Cross-silo Partnerships Boldly Tackling Inequities in the Midst of the Pandemic

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New COVID-19 hospitalization data shine a stark light on the connection between homelessness and poor health.  The Minnesota Department of Health found that people residing in homeless shelters who were diagnosed with COVID-19 were 4 times more likely to be hospitalized and 3 times more likely to be admitted to an intensive care unit (ICU) than the overall population of Minnesota residents with a COVID+ diagnosis.  The hospitalization and ICU rates for people living unsheltered were even worse:  almost 10 times more likely to be hospitalized and 7 times more likely to receive treatment in an ICU. 

While attempting to manage the massive and complex response to the pandemic, states and local communities continue to wrestle with how to align responses to the toxic stew of health, housing, and financial crises into which our most vulnerable neighbors increasingly plunge.  Siloed policy, planning, and administrative structures hamstring state and local efforts to integrate housing, healthcare, employment, and other solutions for the enormous pool of people who either live on the verge of homelessness or have already fallen over the edge—a pool so large in many communities that it has overwhelmed local homeless response systems.  Yet, in the midst of the current COVID-19 crisis, innovative and heroic cross-sector collaborations have emerged, and these efforts can provide inspiration for working successfully across silos as the pandemic recedes and its aftermath for our most vulnerable comes into better focus, especially within neighborhoods where large numbers of Black, Brown, and Indigenous people reside.

This month’s newsletter spotlights several examples of successful cross-sector innovation addressing the decades-old public health crisis of homelessness.  The featured articles, briefs, and webinars shared below show how developing strong, collaborative relationships among even a few leaders working in different sectors can make a huge difference.  These relationships can speed the process of getting COVID-19 vaccine to people living unsheltered, quickly stand up non-congregate shelters to protect those people living homeless who are most at risk from dangerous COVID-19 complications, and dramatically decrease the time it takes to house and provide intensive and ongoing supports people with chronic medical, mental health, and/or substance use conditions.  I hope these examples prove helpful.

  • A Minnesota Department of Health presentation (starts at 18:10 into the video) provides a thorough description of how Minnesota created an integrated, multi-faceted strategy to increase the rate of COVID vaccination among people experiencing homelessness in both urban and rural communities across the state.  Blaire Harrison and Elizabeth Dressel describe how they pulled together public health departments, community health centers, Medicaid managed care plans, and for-profit healthcare providers after reaching out to communities and identifying the gaps that could not be addressed by any one sector alone. Critically, the presentation starts with a compelling statement explaining why and how Minnesota centered racial equity in this initiative:  

The Minnesota Department of Health acknowledges that structural inequities result in poor health outcomes across generations. These social, political, and environmental inequities have been exacerbated by the SARS-CoV-2 pandemic.

 To ensure equitable vaccine access, we commit to continuing to name systemic racism in health care, the ways in which individuals and families experiencing homelessness have been made to be vulnerable to COVID by the systems we work in every day, and the valid distrust in public health by many who live and work in homeless service settings and encampments.  

  • Strengthening Partnerships for Better Health Outcomes During COVID-19 is an excellent brief recently prepared by Barbara DiPietro, Ph.D. and the National Health Care for the Homeless Council and released by the National Alliance to End Homelessness.  It spotlights successful cross-sector community initiatives in Atlanta, Chicago, and the State of Connecticut, all aimed at improving health care quality and outcomes for people experiencing homelessness during the COVID-19 response by strengthening partnerships between homelessness assistance systems and health care providers.  The brief also describes how each community specifically worked to address health outcome disparities impacting Black, Brown, Indigenous, and other marginalized groups.
  • A recent Los Angeles Times article spotlights a highly unusual cross-sector partnership to build up to 1,800 units of supportive housing for homeless people without government construction subsidies.  Initiated by Homeless Health Care Los Angeles and a private market developer, the highly collaborative partnership also includes a group of Los Angeles church leaders, a social-impact investment manager, and managed care organization Kaiser Permanente, which is the largest investor.  The partnership is on track to build supportive housing units much faster and at a much lower cost than those financed through traditional government programs and to provide on-site services under the auspices of Homeless Health Care.

Other Articles

A Compassionate and Effective Port in a Storm: The Case for Investing in Medical Respite Care for People Experiencing Homelessness

Stories like the one related by Dr. Leslie Enzian during a panel discussion at this month’s annual Washington Conference on Ending Homelessness have helped me appreciate the critical role that medical respite care (aka recuperative care) plays in homeless response systems. Medical Director of Seattle’s Edward Thomas House medical respite program, Dr. Enzian joined Washington Health Care Authority Deputy Chief Medical Officer Dr. Charissa Fotinos, Ben Miksch of United Health Care, and myself to talk about medical respite care’s unique approach and contributions to local COVID-19 responses. We also discussed efforts to bring medical respite care to a scale that can better meet community demand — in Washington and around the country. Early in the discussion, Dr. Enzian described the experience of Edward Thomas himself, the African-American formerly homeless man for whom Seattle’s medical respite care program is named and who granted permission to share his background and path to stability. Depicted in the photo above, Mr. Thomas…

2020’s Converging Housing, Health Care, and Racial Inequity Crises

The current pandemic has shined a spotlight on pre-existing structural problems that lie beneath the massive inflow of people into homelessness and how federal policies perpetuate them.  In a brief slide deck, I recently highlighted for Congressman Derek Kilmer how federal labor and housing policies seed homelessness, particularly for Black, Indigenous, and People of Color (BIPOC), making it virtually impossible for many communities, even those with robust homeless services systems, to keep up with the inflow of new people losing their housing and needing shelter and other assistance. 

The Capitol

A Public Health Lens on Homelessness Exposes Problems with the Trump Administration’s Proposed Approach

A recent
University of California study titled Health
Conditions Among Unsheltered Adults in the U.S.
brings into focus
public policy blind spots that make progress challenging for clinicians and
other professionals working to end homelessness.  Personally, the study’s findings evoke a
question that preoccupied me during my tenure as director of a 10-agency
health care network
treating over 21,000 unduplicated homeless individuals
per year: Why do policy debates about homelessness pay such scant attention
to significant health needs that both precipitate the loss of housing and
create daunting obstacles to regaining stability after an individual or family has
become homeless?