Hospitals, Housing, and a Failure of Governance

It appears that hospitals are getting into the housing the homeless business (boldface mine):

In the first half of this year alone, the hospital treated more than 100 long-term patients. All had a medical issue that led to their initial hospitalization. But none of the patients had a medical reason for remaining in the hospital for most of their stay.

Legally and morally, hospitals cannot discharge patients if they have no safe place to go. So patients who are homeless, frail or live alone, or have unstable housing, can occupy hospital beds for weeks or months — long after their acute medical problem is resolved. For hospitals, it means losing money because a patient lingering in a bed without medical problems doesn’t generate much, if any, income. Meanwhile, acutely ill patients may wait days in the ER to be moved to a floor because a hospital’s beds are full…

To address the problem, hospitals from Baltimore to St. Louis to Sacramento, Calif., are exploring ways to help patients find a home. With recent federal policy changes that encourage hospitals to allocate charity dollars for housing, many hospitals realize it’s cheaper to provide a month of housing than to keep patients for a single night….

Hospital executives find the calculus works even if they have to build affordable housing units themselves. It’s why Denver Health is partnering with the Denver Housing Authority to repurpose a mothballed building on the hospital campus into affordable senior housing, including about 15 apartments designated to help homeless patients transition out of the hospital…

It costs Denver Health $2,700 a night to keep someone in the hospital. Patients who are prime candidates for the transitional units stay on average 73 days, for a total cost to the hospital of nearly $200,000. The hospital estimates it would cost a fraction of that, about $10,000, to house a patient for a year instead.

“The hospital really is like the most expensive form of housing,” Stella said.

When you first read the piece, it seems like one of those slightly contrarian, win-win pieces whose unconventional solution is supposed to make people feel good (it’s a good business model for writers!). But don’t be fooled: this is a complete failure of governance. Governments, whether through the private or public sector (a subject for another post), should not have homeless citizens. This is a policy failure. Turning it over to some asshole with a blog:

Yet like many problems Trump raises, he’s not wrong to say it’s [urban homelessness] a failure, even if his solutions are monstrous and his motivations vile. Homelessness is a massive failure of governance, especially at state and local levels. In many places, one could blame divided government: the state government, controlled by Republicans, might be starving municipalities for funds. But California is nominally controlled top to bottom by Democrats and has been for a while (arguably, the two-thirds majority required for tax increases limited Democratic initiatives for a long time, but important subtleties like that will get lost in the political weeds). Yet the state and its cities have failed on the whole. It’s very difficult to build market-rate housing in most Californian cities. It’s even harder to build a homeless shelter (got NIMBY?).

This is another manifestation of the crisis in governance in the U.S.

Democrats, and not just the ones operating at the national level, need to learn that, if they don’t solve (or at least significantly reduce) problems, Republicans–usually the worst of the lot–will propose solutions that will be awful in so many ways. Democrats, especially at the state and local levels, needed to be much more effective when it came to urban housing, but, instead, treated homelessness as ‘normal.’ The trouble with normal is that it always gets worse.

I realize Democrats often have to fight so hard just to prevent things from getting worse, but rank-and-file Democrats, especially in Democratic strongholds, really need to start to hold Democratic office holders accountable for policy failures. The failure to build enough housing is definitely one of those policy failures.

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