Permanent Supportive Housing:Impact on Hospital and Jail Usage for High Utilizers

Virginia Supportive HousingKristin Yavorsky

Supportive Services Director

The Permanent Supportive Housing Model• Permanent supportive housing (PSH) is a program model that combines

affordable rental housing with community-based supportive services.

• PSH has been identified by the federal Substance Abuse and Mental Health Services Administration as an evidenced-based practice for individuals experiencing chronic homelessness who also have serious behavioral or physical health conditions.

• Multiple peer-reviewed research studies, including seven randomized controlled trials, have found that PSH is particularly effective in improving participants housing stability and reducing their emergency department and inpatient hospital utilization.

• The target population is often among the highest utilizers of these and

other costly public services while homeless.

About Virginia Supportive Housing• Virginia Supportive Housing (VSH) is a non-profit organization founded in 1988

expressly to provide permanent supportive housing to homeless individuals.

• For the last seven years, VSH has been deeply targeting individuals with the longest histories of street homelessness who often have co-morbid physical and behavioral health conditions. A Housing First approach is used.

• Supportive services at VSH include community-based case management with a low staff to client ratio, peer recovery services, street outreach, landlord mediation, healthcare navigation, medication management, independent living skills training, and assistance with benefits acquisition.

• As direct result of a community effort to target and prioritize unsheltered homeless individuals for permanent supportive housing – Richmond has saw a 40% reduction in its annual count of unsheltered homeless individuals from July 2011 – July 2013.

VSH Apartments Community-Based Apartments

Total - PSH for Individuals

Region Clients Clients Clients

Richmond 138 160 298

Hampton Roads 240 91 331

Charlottesville 60 0 60

TOTAL 438 251 689

Chronically Homeless 88 %

Veterans 18 %

Mental Health Condition 76 %

Substance Abuse Condition 53 %

Chronic Physical Condition or Disability 68 %

Client Characteristics(n = 287 clients served by VSH in Richmond in 2013)

VSH Housing Outcomes – 2013Richmond

• 81 individuals newly housed in PSH• 97% (n=287) did not return to homelessness

Hospital Utilization and Cost OutcomesPre and Post Permanent Supportive Housing

• VCUHS shared data for mutual clients served across all three VSH permanent supportive housing programs through the end of calendar year 2013.

• Of the initial data set of 253 VSH clients, 95.3% were found to have utilized VCUHS inpatient or Emergency Department (ED) services in the indicated time frame.

• VSH conducted an analysis of this data to determine – (1) inpatient and ED utilization– (2) return hospital visits within 30 days, and– (3) fiscal impact

Hospital Utilization and Cost Outcomes

• 148 individuals were identified who had been in housing for at least twelve months.

• 495 inpatient or ED visits during the 12 months prior to housing and only 228 visits in the 12 months after housing – a 54% reduction in the number of visits.

• Actual payments per ED visit increased by 76% after VSH housing, and payments per inpatient visit increased by 126%.

The 20% Highest Utilizers

• A small subset of 30 patients accounted for 63.4% (314) of the full group’s inpatient and ED visits while homeless.

• One patient of note had 61 ED visits in the year before being housed and none afterward.

Number of ED & Inpatient Visits to VCUHS – 12 months before and after VSH Housed (n=30)

Homeless VSH Housed0

50

100

150

200

250

300

350

ER

INPT

ED InpatientHomeless 268 46VSH Housed 68 22

- 71%

Annual Average VCUHS Visits Per VSH Client

ED Inpatient Both ED & Inpatient0

2

4

6

8

10

12

Homeless VSH Housed

-75%

- 52%

-71%

ED Inpatient BothHomeless 8.9 2.3 10.5VSH Housed 1.5 0.7 3.0

Return visits to VCUHS ED or Inpatient within 30 Days of Discharge (excluding same day returns)

Homeless VSH Housed0

20

40

60

80

100

120

140

160

180

200

-81%

Number of VisitsHomeless 187VSH Housed 35

Average Days between VCUHS Visits

ED Inpatient0

10

20

30

40

50

60

70

80

90

HomelessVSH Housed

+109%

+108%

+81%

ED InpatientHomeless 33.9 40.3VSH Housed 70.6 84.2

Total Monthly VCUHS ED + INPT VisitsBefore and After Move In for High Utilizers

-12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 120

5

10

15

20

25

30

35

40

45

50

VSH Move In Date

Month

Fiscal Impact to VCUHS for Housing High Utilizers

• $560,068 reduction in unpaid charges• Savings of $18,669 per patient.

Richmond City Jail UtilizationPreliminary Analysis

98 VSH clients had data available a stay in housing of at least a year and a record in the City jail (ever). 36.7% (36) had an incarceration in the time frame.

Post VSH housing results for those with an incarceration:• 28.6% decrease in number of incarcerations• 37.8% decrease in jail days• 54.9% decrease in number of clients incarcerated (for at least

one day)• 37.8% reduction in total jail cost• Total cost savings $39,900 or $1,108 per person.

Contact information:

Kristin YavorskySupportive Services Directorkyavorsky@virginiasupportivehousing.org