A Hospital Offers Frequent ER Patients An Out — Free Housing

For a lot of us, the hospital's emergency room is a stressful place.

Not so for Glenn Baker.

When Baker, 44, steps into the emergency room at the University of Illinois Hospital in Chicago, he's completely comfortable.

He has a favorite double-wide chair in the corner, knows where to find the Cheetos in the vending machine, and the staff is like family.

Patty Zion, a nurse at the hospital on the West Side, says she knows Baker well: "He's one of our very famous patients who comes around and sees us quite often when he's not feeling well."

Baker has severe asthma and other chronic medical issues. But he's quick to admit he often ends up in this hospital not because he was sick, but because he was homeless.

"I would just try and fake an illness or something so that the hospital would admit me," Baker says, "so I wouldn't have to be on the streets when it was cold."

Baker says that last winter he spent about 20 nights every month checked into different Chicago hospitals.

In the medical world, patients like Baker are often called "superutilizers" or "frequent fliers" — people with a mix of chronic medical problems, mental health issues and homelessness that drive them to visit the hospital far more than the average patient.

There are thousands of these patients across the country. More than 55 million people are on Medicaid in the U.S. But according to a recent government report, about half of the program's annual resources go to just 5 percent of its beneficiaries.

This year the University of Illinois Hospital is trying something different to care for Glenn Baker and its other "superutilizers."

The hospital is paying to get them out of the emergency room and into housing.

"I think this is a program that is a win, win, win for everybody involved," says hospital CEO Avijit Ghosh. "Glenn wins, other patients who are in that same situation win, the hospital wins ... and I think society and the state win by the cost savings."

The hospital's pilot project is using $250,000 of its own money to get 25 patients like Baker into "housing first" style housing.

Along with an apartment, patients get a case manager who helps them do things like schedule doctor's appointments instead of going to the ER. The program is run in partnership with Chicago's Center for Housing and Health.

Ghosh is quick to note the program is focused on getting patients healthy — it's not simply a financial calculus. But he does point out that hospital care costs about $3,000 per day.

By contrast, the hospital pays about $1,000 a month for the patients' apartments.

"So you can see the difference between $3,000 a day, and $1,000 a month," Ghosh says.

And the program is already showing results: Currently, the health care costs of the 15 people the hospital has helped house so far, including Baker, are down 75 percent.

That's good for them, Ghosh says, and good for the hospital's other patients as well. "Quite often we are at capacity. So if we are using a bed for somebody who really doesn't need to be there, somebody else is forgoing the care."

Treating housing as part of a patient's health is an idea that has caught on in recent years, says Dr. Kelly Doran. She's an assistant professor of emergency medicine at the New York University School of Medicine who studies how homeless people use emergency services.

"The new thing here, really, is that the hospital is putting forth money for this effort," Doran says.

But for a program like this to work, there needs to be a long-term investment, Doran says. The Chicago hospital's pilot project is set to run out of funding by next summer.

"Housing is an intervention that goes on for many years," Doran says. "So, for how many years will they be paying for the housing? And after they stop paying, who's going to pay for the housing?"

Hospital officials say they are looking into ways to continue the project, but they pledge that nobody who has been housed already will lose housing if that does not happen.

The hospital's investment so far has got Glenn Baker into a light, airy one-bedroom apartment with a living room and kitchen.

He says he is thrilled to have a home of his own. Even if there are some things he misses about the hospital.

"This bed here is like, it's kind of firm," he says, laughing. "So, I mean, I would take a soft, comfortable hospital bed any day."