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Supportive housing may be a feasible and appropriate model of care for chronically homeless persons

Supportive housing is subsidized housing for chronically homeless persons that provides them with on-site or closely linked medical, substance abuse, and mental health services. Despite the resistance of many homeless persons to housing, three-fourths of those admitted to supportive housing without requiring sobriety or "housing readiness," remained housed 2 years later, according to a new study. However, the housed homeless still had similar use of emergency department (ED) care, average care use, and hospitalizations as those not admitted to the supportive housing program.

Based on the high hospitalization and mortality rates of both groups, it is likely that even the housed homeless suffered severe medical illness at study entry. Also, medical, as opposed to psychiatric, health care use may be less disposed to alteration through housing. It may be that supportive housing has to be introduced prior to the point when homeless persons have end-stage medical illnesses.

On the other hand, failure to find a decrease in use of most medical services among those provided supportive housing may have been due to increased detection of medical need, note the California researchers.

They retrospectively studied health care use of 249 homeless applicants to a supportive housing program (114 were housed in the program) 2 years before and 2 years after the supportive housing intervention. The health care use by this homeless group was similar in magnitude to that of the frail elderly. Both housed and nonhoused participants used a great deal of health care services, more than one health care service per week. Housed and nonhoused persons did not differ in average service use, outpatient mental health use, or change in care use prior to or post intervention. The 2-year time course may have been too short to provide medical stability and decrease use of acute medical care. The study was supported in part by the Agency for Healthcare Research and Quality (HS11415).

More details are in "Public health care utilization in a cohort of homeless adult applicants to a supportive housing program," by Eric R. Kessell, M.P.H., Rajiv Bhatia, M.D., M.P.H., Joshua D. Bamberger, M.D., M.P.H., and Margot B. Kushel, M.D., in the September 2006 Journal of Urban Health 83(5), pp. 860-873.

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