It is because we know better is always possible. An economy that works for the middleclass means a country that works for everyone. Not in spite of our differences but because of them. More of both of those things. After 10 years of mr. Harper, so do we. I am in this and i want to be your prime minister. Mr. Wells thank you, mr. Trudeau. This concludes the first debate of the campaign. The whole experiment was a bit of a new experience for everyone concerned and i want to thank the leaders for the faith when participate. Good luck on the campaign trail. On behalf of macleans, i want to thank the viewers for tuning in tonight. Be sure to visit the ma macleans website. Stay tuned. I am paul wells. Good night from toronto. [captions Copyright National cable satellite corp. 2015] live now to the Russell SenateOffice Building where the alliance for Health Reform is holding a discussion today on how homelessness impacts the health care of individuals. Ed howard on your screen now giving introductory remarks. There is a connection between health and various social determinants. Be will be looking at the nature and the strength of that connection. In this briefing, and in the subsequent ones in the series. Something you may have seen yesterday, new york city mayor bill de blasio announced at 22 Million Program to connect more Homeless People with Mental Health care. I think just another sign of growing activity at every level to connect the dots. I hope ae will shine lot of light on that topic. Our discussion will center on how housing stability impacts Health Outcomes and health care costs. A look at medicaids role in adjusting the problem. And, how much flex ability to is an federal policy to allow states and communities to meld careing and health streams. Importantly, we want to look at what the obstacles might be the biggest obstacles to making these two Program Areas compatible. We are pleased very much to acknowledge support for todays program by the centene corporation, one of americas operatesnsurers that medicaid and other programs and two dozen states, i believe. Before we get to the program, let me do a little bit of housekeeping. In your packets, there is important information, including speaker biographies, onepage material lists in your kids, and the powerpoint presentations and hardcopy, so you can follow along. There will be a video recording of this briefing available on the alliance website. Allhealth. Org. Probably monday. Followed by a transcript a few days later, along with all of the materials in your kit, along with materials that we think might be helpful to you. At the appropriate time, you can ask our panel a question by filling out one of the green cards that are in your packets, or you can come to the microphones. There is one on either side of the room. You can use the he althandhousing to tweet o tweet generally. If you are watching on cspan, and want to ask a question, you can also tweet a question. At the end of the briefing, there is a blue evaluation form in your packets that i would very much appreciate your filling out, so we can improve these briefings, and target them to the needs of the folks who come and need some guidance. Lets hear from our very well panel. D ba i will give them inadequate introductions, and i will do it aly so we do not disrupt the flow of the discussion. We will start with barbara dipietro, director of policy at the National Healthcare for the Homeless Council. She is also active in the health maryland. Omeless of she has a multilevel perspective on how to deal with these problems. We have asked barbara to highlight the connection between health care and housing in general, white is important, and state,nities on the federal, and local levels to address it. Then, we will hear from jennifer ho, Senior Adviser for housing and services to hide secretary Julian Castro hud secretary Julian Castro. She will describe how her agency and others are collaborating on health and housing issues be a gretchen hammer will be next. She is director of colorados department of Health Care Policy and financing. We have asked gretchen to tell us about colorados efforts to Bridge Health and housing policies, and what gets in the way of those efforts. Our final panelist assister adele osullivan, a family physician, and founder of circle the city, a phoenix nonprofit that brings private and public sectors together to help those experiencing homelessness and illness. Describe thewill innovative model and what gets in the way of this approach. We have come to the part of the program that actually has some substance to it, and that is to say, barbara dipietro. Barbara. Dipietro i appreciate so may people being here today. Shows the importance that housing has on Peoples Health status. The National Healthcare for Homeless Council represents Health Centers and the homeless patients that they serve, about 250 nationally. Over one million patients are being seen in americas Health Centers each year. Of their and breath knees, specifically because of a lack of housing, is really an issue for not only Health Centers, but for the larger Health Care Industry that we are looking to change. One of the things that might not housing ise is how health care. Back in the 1980s, the institute of medicine did a study looking at that impact. They found three major findings. Causesthe core health homelessness. Typically we were seeing a spiral of people with an injury or illness, unable to work. When you are unable to work, of course the work goes away, you get fired or laid off, o and you can no longer bring in income. Soon after that, you cant make rent or mortgage. You move in with friends, pretty soon that doesnt work out, so you slide into a shelter situation or on the street. We also see the congress. Homelessness causes for health poor health. If you can imagine living on the it is or in a shelter, stressful. If you did not have issues before, you tend to develop issues when you are homeless. It is very hard to be on the street and exposed to extremes of weather without getting hospital visits tend to be frequent. High pressure. If you want stress before you must housing, you get stressed out. Develop, orends to depression. Lack ofo think about housing, gives treatment. We are putting billions of dollars into our Health Care Industry every year trillions. None of that funding works well and efficient as Health Care Providers. Nothing we do works well with someone who lives on the street. Every time we turn somebody in recovery only to discharge them to the street, we have complicated, and in fact compromised, the treatment we have just affected. What we discharge people to shelters or the street, the care that we just paid for is compromise. These are the things that are all bundled up together in the intersection of health and housing. We really need to appreciate how that throughy housing. One of the things we are seeing, as again, we represent the nurses, and the workforce that goes behind caring for these patients. Not surprisingly, is very high rates of acute and communicable diseases. Respiratory illnesses. All the things you would expect. Infections from cuts you cant keep clean on the street. Try being diabetic with needles on the street. The rate at which we replace medications is astronomical because of the rate that they are stolen. When you cant keep things safe when you cant keep medications refrigerator, it is very difficult to maintain compliance to your health care. How many times has anyone here got to the doctor and then prescribed medication that requires them to go to the bathroom more often . No need for a show of hands. That is not possible when Homeless People did not have the opportunity to go to the bathroom. Life in ar private public space can be extremely an a decent. What we see is Health Care Providers and their clients come in and say, i did not take that medication because otherwise i would get arrested, or i was afraid of getting arrested, or he had nowhere to go, or my meds were stolen. This is what we hear. We see when we look at the literature, the literature shows that people who are homeless have chronic disease three to six times more than other people. Diabetes,ill asthma, hypertension, high cholesterol, heart disease, and all the rest, but at higher rates. We see a lot of intensive needs to coordinate this care. We see both extremes of a use of a Health Care System. We have the high end user, where we are putting a lot of money into a small number of people that we need to stabilize, but we also see People Living on the outskirts of our society who avoid the Health Care System, but have intensive needs, usually in the Mental Health and Substance Abuse areas. How is it that we reach those people . When we look at a hospital systems, hospitals are really strapped. When you are a hospital, what are you supposed to do when you have no safe discharge option for a client that is ready for discharge. It is illegal to discharge to the street, but as anything else else, what dohing you do for someone who does not have a place to go. These are the real issues that Health Care Officials are struggling with two friday capacity to have safe and ethical treatments for people. Whenso see people that they are ill, it is very difficult to get out of homelessness. When you are fighting an addiction or illness, it is very hard to get off the street. This is just one example of how in a health care population, highers people have rates of just about every disease you can imagine. This brings us to Supportive Housing. When we think about what is Supportive Housing, typically it is helpful to think about in terms of a traditional model that emphasizes recovery first. Traditionally, in our communities, we require people to get clean and sober, enter into treatment, and be successful with that before we give them into a housing unit. If everyone follows the rules, and continue to follow the rules, maybe one day you could be in independent housing. While that works for some, where it didnt work was for people who have really Serious Health care conditions. It is hard to get clean when you are living on the street. Thatrtive housing slips model. It is not timelimited. Frankly, any number one of any of us can go home and have a drink. That is perfectly right in our home. It needs to be an opportunity. We need to work with people where they are in the stabilizing unit of housing, so they have a place to put their medications, to put an appointment card. We have a stable place to visit them. Our outreach workers cant find people when they are shifting around in the street. We need to think about how are we supporting housing in this way. A wide range of teambased way to make this work. When you combine the stability of housing with healthcare helpces, we can really people be stable in a housing. This is mainstream right now for seniors and people with disabilities. My grandmother can have meals care. Med to her, in care think about extending the into this population so we are both supporting the housing and services that people need. Relapseto talk about is part of recovery. These are the kinds of things we need to expect. Recovery and Mental Health and ction does not look like black and white. It looks like a struggle. Can just one slip up jeopardize housing and are you back in the street. It is really important that we are able to work with people and adjust services. Again, there is no requirement to sobriety and the services are voluntary. When we find is that people are very excited when they get into a unit. So many things look possible that didnt before. We have been evaluating the effects of housing for about 25 years now. Consistently, what we find is housing improves health, and it improves health i outcome and lowers the cost of health care. I think this is where we need to be thinking. We are so focused on cost, understandably so, but we need to think about it where is it that we can make inroads and partnerships. You can read this site here. Our consistent findings on all of these issues. Again, we want to focus on how is it that bringing these two sectors together is really bringing out the things that we need. There are a lot of opportunities at both the federal, state, and local level. Your states are working on strategies to end homelessness, and to improve health. We also look at greater determinants of health. What are the things that i think is important, particularly here in d. C. To remember, we need federal support for the housing piece. My colleagues will talk a lot about what they are seeing in their sectors. That are being required by sequestration, if we dont have the Housing Support amount of our Healthcare Services will make this work well. We need these to come together. Another thing that i would really recommend as a second point,t as a takeaway for all of you who are health staffers, get to know each other. You have a lot in common. A lot of times we are not talking together at the federal level it like we asked people to do at the local level. Really, what we are doing at the federal level is that bridge between build that bridge between health care and housing. We are in a rapidly changing environment. A whole is system as changing. We are focused on outcomes and costs, but we also need to focus on really potable people, i getting them what they need. Nothing works well as a Health Care Provider when people are living on the street. We really want to b the orient to housing as a health care intervention. My colleague will talk about how hard they have focused on building this bridge, but really as an illustration of making this model work. Myant to point out that m colleague, matt, if anyone is interested in learning more about this, matt will take your card. Mr. Howard we will turn to jennifer ho. i am jennifer ho, the d secretary. I like to joke saying that im the one person that knows the difference between medicare and medicaid every day. You know what im talking about, dont you . Iy background is actually spent my first 10 years and care in managed care. It was in that way that i was brought to a table to consider link between homelessness and health and the impact that Public Housing would have on health. I have a doing that ever sense for the last 18 years i have been doing that ever since for the last 18 years. I want to assure you that there is an unprecedented level of andaboration between hud hhs. Not just because that is my job, but because it really is the case. Hud is talking to the center for medicaid almost every day. Were talking to folks at , at the and medicare ndministration on children and families almost every day. I know and feel sometimes that housing and health care are miles apart, and no one is talking, by want to promise you that in this administration, there is an unprecedented level of cooperation. Civil fact about how we invest in things federally that Health Care People dont always know. You operate in a world of mandatory budgets and in tyler programs. Iseral Housing Assistance the only benefit that is not an entitlement. When someone becomes eligible for medicaid or medicare, they get it. A voucher forout housing option, you get in line. We ask congress to invest more in housing, they worry about the renewal burden, the fact that this increases our total budget in future years. Something i like to call keeping people in their homes. The conundrum is that hud pays for a lot of services that medicaid could pay for. Medicaid has a lot of financial incentives for there to be more affordable and accessible housing, and the budget environment is such that we are not doing what we know works, and not at the scale that matches the needs. That is why im excited to be here with you today. Your interest in housing could help create the consensus that we need to make the investments that matter. Thanks for being here, and thanks for allowing me to be on this incredible panel. I will talk about how this plays out in three areas aging, disability, and homelessness. Americans are living longer, and the babyboom will test our commitment to the relationship between housing and health. As we go older, we are more likely to live alone, have more Chronic Health conditions, and less of mo mobility, and we go poorer. The number of eligible households for assistance will in 2030. Between 2011 fory, we provide assistance 1. 2 million seniors. One out of every three singers who is income eligible. That means that we would need 900,000 more subsidized Housing Units by 2030 just to keep up with one in three people who need it getting it. We have not made significant new investments in housing for seniors in some time. Think about where you live today , or what your parents or grandparents live. Less than one half of 1 of existing housing is currently accessible to someone who uses a wheelchair. Only 5 o is livable for someone who has mobility impairments. Most american existing Housing Stock is not designed for them to age in place safely. Imagine twentysomething Million People over the age of 80 fall, and they cannot return to their home, or they dont fall, but they just cant affo