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Denver Housing Authority and Denver Health Collaborate on Rx for Unsheltered Patients

By: Leslie Petrovski Posted on March 1, 2022

655 Broadway, which will house low-income seniors and patients who lack safe housing transitioning from Denver Health Medical Center

Seven thousand two hundred and sixty two. That’s how many people Denver Health Medical Center served in 2020 who reported, they had no homes. The number was likely higher, because it didn’t account for people staying with friends, family or living in motels.

While most of these vulnerable citizens were treated and discharged, some remained at Denver Health for varying amounts of time, not because they needed hospital-level treatment, but because they required follow-up care and lacked secure housing. That’s because hospitals can’t ethically or legally discharge patients who need ongoing assistance and lack a safe place to live. So hospitals keep them. Sometimes for weeks, months or in the case of one Denver Health patient, even years. Care costs for these patients can run into millions of dollars annually.

“A hospital bed,” observed Sarah Stella, a Denver Health hospitalist, ‘is the most expensive possible place for a community member who is unsafely housed to stay.”

Which is one reason why Denver Health, and other hospitals, are expanding their definition of health to include housing.

In 2022 Denver Health in partnership with the Denver Housing Authority and Corporation for Supportive Housing will open 14 hotel-like rooms in a building on their campus that DHA is redeveloping as low-income housing for seniors 62-years and older. While most of the 110 units at 655 Broadway will provide apartments and services for low-income seniors and people with disabilities, Denver Health will lease 14 specially designed units as transitional housing for patients who need additional healthcare and housing assistance.

“Denver Health has had a lot of people filling beds in the ER or elsewhere who they can’t discharge because they need a place where they can get supportive care,” explains Annie Hancock, DHA’s interim director of Community Connections. “They need something between independent living and skilled nursing or hospice care that’s a middle area between the two. The idea was to create this middle ground, a safe place to discharge people where they can work their way back to independence. The (Denver Health/DHA) partnership is born out of that.”

Which is one reason why Denver Health, and other hospitals, are expanding their definition of health to include housing.

In 2022 Denver Health in partnership with the Denver Housing Authority and Corporation for Supportive Housing will open 14 hotel-like rooms in a building on their campus that DHA is redeveloping as low-income housing for seniors 62-years and older. While most of the 110 units at 655 Broadway will provide apartments and services for low-income seniors and people with disabilities, Denver Health will lease 14 specially designed units as transitional housing for patients who need additional healthcare and housing assistance.

“Denver Health has had a lot of people filling beds in the ER or elsewhere who they can’t discharge because they need a place where they can get supportive care,” explains Annie Hancock, DHA’s interim director of Community Connections. “They need something between independent living and skilled nursing or hospice care that’s a middle area between the two. The idea was to create this middle ground, a safe place to discharge people where they can work their way back to independence. The (Denver Health/DHA) partnership is born out of that.”

The collaboration between the Denver Housing Authority and Denver Health may be the first time a local hospital authority and housing authority have joined forces to provide housing and services to patients experiencing homelessness. This new model represents an opportunity for Denver Health to reduce costs, open hospital beds, and serve these long-term patients outside the hospital setting, which typically is not the best place to recuperate. Long-term hospital stays increase the risk of infections, deconditioning, falls, and adverse drug events. Extended hospitalization is also extremely isolating. “Often, patients who remain hospitalized for an extended period do not go outside or even off their hospital unit for weeks to months at a time,” explained Stella. “This is a strain for anyone socially and emotionally.”

Housing is Healthcare

Denver Health isn’t the only healthcare organization to recognize that housing is good medicine. In fact, the National Health Care for the Homeless Council calls

housing, “healthcare,” stating that being without a home is a “dangerous health condition.”

Without a stable place to eat and sleep, it’s impossible to live a healthy lifestyle. For people experiencing homelessness every day is an assault on the nervous system. Living in encampments, shelters, or on the street exposes people to unremitting stress from crime, violence, unsanitary conditions and tumultuous weather. Without a home, people can’t maintain good nutrition, manage chronic conditions like diabetes, asthma, and high blood pressure or get proper sleep.

Studies of people experiencing homelessness show extreme disparities in life expectancy compared to the general population. Mortality rates for unhoused adults range from 4.5 to nine times higher depending on age with younger people succumbing frequently to drug overdoses and older adults dying from heart disease and cancer. The pandemic, too, killed unhoused people at vastly different rates. A 2021 study by UCLA discovered that unhoused individuals nationally were 30 percent more likely to die from COVID-19 than housed people. Overall, data shows, homelessness shortens lives — by as many as 20 to 30 years.

To manage chronic health conditions, unhoused patients turn to the ER, which can lead to a revolving door of treatment, discharge, and readmission, or long-term stays. So, hospitals are beginning to see their roles more broadly with some adopting the Housing First philosophy, which prioritizes permanent housing as a platform from which better physical, mental, and financial health — and lower costs — can spring.

University of Illinois Hospital and Health Sciences System, for example, invested in a program to transition unsheltered patients post treatment into permanent housing and surround them with services that included physical and mental healthcare and human services. The program has since been replicated by other Chicago-area hospitals, in Boston, Peoria, Illinois, and St. Louis.

Bon Secours in Baltimore has been working for years to develop affordable housing as a way to bolster overall community health. In Portland, Oregon, five hospitals and a low-income health plan banded together donating millions to build nearly 400 housing units for unhoused Portlanders. And in Durango, Colorado Centura Health’s Mercy Regional Medical Center worked to identify insecurely housed patients, collaborating with a local housing agency to get them housing vouchers — a move that enabled them to take better care of themselves and reduced trips to the ER.

Providing Healthcare and Housing

Located on the Denver Health campus, 655 Broadway looks like a lot of mid-century American office buildings — a 10-story, rectangular cuboid built in the 1950s — little to distinguish it but for the fact that it was Denver’s first glass-and-steel sheathed structure.

Over the years it’s seen various incarnations. Neil Bush, son of George H.W. Bush vice president at the time of the Silverado scandal, famously had an office there. Denver Health used the building for years to house administrative offices. But it’s stood vacant since the 2000s, while the hospital searched for a meaningful purpose. 655 Broadway was an ah-ha that was waiting to happen.

In 2020 DHA purchased the 655 Broadway building from Denver Health and Hospital Authority for $5 million through a 99-year ground agreement, with the hospital authority retaining ownership of the land. The redevelopment of the vacant ’50s edifice calls for creating 96 units that will serve low-income seniors whose incomes range between 20-to-60 percent of the Area Median Income. Another 14 single-room occupancy rooms on the building’s second floor will serve as transitional housing for people who need additional care and housing assistance when they’re released from the hospital.

“One big advantage is that the building is right on their campus,” observes Haley Jordahl, senior development manager for DHA. “While that resident is in the hospital, Denver Health can get them set up on Medicaid with home healthcare or mental health providers who will continue to provide care.”

The $20 million renovation will retrofit the vintage building into apartments and the single-room occupancy units for patients transitioning from Denver Health. Funded through a blend of tax-credit equity, tax credits for historic preservation (DHA is pursuing historic designation through the National Park Service because of the building’s architectural significance) and traditional financing, 655 Broadway will support itself through tenant rent, housing vouchers and income from Denver Health, which rents the second floor.

A history of the building will be displayed in the lobby area, which also features a community center, offices, a fitness room, mail room and other amenities. Systems and windows have been replaced for energy efficiency. Every floor will have a color theme, elevator lobby and seating area. Plus, the new exterior will replicate the building’s original, teal-colored sheathing, adding color to the corner of Speer Boulevard and Broadway.

“It’s ironic that the building that once housed Silverado Savings, the failed savings-and-loan and symbol of greed at the heart the 1980s S&L crisis, can now help some of Denver’s most vulnerable citizens,” observed Keo Frazier, DHA’s communications and public affairs director. “This project is a testament to so much creative thinking and heart. I hope it’s only the beginning.

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