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

Abstract

ONCERNS ABOUT HIGH PUBLIC system costs incurred by chronically homeless individuals have inspired nationwide efforts to eliminate chronic homelessness. 1,2 Homeless people have high barriers to health care access generally but use acute care services at high rates. [3][4][5] Mortality rates among homeless adults are 3 or more times that of the general population. 6,7 Chronically homeless people with severe alcohol problems, sometimes referred to as chronic public inebriates, are highly visible on the streets and are costly to the public through high use of publicly funded health and criminal justice systems resources. [8][9][10][11][12] Typical interventions such as shelters, abstinence-based housing, and treatment programs fail to reverse these patterns for this population. 10,13 Health conditions and mortality rates within this population are similar to those found in developing countries. 14,15 Average age at death is estimated to be 42 to 52 years, with 30% to 70% of deaths related to alcohol. 7,16,17 The provision of housing reduces hospital visits, admissions, and duration of hospital stays among homeless individuals, 5,18,19 and overall public system spending is reduced by nearly as much as is spent on housing. 19 One type

Risk factors for cardiovascular disease among the homeless and in the general population of the city of Porto, Portugal

“…In comparison with samples of homeless people described in other countries, our sample shows a similar distribution for most sociodemographic and homelessness characteristics 14,47,48 . The low proportion of women and low education level in both homeless samples is in accordance with previous observations 14,49 .…”

Daily Substance Use and Mental Health Symptoms among a Cohort of Homeless Adults in Vancouver, British Columbia

“…14 However, there have been a few reports where active substance users achieved residential stability in low-threshold Housing First models, with an accompanying decline in substance use over time. 2,15 Specific policies that address substance use in housing interventions would be a positive development. It is also critical to develop skills in understanding and addressing substance use and associated behaviors among persons who provide support and care to this population.…”

Homeless healthcare: raising the standards

“…16 The median number of drinks consumed progressively declined from 15.7 drinks per day to 10.6 drinks per day at 12 months, at a rate of approximately 2% per month.…”