1. The Source for Housing Solutions NASCSP Conference Charlene M. Flaherty Director, Southwest September 11, 2013

2. Our Mission Improve lives of vulnerable people Maximize public resources Build strong, healthy communities Advancing housing solutions that:

3. Building Strong, Healthy Communities Locations where CSH has staff stationed Locations where CSH has helped build strong communities

4. High Utilization of Hospitals & EDs  A subset of individuals are caught on a revolving door of emergency department visits, inpatient hospitalizations, and use of other crisis health services  These individuals typically have complex needs, with multiple co-occurring chronic conditions and social challenges including extreme poverty, limited social supports, and homelessness  Failing to address the needs of these individuals not only contributes to their worsening health status, but also poor use of public and institutional resources 4

5. 5 A Small Number of Very High Risk Homeless Persons The most expensive 10% of homeless persons have average monthly costs $6,529 LA County linked service and cost records across county departments for a representative sample of recipients to produce this exceptionally valuable data Source: 2,907 homeless recipients in LA County with DHS ER or inpatient records Deciles based on costs in all months

6. Housing Instability Contributes to Frequent ED Use  Growing understanding of role that homelessness and housing instability plays in contributing to frequent use  “The recognition of the complex care needs and fragile social circumstances of these especially high-need patients has stimulated fresh thinking about aggressive outreach, intense coordination of services by integrated care teams, and the need for nonmedical resources such as supportive housing, all of which could likely help curb the cost of health care.” – M. Raven and D. Gould

7. Housing Is Health Care Impacts on Health  Denver study found 50% of tenants placed into SH experienced improved health, 43% had improved mental health outcomes, and 15% reduced substance use  Seattle study found 30% reduction in alcohol use among chronic alcohol users in supportive housing  SH in San Francisco and Chicago had higher survival rates for persons with HIV/AIDS compared to control groups Impact on Health Costs 24% to 34% fewer emergency room visits 27% to 29% fewer inpatient admissions and hospital days 87% fewer days in detox and fewer psychiatric inpatient admissions 41% to 67% decrease in Medicaid costs

8. Supportive Housing Solution  Communities across the country are pursuing initiatives that use supportive housing to reduce ED and hospital use among frequent users  Using data matches to identify homeless frequent users  Assertive outreach and recruitment in crisis health settings  Stronger links to coordinated, patient-centered healthcare

9. What is Supportive Housing? Supportive housing is permanent, affordable housing combined with a range of supportive services that help people with special needs live stable and independent lives

10. Characteristics of Supportive Housing  HOUSING  PERMANENT: Not time limited, not transitional  AFFORDABLE: For people coming out of homelessness  INDEPENDENT: Tenant holds lease with normal rights and responsibilities.  SERVICES  FLEXIBLE: Designed to be responsive to tenants’ needs  VOLUNTARY: Participation is not a condition of tenancy  INDEPENDENT: Focus of services is on maintaining housing stability.

11. Who Lives in Supportive Housing?  Long-term homeless  Veterans  Domestic violence victims  Unaccompanied Youth  People with mental illness and/or chemical dependency  People coming home from correctional facilities, treatment, jail, hospitals, detox

12. HUD Focus on Performance  HUD Continuum of Care on Homelessness/ HEARTH Outcomes  Reduce new episodes of homelessness  Reduce length of homeless episodes  Reduce returns to homelessness (Note: CoC includes ALL homeless programs including those not funded by Continuum of Care)  Coordinated Assessment and Entry  Rapid Rehousing  Permanent Housing

13. Common Ground – Housing & Health High Cost Health Care Utilizers High Cost At-Risk/ Homeless Supportive Housing

14. SJHMC FUSE Pilot  15 Frequent and high cost utilizers of SJHMC ER  Chronically homeless individuals  Long-term homeless  Disability  Care Navigator/Case Manager  Permanent Supportive Housing  Evaluation

15. SJHMC FUSE Pilot  Dignity Health/St. Joseph’s Hospital and Medical Center  Corporation for Supportive Housing  Circle the City Medical Respite  Native American Connections  Arizona Housing Inc.  Arizona Behavioral Health Corporation  Native American Community Health Center  Valley of the Sun United Way  St. Luke’s Health Initiative

16. Success Story – “Mr. 280”  280 visits to SJHMC ER  Traumatic Brain Injury and seizures  Chronically homeless  Criminal history  History of failed housing attempts

17. Success Story – “Mr. 280”  Seizures under control  Housed at 209 W. Jackson  Employed  No additional ER visits  Reconnected with family

18. Stakeholders & Community Partners  HUD Continuum of Care  Hospitals  Public Housing Authorities  State Department of Housing  Local Government  Homeless Housing and Service Providers  United Way  CAP Agencies

19. Considerations/Questions  What are my organization/clients needs?  How do our goals align with the goals of the ACA?  Are we engaged in the discussion and decision making processes in our community?  Are we open to realigning our priorities and resource allocation to participate in initiatives?  What resources do we have to bring to the table?

20. Charlene Flaherty Director, Southwest 480-203.8131 Charlene.flaherty@csh.org