For two decades, CORE’s housing and health work has contributed to a growing body of evidence on the links between housing, health and other outcomes. Yet while consensus has grown around the importance of safe and stable housing for health, there remains much to uncover about the complex ways housing influences health care costs, access, and outcomes.
CORE remains at the forefront of this exploration. By collaborating with health systems and housing advocates, our researchers are delivering evidence on how housing affects health—and providing insights to help shape more effective and expansive interventions.
Below are several highlights from our housing and health portfolio. To learn more, get in touch with CORE!
- Re-entry housing: Strategies for housing individuals with criminal records
- Kaiser Permanente NW Community Health Housing for Health initiative
- Health in Housing study: The impact of housing on health
- Integrating housing & health: Bud Clark Commons
- Local housing voucher policies’ impacts on health care utilization
1. Re-entry housing: Strategies for housing individuals with criminal records
In 2021, we completed an evaluation of the housing impacts of the Re-entry Housing Collaborative, which sought to re-house individuals experiencing barriers to housing due to criminal records—a significant challenge that, due to systemic racism, disproportionately impacts communities of color. With funding from Meyer Memorial Trust, partners, including Urban League of Portland, ACCESS, and Sponsors, Inc., helped remove barriers to housing, such as prior debt, fines, and fees. They also provided case management and additional assistance with deposits, rent, and expenses.
Our findings, published in early 2022 in the Journal for Advancing Justice, demonstrated the substantial potential impact of targeted financial assistance combined with supportive case management, both in getting people housed and aiding in the re-entry process.
Key findings
- 63% of housed clients were housed within four months of initially engaging with the program.
- When combined with hands-on case management, relatively small financial interventions can make a big difference for clients facing housing barriers due to criminal history.
- Even when financial support is provided to clients, re-entry housing programs depend on staff capacity and case management infrastructure for success.
- Clients felt the program was critical to their re-entry process, including preventing recidivism and helping them feel better physically and mentally.
Publications & Reports
- Housing and Reentry: A Mixed-Method Evaluation of a Low-Cost Community-Based Intervention for Increasing Access to Housing Post-Incarceration
- CORE blog: Evaluating strategies for re-entry housing
2. Kaiser Permanente NW Community Health’s Housing for Health Initiative
Beginning in 2016, Kaiser Permanente NW Community Health created the Housing for Health initiative to address the housing crisis for Oregon and Southwest Washington’s most vulnerable community members, especially those with mental health and substance use disorders. Kaiser awarded $1.5 million in grants across seven community-based organizations to launch programs that provide housing and support through Traditional Health Workers (THWs).
KP engaged CORE to study the programs and their impacts. Our team analyzed and combined various data, including baseline and follow-up surveys, program and Medicaid claims data, and staff and participant interviews, to provide a more complete view of these programs, their participants, and outcomes.
Key Findings
Our results captured key process learning, including successes and challenges of implementing the THW model. We found that:
- Participants saw substantially improved outcomes, including less housing instability, continuous health care coverage, decreased self-reported arrests, and increased likelihood of meeting their health care and basic needs.
- The programs served clients with extensive histories of trauma and instability, as well as deep mistrust of the system.
- THWs built trusting relationships with participants and helped them navigate the complex housing, health, and social services system to connect to needed resources.
Publications & Reports
- Kaiser Permanente Housing for Health final report
- CORE blog: Housing for Health program delivers promising results
3. Health in Housing study: The impact of housing on health
This study, completed in 2016 in partnership with Enterprise Community Partners, was one of the first to assess the impact on health care costs when low-income individuals move into affordable housing. The research explored the link between affordable housing and health care through the lens of several national health reform metrics: better connection to primary care, fewer emergency department (ED) visits, improved access and quality, and lower costs.
The study included more than 1,600 Medicaid members and 145 housing properties of three different types: family housing, permanent supportive housing, and housing for seniors and people with disabilities. Medicaid claims data were used to measure changes in health care cost and use, and survey data were used to examine health care access and quality.
Key Findings
- Results showed that in the year after obtaining affordable housing, residents used more primary care, had fewer emergency department visits, and accumulated fewer medical expenditures than in the year before they moved in.
- Many residents also reported better access to care and quality of care.
- We also examined the impacts of the different types of services available at the properties and found that having health services was a key driver behind lower costs and emergency department visits.
Publications & Reports
4. Integrating housing & health: Bud Clark Commons
In 2011, Bud Clark Commons (BCC) began providing stable housing to some of Portland’s most vulnerable residents. BCC offers 130 apartments and supportive services, combining fully integrated services with a “harm reduction” model for its most vulnerable applicants. Over four years, CORE reviewed Medicaid claims data of 98 residents to reveal whether and how health care utilization and costs changed after moving into the property.
To provide an even deeper analysis, CORE used personal surveys with the residents to learn more about their health status, health care use and levels of trauma they had experienced in their lives and whether that changed after having permanent housing.
Key Findings
- Residents with Medicaid coverage saw significant reductions in medical costs after moving into BCC: the average resident saw a reduction of $8,724 in annual claims.
- We found evidence that residents maintained connections to outpatient behavioral health, primary care, and pharmacy after moving in but saw significant declines in inpatient and ED utilization.
- After moving in, residents maintained connections to outpatient behavioral health, primary care, and pharmacy but saw significant declines in inpatient and ED utilization.
- Interviews with residents also revealed some challenges of the supportive housing model.
- Some residents told us that getting clean and sober was actually more difficult than they expected in an environment where others are still actively using.
- Others mentioned feeling unsafe or threatened by others living in the building, which sometimes hampered their involvement in social activities or the use of other services. New strategies to overcome these challenges will help residents fully engage in the BCC model.
Reports & Publications
- Health in Housing: Exploring the Intersection Between Housing & Health Care
- The Oregonian: Study finds lower Medicaid costs for people who moved into Bud Clark Commons
5. Local housing voucher policies’ impacts on health care utilization
In partnership with two public housing authorities located in geographically adjacent cities, CORE conducted a natural experiment on the impact of two different Housing Choice Voucher prioritization policies on health care outcomes. Both organizations distribute vouchers by randomly selecting applicants from their waitlist; however, they prioritize different populations to obtain access to their waitlist. Housing Authority A prioritized seniors and people with disabilities, and Housing Authority B prioritized medically complex individuals and families with school-aged children.
Our team leveraged that random selection, using a natural experiment study design with an instrumental variable analysis, to assess the impact of obtaining a housing voucher on health care utilization. We then compared results between the two housing sites to assess differences in the impact based on the prioritization policies.
Key Findings
- Housing Authority A vouchers were associated with increased outpatient visits (OR = 1.19; P = 0.051)
- Housing Authority B vouchers decreased the likelihood of emergency department visits (OR = 0.61; P = 0.042).
- This study provides evidence that, while obtaining housing can result in better health care outcomes overall, local prioritization policies can influence that impact.
Publications & Reports
