What We Can Do

After caring for Terry, I’ve often wondered how many cases like his I had come across in my practice. How many of these individuals whom I had seen actually had city and state housing opportunities simply waiting to be utilized?

Recently, analyses of the interplay between housing and health have prompted hospital systems to institute programs that address homelessness. Through these programs, successful institutions often find ways to identify homeless patients and then connect them to appropriate housing and ancillary services.

The methods vary. Some institutions rely on case managers to tack on extra workflows of basic housing navigation to their already overflowing list of responsibilities, while others use inundated social workers to perform these tasks. Data show that social workers or case managers combined with intensive housing assistance may be effective. But unfortunately, most social workers and case managers can’t or don’t solely focus on housing their patients. Thus, these benefits are often not sustainable. This fact, combined with the complexities of the housing sector, has pushed hospitals to introduce a new field of hospital staff: housing navigators.

Housing navigators are workers trained in helping advance the housing status of the homeless. They have been effective in contributing to higher rates of long-term housing permanency for the homeless. Traditionally, housing navigators have only existed outside of hospitals and only work in shelters or community outreach programs that address homelessness.

That is beginning to change as a growing number of hospitals and emergency departments are employing housing navigators who are helping to advance the housing status of our nation’s homeless.

In Minnesota, Hennepin Healthcare System created a program that leverages housing navigators. Its preliminary results? Emergency department visits fell 35 percent among their homeless high-utilizer population, and nearly 50 percent of their highest utilizers became stably housed. Similarly, in California, Hospital Harbor Interfaith Services partnered with South Bay Hospitals to create a housing navigator position that helps hospital social workers navigate the complex housing system for their patients. The results were so substantial that after only one year of implementation, partnering hospitals funded the program for an additional three years.

Minnesota and California are not alone in these endeavors. In New York, Mount Sinai Health System recently hired a housing navigator to help homeless patients transition to permanent housing, and Vanderbilt University Medical Center in Nashville also introduced a housing navigator in 2016.

What about the finances? The good news is that even payers have identified the utility of implementing housing navigators. UnitedHealthcare is employing housing navigators to work with emergency departments in Texas, Washington, and throughout the Midwest. For obvious reasons, they see the value.

Introducing emergency departments to housing navigators means that patients such as Terry will no longer have to rely on a slim chance of clinicians glancing at housing lists to claim the resources available to them.

Instead, homeless patients unaware of the resources available to them would be assessed by housing navigators and transitioned into housing opportunities at the city and state level or be triaged to transitional care, such as shelters, respite care, and adult foster care, when longer-term solutions are not immediately available. These housing navigators act as additional specialists who can help unburden busy ED providers who are not well-versed or trained in navigating their community’s housing ecosystem, let alone doing so at 2 a.m.

With the increasing administrative focus on social determinants of health, I strongly believe that hospital-based housing navigators can serve as powerful resources, not only to reduce health care costs but also, more important, to house people who frequently present to our emergency departments in search of temporary shelter.

Emergency departments have an opportunity to treat homelessness like any other medical problem by connecting homeless patients to the specialists they need most. The implementation of housing navigators is the first crucial step in doing so.