Topic: Homelessness

This report addresses the question of whether health service use and health service costs fall as a consequence of supported entry to public housing for formerly homeless people and those at risk of homelessness. It also examines the health and social outcomes of formerly homeless and at-risk of homelessness tenants.

An important benefit of the present study compared with previous Australian studies is the use of linked housing and health administrative data. The large sample size increases confidence in the findings presented because a larger number of clients and experiences are able to be investigated and the rigour of statistical analysis is improved.

The study links Western Australian person-level health service system records with person-level public housing tenancy records and tracks the health service use patterns of 983 NPAH and 2,400 priority housing (homelessness) tenants before entry into housing and following entry into housing. On the basis of the linked health and housing data in Western Australia, our study finds that the provision of public housing for NPAH program participants as well as those entering public housing through priority housing (homelessness) was associated with reduced health service use (both in the proportion using services as well as frequency/duration of use) in the year following entry into public housing as compared with the year prior to entry.

In particular, significant reductions were evident, pre- and post-entry into public housing, in the proportion of NPAH program and priority housing (homelessness) tenants accessing an Emergency Department (ED), an Intensive Care Unit (ICU), or psychiatric service or mental health provider, staying overnight in a hospital, or having a prescription for opioid dependence. There was no significant change for hospital in the home (HITH) services. Reductions in the frequency of visits to an ED or ICU, the duration of time spent in hospital, in psychiatric care or with a mental health service provider and the mean number of prescriptions for opioid dependence were also observed, with only an increase, post-entry into public housing in average days per person/per year utilising HITH services.

This study also provides an estimate of the potential economic impact of the change in health service use associated with provision of public housing and NPAH program support for homeless people and those at risk of homelessness. The overall decrease in frequency and duration of health service use, comparing the year prior to and the year following entry into a public housing tenancy, results in a combined potential health system cost saving in Western Australia of $16.4 million per year or $4,846 per person per year. If priority homeless clients are excluded; the change per person with NPAH support is nearly triple this at $13,273 per person per year. The large cost offset is primarily related to reduced health service use among clients of the NPAH Mental Health program, where potential health savings amount to $84,135 per person per year. Across all NPAH programs, the change in stays in hospital ($3,114 per person per year) and in psychiatric care ($1,558 per person per year) account for the vast majority of potential health cost savings.

The average cost of providing support under the NPAH programs examined is estimated as $6,462 per person per year (2009–12). This is less than half the potential health cost offsets associated with the NPAH programs ($13,273 per person per year (2012–13)). In particular, the large estimated health cost offset associated with the NPAH Mental Health program ($84,135 per person per year) suggests a large potential positive impact on government budgets is associated with this program. Cost savings of the kind identified in the present study are presently not identified in government budgets. The estimated cost savings simply accrue to the health service system and result in more needs being met in the health care system than would otherwise be the case. In short, more resources are freed up in the health system to meet health needs because of a successful housing and homelessness program.

The aim of the 50 Lives 50 Homes project (hereafter referred to as 50 Lives) is to house and provide support to 50 of Perth’s most vulnerable homeless people.

This research report constitutes the first of three reports for the evaluation of the 50 Lives. 50 Lives is a cross-sectoral collaborative project between a range of Perth-based agencies, including Ruah Community Services (which provides backbone support to the project) and, 27 other partner organisations to date, including, homelessness support services, community mental health services and government housing and health services.

The aims of this evaluation are to determine: 1) how effective and efficient the 50 Lives approach is in providing sustainable housing and wellbeing outcomes for the most vulnerable rough sleepers; 2) the impact of the 50 Lives project on client health, mental health, wellbeing, housing and justice outcomes; 3) the economic and social impact of the 50 Lives project; 4) the extent to which the 50 Lives collaboration enables improved service efficiencies and new innovative ways of working to improve client outcomes and addressing homelessness, and; 5) the main challenges and barriers to the 50 Lives project in efficiently and effectively providing sustainable housing outcomes for the most vulnerable rough sleepers.

The primary focus of this first evaluation report is to provide baseline data pertaining to objects 1 and 4. The evaluation of the 50 Lives project is being conducted by The Centre for Social Impact University of Western Australia (CSI UWA) with collaborators from Royal Perth Hospital (RPH), Homeless Healthcare (HHC) and the UWA School of Population and Global Health.

This evaluation has been designed as a longitudinal study and has utilised various sources and collection methods to measure the impact of the 50 Lives project. This includes data from the Vulnerability Index – Service Prioritisation Decision Assistance Tool (VI-SPDAT); client satisfaction surveys; de-identified administrative data from RPH and HHC; data from the Ruah After Hours Support Service (AHSS); in-depth interviews with 50 Lives clients and case studies on the working groups. The VI-SPDAT will be re-administered with the 50 Lives clients in early 2018, enabling comparative analysis and measuring changes in outcomes over time.

Overall the evaluation takes a realistic evaluation approach and recognises that there are a range of factors that influence the extent to which positive outcomes are attained for a client and this will be monitored over the course of the evaluation.