Policy makers seem to have forgotten that people don’t live in hospitals or physician offices. In the process, they seem to be ignoring the fact that housing could be one solution to health-related challenges.
Over the past several weeks, I’ve read a handful of articles discussing challenges or barriers to reducing health care use and costs.
- A brief in Health Affairs identifies the various ways we are wasting health care dollars and makes recommendations for eliminating that waste. One key category of waste is disjointed care that is experienced, for example, when patients transfer from one setting to another.
- A Robert Wood Johnson Foundation report on hospital readmissions highlights myriad complaints from patients about how the discharge process has let them down. Patients told interviewers that they didn’t understand their discharge instructions or those instructions were too general. They were overwhelmed by their diagnoses. Their primary care physicians weren’t kept in the loop. They had no support at home. They weren’t educated about their chronic diseases or needed support changing behaviors.
- Another article in Health Affairs discusses the critical role that social supports, in conjunction with health care services, can play in lowering health care use and costs. Unfortunately, the article notes, fragmentation presents a barrier to integrating health care and social service delivery.
There’s obviously a lot of effort going into addressing the challenges facing our health care system. But many of those efforts, including Affordable Care Act initiatives, are based in health care settings.
Policy makers seem to have forgotten that people don’t live in hospitals or physician offices. In the process, they seem to be ignoring the fact that housing could be one solution to these challenges.
Critical Questions: The Limitations of Health Providers
How often do providers see their patients? Not very often. How will these physicians notice that an individual is looking or acting differently than they regularly do? Recently a service coordinator told me about a resident whose behavior was “really off” from her norm. The service coordinator visited the resident in her apartment to see if she could get some insight into what was going on. She discovered that the woman’s medications were completely mixed up. The resident had been prescribed one pill she needed to cut in half and another that she was only supposed to take every other day. You can imagine what was happening. The service coordinator helped get a better system set up to help the resident manage her medications correctly.
How many physicians know about a patient’s resources or support network? A recent study by the University of Georgia found that individuals with food insecurity were more likely to skip or manipulate their medication doses. Is a doctor going to know what’s in a patient’s fridge? Service coordinators have a more comprehensive picture of residents. They can help residents apply for food stamps, meals programs or other food/grocery assistance programs if those residents have limited incomes or access barriers. Or they can help with other social needs that may impact a resident’s health. In a survey conducted by the Robert Wood Johnson Foundation, 85% of physicians say unmet social needs are directly leading to worse health for Americans. Yet, only 20% of doctors feel they have the ability to help address those needs.
How can health providers monitor or educate individuals they see only occasionally? It’s hard to share complex information in a 15-minute visit. But a wellness nurse in a housing property can provide a regular presence to help monitor vital signs and health conditions. That nurse can spend time helping a resident understand health-related questions. Housing properties can sponsor education sessions to help residents understand and manage chronic conditions. Access issues are easily resolved when education sessions are only an elevator ride away.
Does the risk of re-hospitalization go away 30 days after a hospital discharge? Probably not. Service coordinators and other housing staff can help with the transition from hospital to home. They can help ensure that home health or home care services start up, or that a resident has needed adaptive equipment, gets and understands any new medications, and sets up an appointment with the primary care doctor. These staff members can also continue to keep an eye on the resident long after a hospital-based transitions program would stop calling.
The Housing Advantage: Population Concentration and Built-In Support
I’m not implying that hospital- and clinic-based programs aren’t worthwhile. But independent congregate settings can offer another strategy that addresses some of the problems we are trying to tackle through various health care reform efforts. These settings offer 2 advantages:
- A concentration of the very individuals that many health initiatives are trying to address. The population of independent senior housing settings is generally advanced in age and low-income. Many residents are members of minority groups. They suffer from multiple chronic conditions, face functional limitations, and are at risk to be frequent users of 911, the emergency room and the hospital.
- An infrastructure that can help address various needs. Service coordinators can help residents identify and access a range of services and supports. They also build relationships with residents. This helps service coordinators notice changes in individuals. It also helps residents trust their service coordinators and follow through on their advice. Link in an onsite wellness nurse, fitness activities, health education programming or other services and you’ve created an easily accessible set of resources to help potentially high-risk individuals better manage their health care.
Alisha Sanders is director of housing and services policy research in the Washington, DC office of the LeadingAge LTSS Center @UMass Boston. Her work focuses on identifying, evaluating, and advancing strategies and policies that link affordable housing settings with health and supportive services.