February 12, 2020 -Making improvements to public housing may not have an impact on any specific healthcare condition, but housing quality certainly does affect net quality of life, according to data published in the latest issue of Health Affairs.

The healthcare industry has become increasingly concerned with affordable housing in recent years, as industry experts tout the importance of the social determinants of health and access to affordable, quality, and stable housing. Leaders say that individuals experiencing homelessness have more difficulty managing chronic illness as well as a higher likelihood of incurring costly acute care crises.

To address this issue, many hospitals, health systems, and payers have invested billions of dollars into creating affordable housing units. The logic holds that improving access to quality housing will save the stakeholders in downstream healthcare costs.

But what of older affordable housing units that have been serving vulnerable populations for decades? How can addressing the quality, not necessarily the amount, of affordable housing units impact patient health?

This is a real and pressing problem, the researchers explained. Currently, about 1.1 affordable housing units are facing nearly $50 billion in capital needs, per estimates from the Department of Housing and Urban Development (HUD).

Conditions in these buildings including broken elevators, leaks, old heating systems, and lead paint exposurepotentially threaten the health of the roughly 2.3 million low-income children and adults who live in public and other HUD-assisted housing, the researchers said. Moreover, many of these units will deteriorate further and become uninhabitable unless they are renovated.

And while making these repairs may not have a measurable impact on any one healthcare condition, it could have a significant effect on tenants quality of life, a key measure in patient experience and wellness.

Looking at a case study in New York City, the researchers specifically found nominal change in individual outcomes or utilization for asthma, anxiety or depression, injury, hypertension in adults, and acute respiratory infection.

However, they did find improvements in disease burden for each of those diseases, excluding hypertension in adults. This finding illustrates an improvement in quality of life, which is essential on the road to patient wellness and healthy lifestyle.

The researchers specifically looked at a New York City Housing Authority move from back in 2015, during which the Housing Authority sold 50 percent stake in six delipidated housing units to two private real estate development groups, establishing a public-private partnership for housing.

Through the partnership, the housing units received a renovation, including improvements to elevators, stairway handrails, heating and hot water systems, emergency generators, and roofs. The project also tackled more cosmetic changes, such as bathroom and kitchen repairs complete with new appliances, window replacements, painting, and air conditioning units.

The public-private partnership also resulted in exterior improvements.

Finally, New York City Housing Authority relinquished building management responsibilities to the private real estate firms, which revamped rent collection and other management issues.

On the whole, these changes improved patient experiences, quality of life, and in some cases, health.

This pattern of findings was not surprising, since we were examining the impact of broad-based renovations not targeted to address any particular health conditions or populations, and we observed people for only three years after the renovation was completed, the researchers reported.

It is possible that over a longer period and with a larger sample, we might have seen a significant impact on individual diseases as well as larger impacts on overall disease burden.

Of note, measures about emergency department or hospital utilization remained largely unchanged, the team found.

Patterns of health system usesuch as the proportion of residents visiting the ED or hospital appeared to be less sensitive to the renovations than disease outcomes were, the team said. This may indicate that peoples manner of engaging with the health care system is persistent, even when their mix of exposures, conditions, and overall well-being changes.

These housing interventions also made an improvement with overall patient satisfaction with their housing options.

Compared to individuals living in nearby affordable housing complexes, more intervention patients said they would recommend their complex to a family or friend, 54 percent versus 83 percent, respectively. Only 18 percent of intervention residents reported plans to move, compared to 34 percent of those in nearby affordable housing complexes.

See the rest here:
Housing Fixes Boost Quality of Life, Limited Impact on Outcomes - PatientEngagementHIT.com