The relationship between quality of housing and quality of life: evidence from permanent supportive housing

ABSTRACT

State Medicaid expansion, coupled with financial incentives from alternative payment models, have fostered an increase in housing programs supported and implemented by hospitals and health systems. Permanent supportive housing (PSH) can improve patients’ health, quality of life (QOL) and wellbeing, and reduce healthcare costs over the long-run. Yet, there is limited research to understand the challenges and opportunities that arise, particularly with regards to housing quality, when stakeholders such as health plans decide to operate PSH programs. We describe a PSH program administered by a large Medicaid managed care plan, serving individuals experiencing homelessness with complex medical histories, and outline participants’ perceptions (n = 22) on the relationship between quality of housing and QOL – including physical health, mental health and social wellbeing. Findings indicate perceived improvements in physical, mental, and social aspects of QOL were attributed to housing stability, location, and quality. However, participants also highlighted stressors perceived to diminish QOL, particularly issues with the location and physical characteristics of the housing environment, challenging relationships with landlords and perceived discrimination. These results offer policy implications, including identifying roles for local and regional stakeholders to improve PSH programs by enhancing housing inspections, code enforcement, and prospectively tracking participant QOL.

KEYWORDS:

• Permanent supportive housing
• managed care plan
• housing quality
• qualitative methods

Disclosure statement

No potential conflict of interest was reported by the author(s).

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individuals included in the study.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This work was supported by Unnamed Managed Health Plan under contract number PSA_14AUG2018 (PIs Hunter, Cefalu).

Notes on contributors

Alina I. Palimaru

Alina I. Palimaru, Ph.D., M.P.P., is an Associate Policy Researcher at the RAND Corporation. She is a mixed methods researcher, including survey development and psychometric evaluation, and in-depth, focus group and cognitive interviewing. Her research focuses on health outcomes measurement, quality of life, and quality improvement. Alina has been studying the impact of quality of care on quality of life in the context of disabling pathologies (spinal cord injury), but also mental health and aging populations. She also co-leads the Housing and Homelessness Strategy Group at RAND, and has conducted several qualitative evaluations of housing programs in urban areas in the U.S.

Ryan McBain

Ryan McBain, Ph.D., M.P.H., is a Policy Researcher at the RAND Corporation. His research focuses on evaluation of programs and policies meant to reach vulnerable populations--including those coping with mental illness, HIV/AIDS, homelessness and poverty. To achieve this, Ryan uses a wide range of methodologies, including quasi-experimental methods, cost-effectiveness and decision analysis, and qualitative approaches. Ryan is also Director of Economic Evaluation at Partners In Health, a global healthcare delivery organization, where he has spent time evaluating national and regional healthcare delivery systems with respect to their cost and quality. His work has been published in journals such as The Lancet, WHO Bulletin, and Annals of Internal Medicine and has appeared in media outlets such as Huffington Post and U.S. News.

Keisha McDonald

Keisha McDonald, B.A., is a Survey Coordinator in the Survey Research Group at the RAND Corporation. She has over 7 years of experience in data collection. She has been involved with projects in areas of adolescent drug and alcohol use, adult alcohol use and patient experience of care. Ms. McDonald has experience working in a number of different modes including in-person, telephone, web and mixed-mode.

Priya Batra

Priya Batra, M.D., M.S., is a health services researcher, health plan administrator, and practicing women’s health clinician. Her work highlights how the implementation of health policies and health care delivery system innovations impact the social determinants of health.

Sarah B. Hunter

Sarah B. Hunter, Ph.D., is a Senior Behavioral Scientist at the RAND Corporation and Professor at the Pardee RAND Graduate School. Her primary areas of interest are improving services for vulnerable populations, building community capacity for evidence-based program delivery, continuous quality improvement, health care integration, implementation science, and program evaluation. She has used a variety of methods in her work including qualitative and quantitative approaches. She has published over 100 peer-reviewed journal articles, book chapters, and RAND publications in a wide range of fields. Hunter currently serves on the editorial board for the Journal of Substance Abuse Treatment. Dr. Hunter started working in the field of supportive housing for individuals experiencing homelessness in 2009 as an evaluation consultant for Skid Row Housing Trust, one of the largest providers of permanent supportive housing in Los Angeles County. In 2017, she and her colleagues produced a report on Los Angeles County’s Housing for Health permanent supportive housing initiative that described changes in county service utilization and health functioning among individuals enrolled in the program that has been featured in a number of media outlets.