HOME: Impact of Housing Transitions on Health Outcomes for Persons Experiencing Homelessness

About This Grant

Project Summary / Abstract Persons experiencing homelessness are far sicker, age faster, and die younger than their housed neighbors. Homelessness, a federally recognized social driver of health, is caused by multi-level, intersecting factors. Cross-sectional studies have repeatedly shown that persons experiencing homelessness have poorer health than their housed counterparts. For example, chronic conditions such as diabetes and kidney disease are increasingly common conditions among the aging homeless population, but their management is made harder by lack of stable housing. Further, the progression, morbidity, and mortality of these conditions is accelerated for persons experiencing homelessness due to reduced access to care and suboptimal treatment of risk factors including hypertension, chronic viral diseases, mental health conditions and substance abuse. While the detrimental impact of housing loss and improvement from gaining housing is conceptually clear, the evidence of the impact of these housing transitions remains sparse. Systematic reviews, consensus, and federal reports highlight gaps in research where little evidence exists to support that becoming housed improves health outcomes. Most research has focused on single-source data that represent only a snapshot of health – a substantial limitation given the reduced surveillance and access to regular care for persons experiencing homelessness – or come from pilot programs rather than real-world data. Thus, there remains a limited understanding of the longitudinal relationship between housing and health and a resultant lack of adequate targeted health care interventions. We will create a first-of-its-kind integrated dataset by harmonizing data from national, state, and local data sources and then use this dataset coupled with a novel qualitative approach to investigate housing status and health outcomes for persons experiencing homelessness. Our unique longitudinal data, transdisciplinary Housing and Health Advisory Board, and expertise of the study team will enable novel investigations of the health care needs of persons experiencing homelessness during times of housing transitions. Our study aims to (1) Develop a comprehensive and integrated housing and health dataset using real-world data from national, state, and local data sources, (2) Examine the impact of housing status changes, housing program participation, and social service support on health outcomes among persons experiencing homelessness with diabetes and kidney disease, and (3) Identify pathways, facilitators, and barriers that contribute to health care and outcomes for persons experiencing homelessness. This study will yield actionable information to guide clinics and providers in care for persons experiencing homelessness, isolate leverage points and propose interventions, and guide federal-, state-, and local policymakers and program administrators in ways to improve the health for persons experiencing homelessness.