Piloting a Housing Support Navigator Program at a Safety Net Hospital

Area of Science:

• Healthcare Innovation
• Social Determinants of Health
• Patient Navigation

Background:

• Homelessness significantly worsens health outcomes and increases healthcare usage.
• Current social worker and case manager roles are often insufficient for complex housing needs.
• A pilot intervention introduced a novel housing support navigator (HSN) role within an electronic medical record system at a safety-net hospital.

Purpose of the Study:

• To pilot a novel housing support navigator (HSN) role within a safety-net hospital's existing electronic medical record workflow.
• To address the inadequacy of existing roles in meeting the complex housing needs of homeless patients.
• To evaluate the feasibility and initial impact of the HSN role.

Main Methods:

• Surveyed social workers and community health workers to identify housing resource demand and barriers.
• Developed a new HSN role to utilize the Homeless Management Information System for patient referrals and resource connection.
• Tracked HSN referrals from 2021-2022 and conducted a point-in-time count of patient housing needs.
• Collected descriptive data on HSN referrals, including demographics and discharge locations.

Main Results:

• Nearly 50% of patients referred to the HSN were successfully connected to housing resources (e.g., shelters, nonprofit organizations).
• Key challenges encountered included managing timely referrals during short inpatient stays.
• Securing stakeholder buy-in presented another significant hurdle in the pilot program.

Conclusions:

• The housing support navigator (HSN) role shows promise in connecting unhoused patients with essential housing resources.
• This early innovation report provides a foundation for other institutions seeking to implement similar roles.
• Further research is needed to assess the long-term impact of HSN utilization on patient health and healthcare utilization.