Opinion: A housing first policy will save lives among Utah’s unsheltered population

The life expectancy for those experiencing homelessness is 50 — that’s two decades younger than the general population

(Leah Hogsten | The Salt Lake Tribune) The area behind Rio Grande Depot at 500 W 300 S, where homeless individuals live in makeshift tents and shelters, Dec. 16, 2022.

Housing takes precedence in the political sphere of Salt Lake City. Along with the rest of the nation, housing prices for both renters and potential buyers are prohibitively high. We are already seeing the effect of the lack of affordable housing with shelters consistently full and the growing encampments dotting the streets.

With more people experiencing homelessness, Salt Lake City can expect an increase in patients in their emergency departments.

Housing and healthcare are intricately intertwined. The life expectancy for those experiencing homelessness is 50, two decades younger than the general population. Both the unsheltered and sheltered homeless encounter more exposure to communicable diseases, harsh weather conditions, violence, drug use and malnutrition. People without housing are also more likely to be without health insurance; exacerbating any symptoms or conditions someone has by failing to seek out care or delaying treatment.

This lack of care mixed with the increased vulnerability results in homeless individuals requiring more frequent and longer hospital visits. People experiencing homelessness are three times more likely to use the emergency department in one year than the general population. The frequency of hospital visits is also increasing for the homeless. According to the Centers for Disease Control and Prevention, there were 141 visits to the hospital per 100 people experiencing homelessness in 2010-2011, which rose to 310 visits in the years 2020-2021.

It’s rare that an unhoused person leaves the hospital with their physical and/or mental health problems solved. They typically have multiple issues, called co-morbidities, that require specialists, medication management or referrals to mental health treatment centers that are rarely addressed in one emergency hospital visit. If they are addressed, it is a monumental task getting an unhoused person to follow-up appointments, still with limited or no insurance.

Lack of full treatment coupled with the rise in homelessness will perpetuate more emergency hospital visits. What can be done to alleviate the homeless healthcare fallout? Salt Lake City can implement more permanent supportive housing with the “housing first” model.

In 2015, Utah took center stage in national news for drastically decreasing homelessness when it first adopted the housing first approach. This approach is as it sounds: Provide the homeless with housing before you address their other needs. Permanent, supportive housing gives those who are chronically homeless and disabled, the most frequent users of hospitals, access to services such as case managers to help them navigate community, state and federal resources to get them on track.

A study of those who moved into permanent supportive housing saw their emergency department visits decrease by 37%, as well as cost savings of $84 per month if they were on Medicaid. The city’s financial incentive? Housing first initiatives can save $23,000 more per consumer than a shelter program.

In 2023, 74 people died while experiencing homelessness in Utah. The “housing recession” that many were hoping for is not expected any time soon. More people will lose in the fight for the limited affordable housing, and we ought to be worried about the death count that will be reported this year.

Melissa Weegman

Melissa Weegman is in the master of social work program at the University of Utah. She has worked in social services for the past six years, most recently at The Road Home, where she was a supervisor of the permanent supportive housing case managers and saw the impacts of what lack of housing can do to one’s health.

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