Housing is Healthcare!

This morning on Morning Edition there was a discussion about New York state's effort to use federal health care dollars for housing.  They specifically are petitioning the federal government to be able to use Medicaid dollars for housing.  The State's argument is that they already pay for housing in mental health facilities and nursing homes or the inability to discharge people to the streets so why not pay for safe places for people to recover from a serious health condition? WCPN also weighed in with a story about the value of expanded Medicaid to a family. I have seen attempts in Colorado and Boston to do innovative housing using health care dollars.  So, to answer the question posed on NPR, yes, housing is healthcare!

Imagine breaking your leg and going to the hospital to have it set while sleeping in a shelter.  The hospital will release you with a cast and then try to get bed rest to recover from the broken bone.  It is not easy and it is unlikely that you will be able to keep the leg up while you recover.  You have to go get food and most shelters make you leave from 8 a.m. to 3 p.m.  How do you recover from a fever in a shelter or even surgery?   Behavioral health issues are just as big of a problem for those without housing because they cannot find a place to recover.   There is the problem of repeated trips to the most expensive part of the health care continuum with emergency room care.  There is repeat visits because homelessness and bed rest are mutually exclusive.  There is the issue of sleep deprivation in the homeless community which then causes other health issues.  There is an inability to get consistent care for chronic health conditions because of an inability to secure quality health insurance (before 2014).  

Housing is a game changer for people with long term health issues.  If you have a solid bed to go back to and get a good night sleep it will change your life.  Housing takes a great deal of stress and pressure off a person.  Housing allows a person to take their medication on a consistent schedule without their pills being stolen.  You can take care of personal hygiene in housing that is difficult while living in a shelter, and you can make meetings with health care professionals.   Those in housing have regular sleep and can take care of their dietary needs.  Housing is critical to have effective health outcomes.  We know that those who spend a period of time living on the streets do reduce their lifespan.  It is obvious that Housing is a Health care issue. 

Brian Davis

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Alcohol and Drug Addiction Services Effective?

Are we light years behind Europe in how we treat people with addiction? The Diane Rehm Show on Monday featured one hour on the changes in treating alcohol addiction services.  This comes after the release of the The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry (co-written by Lance and Zachary Dodes).  All Things Considered did an interview with Dodes back in March 2014 available here.  

There is a huge split within the homeless community about this issue.  There are those Housing First folks who are winning the argument who admit people to housing even when they are not sober.  Then there are those who feel that a person must be sober to get housing.  They feel that if a sober person is "rewarded" with housing while not taking care of their addiction, they will just mess up and become homeless again.  They also worry that an out of control addiction will contaminate others who will fall off the wagon. 

The problem is that the current treatment method especially for those without health insurance is awful and fails more than it is successful.  Those with insurance can go to inpatient treatment where they are away from the drugs and alcohol that is everywhere around them.  Dodes' book shows that Alcoholics Anonymous is successful between 5 and 10%.  This is disgracefully low success rate that would not allow a prescription drug trial to go forward or behavioral health experiment move to the next trial with a success rate of 7%.   What else do we have for the low income addict living at 2100 Lakeside?   As the book Hooked by Lonny Shavelson from a 2001 details the treatment system is completely broken. 

If we have designed a completely failed system for treating alcohol and drug what other choice is there, but to put people into housing and work on their addiction?   The State of Ohio has suddenly come to the realization that we have a serious prescription painkiller and heroin problem because our kids are dying in large numbers.   So they announce this Public Service Campaign to get people help, and then when your child needs professional assistance, you find that there is a three week wait for treatment.  They tell you to go to meetings and try to maintain your sobriety while you wait for help.   This is an insane approach to the problem of addiction.  Imagine if there were no emergency room health care and instead they just told you to go watch a video about coughing up blood and work through your own problem while you wait three weeks for a medical bed or a doctor visit.  This is the system for behavioral health at this point.  It is no wonder the shelters are bypassing the Alcohol and Drug system by putting people right into housing and hoping that they can find help for the person if they have a room to return to every night. 

Diane Rehm also had a nice show this last Tuesday on income inequality. The guest was Nick Hanauer who is a proponent of increasing the minimum wage.  He has made millions and talked about giving workers more income to be able to be able to live without government support.   It was a good discussion.  Check it out.

Brian Davis

Posts reflect the opinion of those who sign the entry