A qualitative evaluation of Housing for Health in Los Angeles County

ABSTRACT

Homelessness is a widespread and challenging social and public health problem across the United States. Homelessness exacerbates poor health, social, and economic functioning. Permanent supportive housing (PSH) is a housing program model that provides housing as well as a range of supportive services to address co-occurring physical, mental, and social needs. The Housing for Health (HFH) program is modeled on PSH and was launched by the Los Angeles County Department of Health Services in 2012 with the aim of providing permanent supportive housing to individuals experiencing homelessness identified as frequent users of health services. This study uses data from 14 qualitative interviews with senior leaders and nine focus groups with tenants and program staff to understand tenant experiences with HFH and non-HFH programs, as they relate to care coordination. We report linkages to care and social services, variations in care coordination intensity, and the impact of workforce issues on tenant experience. The findings from this study underscore the value of housing programs that promote care coordination across service delivery sectors, and that adopt person-centered approaches to care. Lessons learned from programs like HFH are relevant for many stakeholders that may become providers of housing, as incentivized by recent Medicaid expansions.

KEYWORDS:

• Homelessness
• permanent supportive housing
• housing first
• tenant experience
• qualitative research

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Robert Wood Johnson Foundation under Grant [73693] awarded to Los Angeles County Department of Public Health, and Contract Number [PH-002796-W4] awarded by Los Angeles County Department of Public Health to UCLA Center for Health Policy Research.

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.

Kathryn G. Kietzman

Kathryn G. Kietzman, Ph.D., M.S.W., is a senior research scientist at the UCLA Center for Health Policy Research and an associate researcher in the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Her research agenda focuses primarily on the long-term health and social care needs of physically, socially, and financially vulnerable populations, including older adults and people with disabilities who rely on public programs and other informal supports to maintain their independence.

Nadereh Pourat

Nadereh Pourat, Ph.D., is the associate Center director and the director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research. She is also a professor of health policy and management at the UCLA Fielding School of Public Health, professor at the UCLA School of Dentistry and a member of UCLA/Jonsson Comprehensive Cancer Center, Division of Cancer Prevention and Control Research. Pourat's research focuses on assessing disparities in access to care of underserved populations, including the role of the health care delivery system in disparities and health care outcomes. Pourat has also closely examined the current efforts in primary care redesign including implementation and outcomes of patient-centered medical home, safety-net system integration, and care delivery challenges and the outcomes of these efforts on access to care of underserved populations.

Ricardo Basurto-Davila

Ricardo Basurto-Davila, Ph.D., M.S., is a Principal Analyst in the Los Angeles County Office of the Chief Information Officer. He has experience leading research and evaluation projects at various government levels in the US and other countries. Basurto-Davila’s areas of expertise include health economics, program evaluation, and outcome-driven performance measurement.