Hous­ing is health care, and this bill can help pro­vide it

The Mercury News - - Opinion - By René G. San­ti­ago René G. San­ti­ago is di­rec­tor of the County of Santa Clara Health Sys­tem. He wrote this for The Mer­cury News.

It is time for our state to ac­knowl­edge what our hospi­tals al­ready know: Hous­ing is health care.

Gov. Jerry Brown can take an im­por­tant step in rec­og­niz­ing hous­ing is health care by sign­ing As­sem­bly Bill 74 by Assem­bly­man David Chiu, D-San Fran­cisco.

Our emer­gency depart­ment staff at Santa Clara Val­ley Med­i­cal Cen­ter can do lit­tle to pre­vent a home­less pa­tient from re­turn­ing again and again to the hospi­tal for pre­ventable and man­age­able con­di­tions.

Peo­ple ex­pe­ri­enc­ing home­less­ness are more likely to be ad­mit­ted as pa­tients and stay longer than those with sim­i­lar med­i­cal is­sues who are housed. And home­less pa­tients de­velop ge­ri­atric signs as early as age 45 or 50, and die from con­di­tions that could have been treated if only they had a safe, de­cent place to live.

Cal­i­for­ni­ans ex­pe­ri­enc­ing long-term home­less­ness face a com­bi­na­tion of chronic med­i­cal, men­tal health and sub­stance abuse strug­gles. They are of­ten fre­quent users of hospi­tals and nurs­ing homes, and in­cur dis­pro­por­tion­ate Med­i­Cal costs.

Be­cause they can­not ob­tain suf­fi­cient rest, fol­low a healthy diet, store med­i­ca­tions or reg­u­larly at­tend ap­point­ments, they be­come the sick­est pa­tients and their in­pa­tient costs sig­nif­i­cantly in­crease the longer they re­main on the street.

Coun­ties like Santa Clara are tak­ing steps for­ward with bonds to build hous­ing and with pro­grams like Whole Per­son Care, an in­no­va­tive ap­proach to car­ing for the high­est-risk and most vul­ner­a­ble pa­tients.

AB 74 would be an­other im­por­tant step for­ward for our county and the en­tire state.

AB 74 of­fers a whole-per­son-ori­ented ap­proach to serv­ing vul­ner­a­ble Cal­i­for­ni­ans by cre­at­ing the Hous­ing for a Healthy Cal­i­for­nia Pro­gram. It ties hous­ing re­sources avail­able through the na­tional Hous­ing Trust Fund, a ded­i­cated source of an­nual fed­eral fund­ing, to cre­at­ing sup­port­ive hous­ing for the most ex­pen­sive home­less Medi-Cal ben­e­fi­cia­ries.

AB 74 would re­quire the state to track Medi-Cal data on ben­e­fi­cia­ries as they move from home­less­ness to sup­port­ive hous­ing.

Out­comes of con­di­tions, uti­liza­tion of ser­vices and changes to costs would al­low the Leg­is­la­ture to de­ter­mine fu­ture in­vest­ments in the pro­gram.

Many stud­ies al­ready con­firm that sup­port­ive hous­ing de­creases emer­gency depart­ment vis­its, hospi­tal in­pa­tient stays, nurs­ing home days and psy­chi­atric in­pa­tient ad­mis­sions.

In one ex­am­ple, Medi-Cal ben­e­fi­cia­ries in sup­port­ive hous­ing re­duced their hospi­tal costs by $3,841 per per­son af­ter one year and $7,519 per year af­ter two years.

Other stud­ies of chron­i­cally home­less peo­ple who moved into sup­port­ive hous­ing show dras­tic de­creases in hospi­tal and nurs­ing home stays within a year. Some states have doc­u­mented avoid­ance of med­i­cal costs sur­pass­ing $17,500 for each res­i­dent in sup­port­ive hous­ing.

More im­por­tant than the po­ten­tial cost sav­ings is the un­de­ni­able fact that get­ting peo­ple into hous­ing saves lives and al­lows our care sys­tem to fo­cus on ef­fec­tive treat­ment, rather than the chal­lenges of try­ing to help peo­ple we know will re­turn to our streets and into a cy­cle of ever-de­te­ri­o­rat­ing health.

For th­ese rea­sons, hospi­tals across the coun­try are em­brac­ing sta­ble hous­ing as the key to bet­ter health care and im­proved health for all Amer­i­cans. By sign­ing AB 74, the gover­nor can rec­og­nize the same.

Peo­ple ex­pe­ri­enc­ing home­less­ness are more likely to be ad­mit­ted as pa­tients and stay longer than those with sim­i­lar med­i­cal is­sues who are housed.


A home­less man sleeps on the ground at St. James Park in down­town San Jose.

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