An Effectiveness Trial of Supportive Housing for Homeless Adults with Chronic Medical Illness

Introduction: Homeless adults, especially those with chronic medical illnesses, are frequent users of costly medical services, namely Emergency Room visits (ER) and Hospitalizations. We assessed the effectiveness of a new model of supportive early housing on the health service use for this important and often neglected homeless population.

Methods: We enrolled 407 homeless adults with chronic medical illness into a Randomized Controlled Trial at two Chicago hospitals. Social workers recruited English and Spanish speaking adult homeless patients. Outcome measures were assessed using electronic medical records (ER visits, hospitalizations).

Results: Our sample was 75% men, 75% African American with a median age of 47. After 18 months, 61% of the sample required hospitalizations for a total of 118,738 days. More than half (59%) required at least one ER visit (not associated with hospital admission). Those in usual care had nearly twice the number of ER visits than those in the housing program (4.6 v 2.5, p= 0.01). Those in usual care also had 5 more hospitalized days than those in the housing program (12 v 7 days, p=0.005). On average, the additional ER visits and hospitalized days for those in the usual care group conservatively represent an additional direct cost of $3,352 per person.

Conclusions: Our study demonstrates the effectiveness of a new supportive housing model for homeless adults with chronic medical illness in reducing costly medical services. We encourage policy makers, medical centers and communities to use these compelling findings to develop better programs and policies for this growing population.