Housing and Nurses for Health: Moving From Traditional Care Settings to Where People Live

Purpose:

The value of nursing to reach beyond traditional care settings to promote health where people live was highlighted in a recent Robert Wood Johnson policy brief (Ladden & Hassmiller, 2015). As the nation’s largest body of health care providers with preparation for multiple levels of practice, nursing is best positioned to assume leadership in the current transition to population-focused, community-based, health care that aims to 1) improve the patient experience of care (including quality and satisfaction); 2) improve the health of populations; and 3) reduce the per capita cost of health care in the United States (Berwick et al., 2008). The Housing and Nurses for Health (HNH) partnership embodies these aims. Housing interventions can generate significant health savings (Fenwick et al., 2013). The purpose of this presentation is to describe the HNH model and evidence-based strategies used to integrate systems and coordinate care across sectors in the United States.

Project:

Residents of public housing properties demonstrate far greater need and wield far fewer resources than the general population. In Portland and beyond, many are elderly, disabled, and living below the poverty line. For most of the last decade, the University of Portland School of Nursing (UPSON) has partnered with county housing authorities throughout the Portland, Oregon metropolitan area to improve outcomes for low-resource housing communities. This innovative collaboration has come to be known as the Housing and Nurses for Health (HNH) partnership and has grown to include 17 housing sites wherein UP nursing instructors and students work alongside resident services coordinators (RSCs) to coordinate resident care.

In this innovative model, UP nursing students and faculty coordinate resident-patient care with RSCs, who are community residents at housing sites. RSCs offer residents and families assistance with job training, child care referrals, pathways to home ownership, case management, translation assistance, activities that promote a healthy community such as support groups, youth programs, social celebrations, and resident empowerment workshops. The HNH partnership has disrupted business as usual for both UPSON and housing authorities by integrating and reframing housing and health sector services and staff to work towards joint goals that support an overall mission of enhancing resident and community self-sufficiency. The partnership has five primary goals:

1. Improve resident experience of housing and health care
2. Improve the health of residents and the communities they live in
3. Improve resident housing stability
4. Reduce the costs of health and housing care
5. Prepare nursing students and resident service coordinators to address complex health and social needs of resident-clients

Implications:

Most health problems occur long before people interface with the healthcare system; suggesting interventions are needed outside the traditional healthcare system (Bambra et al., 2009; Williams et al., 2008).  Systematic reviews highlight housing and workplace innovations’ impact on the social determinants of health such as, housing quality, access to healthcare and quality of work, and on the health of specific disadvantaged groups (Bambra et al., 2009; Commission on social determinants of health, 2008; Thomson et al., 2009). Housing interventions can generate significant health savings (Fenwick et al., 2013).  Given persistent disparities and rising healthcare costs, there is a growing need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply available knowledge to improve the underlying conditions that impact the health of populations and reduce the duplication of health and social services.

 

The HNH Model is one example of how nurses are leading the integration of systems and coordination of care needed to improve the underlying conditions that impact the health of populations.