance and health service to people based on their levels of need. We must deliver packages of coordinated, patient-centered health care and affordable housing. We must build collaborations between local, state and federal systems to align public resources including Medicaid and mainstream housing capital and rental subsidies. And, we must as a society invest in interventions like supportive housing, which is the premier example of how communities can align health care with housing.

If we don't, we leave vulnerable men and women to fend for themselves in navigating not one, but two complex and convoluted systems.