New push offers housing and health care

Abram Nunn with Elica Health checks the blood pressure of a homeless man in Sacramento in January.
Abram Nunn with Elica Health checks the blood pressure of a homeless man in Sacramento in January.

Doctors, nurses and others who provide health care to the poor have long known that homeless people tend to be sicker – not only because living on the street is unhealthy but because it limits their ability to manage a chronic illness, take medication and eat a healthy diet.

But for years there was little that health care providers could do about the problem. Their job was to focus on a person’s illness. It was someone else’s job to help them find stable housing.

Now that’s changing. Health care providers are recognizing that it makes no sense to treat the same people for the same ailments over and over when those ailments could be prevented by changes before these patients reach the doctor’s office or hospital, even if those changes involve issues that have not historically been part of the health care industry’s duty.

Acting on their own, several California counties have been tearing down the barriers between their health and social services agencies. They’ve begun combining forces to treat a client as a “whole person” whose needs don’t begin at the door of a clinic.

And this year, the state and federal governments are getting into the act. As part of the Medi-Cal program, the federal government recently approved $1.5 billion over five years that the state will use to match local efforts to help stabilize the lives of the homeless and nearly homeless.

The funds will target people who are frequent users of emergency rooms, hospitals and nursing homes with avoidable conditions linked to their living conditions.

The money won’t pay for rent. But it will go toward a package of services that will help Medi-Cal patients find and keep housing. The goal is to improve health outcomes and improve people’s lives while reducing the cost to taxpayers.

Under the program, county workers or nonprofit contractors will sit down with clients and help them seek housing, fill out applications and, if necessary, meet with potential landlords. The caseworkers will also help the clients find money for security deposits, utilities, moving costs, furniture and modifications to make homes accessible to a disabled person. In some cases the Medi-Cal program will even pay for these one-time costs.

But the assistance won’t end when a person finds housing, because many low-income people with chronic illness, mental health or substance abuse issues cycle in and out of housing whenever a crisis arises. Social workers will coach clients on how to communicate with their landlords or property managers so that small problems don’t grow into big ones that can lead to eviction. They will also help them find and participate in mental health and substance abuse counseling, since these problems often lead to eviction.

The idea, in other words, is to provide all the services necessary to help the most vulnerable people in society keep a roof over their heads – not just because it’s the right thing to do but because it might also be a great way to reduce health care costs.

That might sound like common sense. But for government health care programs, it’s a radical idea. And one that’s been a long time coming.

Daniel Weintraub is editor of the California Health Report. He can be contacted at