Health systems across the country are testing new ways to help patients who are well enough for discharge but don't have a safe place to go find affordable housing, Markian Hawryluk reports for Kaiser Health News.

How to close the housing gap through strategic partnerships

The cost of having patients 'stranded' at the hospital

Hospitals under the Affordable Care Act are required to perform community needs assessments for their charitable efforts, which spurred interest in providing housing.

Patients with unstable housing have long presented a concern to hospitals, as hospitals must ensure that patients have a safe place to go before they're discharged, Hawryluk reports. That means patients who live alone but aren't equipped to care of themselves, are homeless, or have unstable housing can occupy hospital beds for months, even after their medical issue is "resolved," according to Hawryluk.

"Those people are, for lack of a better term, stranded in our hospital," according to Sarah Stella, a Denver Health physician.

But the decision to keep inpatients who don't need medical care can create downstream problems. Namely, it can force other acutely ill patients to wait to be moved to inpatient care because hospital beds are full.

And for hospitals, keeping these patients for an extended period of time often means a financial loss. "A patient lingering in a bed without medical problems doesn't generate much, if any, income," Hawryluk writes. 

According to Kim Reynolds, a researcher at the Urban Institute, housing issues are "on the radar of almost all hospitals." She added, "But it seemed like actually making investments in housing, providing some type of financing or an investment in land or something that has a good amount of value seems to be less widespread."

How Denver Heath is going into housing

To address issues of crowded hospital floors and revenue loss, many health systems are entering the housing business, Hawryluk writes.

One of these health systems is Denver Health.

In the first half of 2019, Denver Health, the largest safety net hospital in the city, treated more than 100 long-term patients. In all cases, the patients were initially hospitalized for a medical reason, but none of the patients had a medical reason for remaining in the hospital long term, Hawryluk writes.

One patient, for instance, was admitted for a bacterial infection and required eight weeks of at-home IV antibiotics, but because the patient had no home, the patient stayed at Denver Health. Another patient even stayed for a hospital record of 1,558 days, which adds up to more than more than four years.

To prevent these long-term stays, Denver Health is partnering with the Denver Housing Authority to turn one of the hospital's old buildings into affordable housing for seniors. The building would also include about 15 apartments reserved to help homeless patients transition from the hospital.

The hospital is selling the 10-story building to the housing authority with a 99-year lease on the land for a small fee, which "really lowers the construction costs" for the hospital, according to Ismael Guerrero, executive director of Denver Housing Authority.

When the renovation is complete in 2021, the housing authority will hire a coordinator and case manager to help patients with housing-related issues as well as their physical and behavioral health needs, according to Hawryluk. Hospital officials expect that, with assistance, the patients will leave the units within 90 days.

In addition, the hospital projects that the housing project will generate savings, Hawryluk reports. For instance, it currently costs Denver Health $2,700 per night to keep a patient in the hospital, costing an average total of about $200,000 for a patient who stays for about 73 days. In comparison, it would cost about $10,000 to put a patient in the transitional housing for a year instead.

"This is an experiment of sorts," said Peg Burnette, Denver Health's CFO. "We might be able to help better their lives, as well as help the financials of the hospital and help free up capacity for the patients that need to come to see us for acute care" (Hawryluk, Kaiser Health News, 10/4).