Originally posted on AAMC.

For Megan Sandel, MD, a pediatrician at Boston Medical Center (BMC) and principal investigator at Children’s HealthWatch, a nonpartisan network of children’s health researchers and policy experts, the benefits of stable housing go far beyond dollars saved. In a 2017 JAMA paper, she notes: “The return on investment involved in expanding affordable housing cannot be fully measured by portfolio profits or even by costs saved by addressing the root causes of residentially insecure families’ health needs. It is also measured by building healthier communities — with plenty of safe, decent, and affordable housing — to improve the well-being of children who, if nothing changes, may be the future’s most expensive patients.”

Innovative approaches

As recognition of the link between health and housing has grown, health systems have taken a variety of approaches to address housing insecurity.

BMC has a long history of partnering with local community organizations to address homelessness. In the mid-1980s, hospital administrators noticed that many of Boston’s frail elderly were being displaced from their apartments. Working with the Boston Housing Authority, the hospital established the Elders Living at Home program in 1986 to assist these vulnerable patients, providing intensive case management and housing assistance. Since that time, the program has helped more than 2,000 homeless elders find permanent housing.

Building on the success of that program, BMC has since expanded its efforts to assist the city’s unhoused population. Since 2017, the hospital system has invested more than $6.5 million in affordable housing initiatives, partnering with the Boston Housing Authority, Cambridge Housing Authority, and Boston Health Care for the Homeless Program; community development organizations including Nuestra Comunidad Development Corporation, Madison Park Development Corporation, and Codman Square Neighborhood Development Corporation; and affordable housing developers including The Community Builders, among others.

“If you don’t have a stable, decent, affordable home, then most of the health care interventions that we would typically provide just don’t work as well,” Sandel says. She gives as an example a person with heart failure, for whom the primary treatment might be diuretics — medications that prompt a person to urinate more frequently to get rid of excess fluid so the heart doesn’t have to work as hard. Someone without stable housing might not have frequent access to a bathroom, and so might choose not to take the medication, which results in them becoming sicker and ending up back in the hospital. “I sometimes joke that we house people very effectively,” Sandel says. “We just house them in the most expensive places, like inpatient units and emergency departments.”