The relationship between quality of housing and quality of life: evidence from permanent supportive housing

Abstract

ABSTRACT State Medicaid expansion, coupled with financial incentives from alternative payment models, have fostered an increase in housing programs supported and implemented by hospitals and health systems. Permanent supportive housing (PSH) can improve patients’ health, quality of life (QOL) and wellbeing, and reduce healthcare costs over the long-run. Yet, there is limited research to understand the challenges and opportunities that arise, particularly with regards to housing quality, when stakeholders such as health plans decide to operate PSH programs. We describe a PSH program administered by a large Medicaid managed care plan, serving individuals experiencing homelessness with complex medical histories, and outline participants’ perceptions (n = 22) on the relationship between quality of housing and QOL – including physical health, mental health and social wellbeing. Findings indicate perceived improvements in physical, mental, and social aspects of QOL were attributed to housing stability, location, and quality. However, participants also highlighted stressors perceived to diminish QOL, particularly issues with the location and physical characteristics of the housing environment, challenging relationships with landlords and perceived discrimination. These results offer policy implications, including identifying roles for local and regional stakeholders to improve PSH programs by enhancing housing inspections, code enforcement, and prospectively tracking participant QOL.