In 2014, county and city leaders decided that something needed to be done about central Florida’s alarming homeless population. The issue plagued not just the region’s streets, but also emergency rooms (ERs), health centers and first responders, as homeless people turned to ERs for regular care. Some of the region’s homeless visited the hospital dozens of times in a single year, racking up millions of dollars in services ultimately paid by the hospital systems and taxpayers.
Florida Hospital’s answer: an unprecedented $6 million to support the “housing first” model to end chronic homelessness.
Traditionally, the battle against homelessness has been fought by tracking down the homeless wherever they could be found (if, indeed, they could be found) and offering basic needs (food, water, clothing, first aid) and services such as case management and counseling. In fact, Florida Hospital created a special program, the Homeless Outreach Partnership Effort (H.O.P.E.) Team, to do just that. But the traditional approach put adequate, permanent housing down the list as a “maybe” rather than a “must.”
“Housing first” flips this model, where those who qualify are first given a home and then offered wraparound services aimed at better health, job training and eventually re-entering the workforce to be able to sustain themselves. Those who suffer from severe mental illness and are unable to work also receive priority because they are the highest users of health and public services.
As of last month, 79 formerly homeless Floridians have been placed into permanent housing. And while only a quarter of the $6 million pledged has actually been spent, Florida Hospital and its partners have already seen significant change. Residents now see primary care physicians on a regular basis, are able to manage their chronic conditions and have case managers checking in to make sure they are able to afford their medications. No longer having to worry about where to sleep, they focus on their health, their skills and thriving with dignity.
It’s notable that Florida Hospital, with 2,200 beds and nearly 18,000 employees, is one of the largest in the US, which may cause rural-state hospital leaders to scoff at trying to duplicate the housing first model. Suffice to say, like hospital size, the homeless problem – and the broader adequate housing problem – is relative to location, as would be any response. What’s not in contention is how firmly connected access to housing is to health, overall quality of life and the cost of health care.
Can hospitals solve the homeless problem? No, not even a giant like Florida Hospital can. But that’s not the point. Effective health care is moving steadily from the reactive – trying to fix what homelessness breaks – to proactive – mitigating homelessness as a health issue with preventive care or, ultimately, by supplying permanent, adequate housing.
Of course hospitals can’t fix homelessness, but along with countless other upstream health issues – from childhood trauma to drug abuse to education to nutrition – hospitals are best positioned to form and lead the coalitions necessary to implement lasting solutions. In fact, in the new health care paradigm, there really is no other option.