Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems

TLDR

Chronically homeless individuals with severe alcohol problems have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates. The study evaluates the association of a Housing First intervention for chronically homeless individuals with severe alcohol problems with health care use and costs. The quasi‑experimental study compared 95 housed participants with 39 wait‑list controls in Seattle, Washington, measuring use and cost of jail bookings, shelter and sobering center use, hospital services, detoxification, emergency services, and Medicaid‑funded services. Housing First participants experienced a 53 % reduction in total service costs relative to wait‑list controls, with median monthly costs falling from $4,066 to $1,492 after 6 months and $958 after 12 months, and cost offsets averaging $2,449 per person per month, benefits that grew with longer housing retention.

Abstract

<h3>Context</h3>Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates.<h3>Objective</h3>To evaluate association of a “Housing First” intervention for chronically homeless individuals with severe alcohol problems with health care use and costs.<h3>Design, Setting, and Participants</h3>Quasi-experimental design comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007 in Seattle, Washington.<h3>Main Outcome Measures</h3>Use and cost of services (jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services, and Medicaid-funded services) for Housing First participants relative to wait-list controls.<h3>Results</h3>Housing First participants had total costs of $8 175 922 in the year prior to the study, or median costs of $4066 per person per month (interquartile range [IQR], $2067-$8264). Median monthly costs decreased to $1492 (IQR, $337-$5709) and $958 (IQR, $98-$3200) after 6 and 12 months in housing, respectively. Poisson generalized estimating equation regressions using propensity score adjustments showed total cost rate reduction of 53% for housed participants relative to wait-list controls (rate ratio, 0.47; 95% confidence interval, 0.25-0.88) over the first 6 months. Total cost offsets for Housing First participants relative to controls averaged $2449 per person per month after accounting for housing program costs.<h3>Conclusions</h3>In this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months. These benefits increased to the extent that participants were retained in housing longer.