An effort by private clinics and hospitals in the southeastern Wisconsin region to find and stabilize housing for their most vulnerable patients is showing some initial promise, according to a study published this week, but a lack of affordable housing and emergency shelter space is limiting its overall success.
Authored jointly by the
Wisconsin Policy Forum (WPF) and nonprofit
IMPACT Planning and Evaluation, the report explores the landscape of health care-related housing initiatives and supports that are offered to low-income individuals in Milwaukee County, how those efforts can be improved, and how they are currently hampered. Its main focus is on the Milwaukee Health Care Partnership’s “Housing is Health” effort, which has aimed to improve health outcomes for low-income and underserved populations by addressing housing instability.
Launched in 2019, the program works with hospitals, community health centers and primary care providers to identify individuals who are homeless or at imminent risk of homelessness and connect them with services that can help them achieve housing stability.
When an individual who is homeless or shows housing vulnerability arrives for treatment at a participating hospital inpatient facility, emergency room, or safety net clinic, staff administer one of two different screening questionnaires to understand the individual’s basic housing needs. If the screening indicates that the patient is homeless or in danger of becoming homeless, a referral is made to coordinated entry (CE), a practice that the federal government requires to ensure there is a standardized process in place to assess homeless persons and refer them to appropriate interventions and supports, the report states.
Some impact
In its first year, HIH resulted in the referral of roughly 100 individuals or families. In 2020 and 2021, the program saw 300 referrals annually. In 2022, after the effort was expanded to include community health centers, like the Gerald L. Ignace Indian Health Center and Sixteenth Street Community Health Centers, and clinics, referrals more than doubled to 653.
Of the 653 individuals who were referred to CE in 2022, roughly 22% achieved a housing placement that was deemed “permanent” by the participating agency or program.
“There is no benchmark to determine whether that number or percentage of placements constitutes ‘success,’” the report states. “Still, given the myriad housing challenges facing HIH participants, and the challenges that public sector and community-based entities have faced in attempting to secure a sufficient supply of appropriate housing options, and resources for vulnerable individuals in Milwaukee County, an initiative that placed 142 individuals in permanent housing in 2022 certainly appears to be one that is making a positive contribution to efforts to combat homelessness in the county.”
Who they are
The majority of the 2022 referrals, about 53%, came from a hospital setting, while 36.4% came from clinics. Hospital systems were more likely to point to the frequent and often unnecessary use of emergency department and inpatient resources by homeless individuals, the report states, with housing services becoming a means to alleviate the strain on these hospital resources.
The study found that HIH primarily serves a population of individuals and families that are not actively employed, which in and of itself, may be a considerable barrier to future housing stability. Most of the 653 individuals or families served in 2022 – about 25% – had no income source, while 19% cited Supplemental Security Income (SSI) as their primary income source. Another 8.6% said their primary income was Social Security Disability Insurance (SSDI). Only 55 clients, about 14.7%, said they received income from employment alone.
Of the 397 referrals in which staff were able to determine the familial situation of a patient, about 60% did not have any other family member with them. The vast majority of remaining cases – about 21% – involved a mother with one or more children. Just over 9% were two-parent families. Eight pregnant women were referred to HIH in 2022.
Affordable housing challenges
Acknowledging that impact that has already been made, the report states that an important next step for the program should be to learn more about the individuals who received an initial referral but were not placed in permanent housing. It would also help to know more about the permanency of the initial placements that the 142 individuals who did receive housing referrals received. That would be achieved, the study's authors state, by tracking participants for some period of time after their successful engagement with the initiative.
But the overall challenge to addressing homelessness, the report emphasizes, is the lack of shelter space and permanent, quality affordable housing in Milwaukee County. Many of those interviewed by the WPF and IMPACT noted that services like housing navigation and case management mean little if there is no housing to which clients can be directed. They also added that patients with unique circumstances that make them ineligible for benefits or undesirable to landlords or shelter providers become nearly impossible to house.
Studying similar efforts in other parts of the country, the report noted that the HIH pilot might benefit from health care systems directly supporting and funding affordable housing projects as has been done in places like Denver and Atlanta.
Such projects would have an impact here as they would address the dearth of affordable and transition housing in the county, the report states.
