This story was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

At first housing may not sound like a relevant health care issue, but research shows that lack of housing leads to increased rates of physical trauma, chronic diseases, dental issues, behavioral health problems, and exposure. Affordable housing was ranked as the #1 need in the University of Vermont Medical Center's 2016 Community Health Needs Assessment. In turn, The Medical Center and its partners in the community have come together to address housing issues to improve the health of not only UVM Medical Center patients, but the community as a whole.

Improving the lives of the communities it serves is inherent in the UVM Medical Center's mission. Not only does hospital leadership feel this is the right thing to do, but using hospital resources to address housing issues has proven to be an increasingly smart investment as the health care system moves away from a model that pays providers for the number of procedures they perform to a model that rewards keeping people as healthy as possible.

The UVM Medical Center is involved with several housing initiatives, but three programs that really demonstrate community collaboration in addressing a need are Harbor Place, Beacon Apartments, and Bel-Aire Apartments.

Harbor Place is a renovated motel that has 39 single units, and 20 one and two-room kitchenettes. The UVM Medical Center discharges patients who have nowhere else to go to Harbor Place. The average length of stay is 13.4 days.

Beacon Apartments is a motel that has been transformed into 19 permanent housing units.

Bel-Aire Apartments is also a renovated motel that has 5 permanent stay apartments and 3 apartments designated for medical respite for complex patients. These patients are able to stay temporarily for up to 6 months.

All three facilities have on-site support services provided by community organizations. First, a case manager from the community's Federally Qualified Health Center, The Community Health Centers of Burlington (CHCB), connects residents with various resources such as medical insurance and permanent housing applications. In addition, mental health services are provided by clinicians from the Howard Center, the region's designated mental health agency, on an ad-hoc basis. Lastly, medical services are provided by several organizations such as the Visiting Nurse Association and CHCB. 

Data Behind the Action

Housing in Vermont

Source: U.S. Census Bureau, 2016

Housing and Health Care

Housing and health care are linked in many ways. Lack of housing leads to increased rates of physical trauma, chronic diseases, dental issues, behavioral health problems and exposure. Additionally, those experiencing homelessness have reduced access to primary care and increased difficulty in self-managing health issues. However, getting treated for health care issues while experiencing homelessness can be costly to both the individual and the health system.

Making it Happen

Partnerships

Harbor Place was the first of the three collaborative housing initiatives to come to life.

In 2012 Champlain Housing Trust (CHT), the community's local land trust and affordable housing provider, initiated a partner survey project as part of its three-year strategic plan. The survey revealed that several community organizations were feeling the impact of increasing rates of homelessness. 

Additionally, the annual Point-in-Time count showed that homelessness had more than doubled between 2010 and 2012, and something needed to be done. In response, CHT purchased a motel in 2013. CHT re-branded it to Harbor Place and made agreements with community agencies that they would send clients in need to the facility.

In addition to the UVM Medical Center, CHT engaged other community partners to make this effort a success. See the Partner/Role table.

Harbor Place's success strengthened the partnership between CHT and The UVM Medical Center. The two organizations moved forward with a second initiative, Beacon Apartments, which permanently houses residents who had been chronically homeless and medically vulnerable. On-site social services are provided by the Community Health Centers of Burlington and their homeless health care program. The UVM Medical Center has helped to fund these on-site services.

These partnerships continued and in December 2016, CHT acquired its third motel property as part of its strategy to combat chronic homelessness. The UVM Medical Center provided the capital for CHT to purchase and renovate the motel into eight apartments and pledged to pay the Community Health Centers of Burlington for medical and social work supports. Five of the eight apartments will be available for permanent housing for those who have been chronically homeless. The remaining three apartments, with seven total bedrooms are master leased to the UVM Medical Center to provide medical respite to those who are discharged from the hospital and have nowhere else to go.

The Impact

"We finally feel like we're home"

-Chuck Gratton and Laurie Pudvah

"Just knowing that when I get through my door I can close it, shut the world out and have all the comforts of home...it's just nice to sit back not not worry about where I'm going to bounce to next."

- Walter Putnam

Beacon Apartments, a converted motel in South Burlington, VT provides 19 permanent, affordable housing units to individuals who were chronically homeless and highly vulnerable. As illustrated below, the number of patient encounters decreased for patients after they moved to Beacon Apartments.

Please note: the direct cost and cost per visit charts depict an increase in the 91-120 days after moving to Beacon Apartments. This is due to an outlier that made the cost appear artificially high.

Challenges

There are many moving parts involved in executing these housing programs. The UVM Medical Center and its partners faced several challenges in the process:

1. The town in which Harbor Place is located initially objected to the zoning classification for short-term housing. To help resolve this matter, The UVM Medical Center's Chief Medical Officer accompanied leaders from CHT to a town meeting and articulated the importance of the facility. 
2. Finding the right individuals to staff the housing facilities can be challenging. Services at Bel Aire were delayed as the partner organizations needed more time to hire the on-site case manager.

Lessons Learned

1. Proactively identify the community-wide gap to solve.
2. Garner support from finance leaders by focusing on initiatives with trackable measures that link cost savings.
   
3. Create bilateral outreach strategy to implementation and influencer partners, especially when targeting stigmatized populations.
   
4. Hardwire clear communication channels, such as quarterly leadership meetings, to systematically break down silos.
   
5. Invest in building strong ties with community health centers, who are best-positioned to face the realities of vulnerable populations.