The University of Vermont Medical Center Addresses Housing Needs, Homelessness in the Burlington Area

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The University of Vermont Medical Center Addresses Housing Needs, Homelessness in the Burlington Area

While preparing its 2013 community health needs assessment, the University of Vermont Medical Center (UVMMC) conducted focus groups and a community survey that identified affordable housing as a major concern. The academic hospital, which serves nearly 170,000 residents in Burlington and the surrounding Chittenden County, considered affordable housing to be an important social determinant of health that should be addressed through community collaborations. In particular, UVMMC recognized that high rates of chronic homelessness led to increased use of the emergency department and longer inpatient hospital stays, which in turn raised healthcare costs and, in response, established its Housing is Health Care initiative. This initiative provides opportunities for UVMMC to partner with local organizations to develop stable and affordable housing that can facilitate convalescence and minimize the chance of relapse and re-admittance of patients experiencing homelessness. UVMMC has collaborated with the affordable housing nonprofit Champlain Housing Trust (CHT) and other community partners to develop three supportive housing projects. Converted from former motels, the projects provide 86 units of transitional and permanent housing along with case management and social services. UVMMC and its community partners attribute notable recent declines in the county’s rate of chronic homelessness to these supportive housing efforts.

Partnership with Champlain Housing Trust

As UVMMC prepared its 2013 needs assessment in accordance with the Patient Protection and Affordable Care Act, state and local social service agencies were confronting increasing rates of homelessness. From 2010 to 2012, Chittenden County’s population of persons experiencing chronic homelessness had doubled from 48 to 101. The state’s motel voucher program, which provides emergency housing when no shelter beds are available, increased 55 percent from 2011 to 2012, but it did not lead to stable housing outcomes for persons experiencing homelessness because support services were not provided. These trends also concerned CHT, which surveyed partner organizations, including UVMMC and social service providers, to discuss ways to improve the state’s emergency housing program. The group hoped to develop lower-cost short-term housing with supportive services that would lead to stable housing outcomes for persons experiencing homelessness.

Julie Cole, UVMMC senior community benefits strategist, says that UVMMC believed that support services were an important component of housing for persons experiencing homelessness, but to provide the services, the medical center needed a partner with housing expertise. When CHT, an affordable housing developer managing a portfolio of more than 2,000 units, approached UVMMC to support a housing project, UVMMC agreed to the partnership. In 2013, CHT and UVMMC began developing Harbor Place.

Harbor Place

Harbor Place is a former 59-room motel that CHT purchased for $1.85 million and opened as a short-term housing option for persons who are unable to secure housing when local shelters are full. Consisting of 39 single rooms, 12 two-room kitchenettes, and 8 one-room kitchenettes, Harbor Place also features a community garden, playground, meeting room, office for resident services, and green space. CHT manages the property and charges a rate that is approximately half of the state’s average motel voucher rate of $70 per night. This arrangement results in significant savings for the state, whose emergency housing program provides funding for most Harbor Place residents. UVMMC pays the rent for patients who are medically ready for discharge from the hospital but lack stable living arrangements. During Harbor Place’s first two years, UVMMC prepaid for a certain number of room nights but later transitioned to making reservations for individual patients. Typically, two to seven former patients stay at Harbor Place each night. The average length of stay for Harbor Place residents is 13 days.

Various providers are responsible for services at Harbor Place depending on residents’ individual needs and how the residents are funded and referred to the site. Discharged patients from UVMMC receive case management and health services from the staff of Community Health Centers of Burlington (CHCB), a federally qualified medical and social service provider. According to Margaret Bozik, director of asset management and special initiatives at CHT, residents are encouraged to use an assessment component of the county’s coordinated entry system to determine their service needs as well as secure permanent housing, a major goal of Harbor Place. When residents are ready to leave, an onsite service agency helps them identify permanent housing options.

Early data indicate that the supportive housing approach used at Harbor Place has measurably reduced healthcare spending. In a 3-year study completed in January 2017, UVMMC analyzed hospitalizations for 147 UVMMC patients discharged to Harbor Place in the 6 months preceding and following their stay. Inpatient admissions decreased by 65 percent, and hospital costs declined by 74 percent. Among those readmitted to the hospital after their stay at Harbor Place, costs declined 25 percent for an average savings of $3,658 per admission.

Permanent Supportive Housing

The success of Harbor Place encouraged UVMMC to support additional CHT projects. UVMMC and its partners recognized that access to permanent housing options would be critical for supporting persons experiencing chronic homelessness. In January 2016, CHT opened Beacon Apartments, a $1.1 million project that converted a motel into 17 studio apartments and 2 one-bedroom apartments of permanent supportive housing. CHCB provides onsite case management and social services, which UVMMC supports with an annual $100,000 payment to CHCB. The Chittenden County Continuum of Care conducts a survey to identify potential residents of Beacon Apartments — single adults who have experienced chronic homelessness and have medical vulnerabilities. The Burlington Housing Authority provides tenant-based rental subsidies through the Shelter Plus Care program and the Non-Elderly Disabled housing voucher program. Although UVMMC does not discharge patients to Beacon, several UVMMC patients have become Beacon tenants. As of July 2018, seven original tenants remain in the property and another seven have been living at Beacon for more than a year. Of the 15 tenants who have moved out of Beacon, 8 successfully transitioned to other CHT permanent housing or to other arrangements.

Bel Aire Apartments, another supportive housing project in UVMMC’s Housing is Health Care initiative, was developed by CHT and opened in August 2017 with permanent and short-term housing options. UVMMC covered the entire $1.6 million development cost after the Green Mountain Care Board, Vermont’s regulatory body overseeing hospital spending, allowed UVMMC to use excess revenue for this purpose. Bel Aire consists of 8 apartments designed to house 12 or more medically vulnerable and chronically homeless residents. Three of these apartments are for residents needing medical respite care after discharge from UVMMC, and five apartments are permanent housing units reserved for those identified through Chittenden County’s continuum of care. Bel Aire allows its medical respite residents to stay up to six months to address their healthcare needs while working to secure permanent housing. CHCB is providing onsite case management and social services, for which UVMMC has contributed $342,000. As with Beacon Apartments, the Burlington Housing Authority provides tenant-based rental assistance so that residents can find other affordable housing units when they decide to leave Bel Aire.

Ongoing Efforts to Address Housing Needs

Supportive housing projects assisted by UVMMC have had positive impacts in the community. In the 2018 annual point-in-time count, for example, Chittenden County’s homeless population had declined to 35, a reduction of 101 from 2015. UVMMC, CHT, and their partner organizations attribute part of this reduction to their coordinated efforts. Encouraged by this early success, UVMMC has invested in another housing-related initiative to address the social determinants of housing. For example, UVMMC contributed $250,000 to help develop a memory care facility in the town of Williston, which opened in December 2017 and serves Medicaid recipients with Alzheimer’s disease and other forms of dementia. UVMMC plans to continually evaluate the effectiveness of this and other housing projects to determine future investments.