Housing Support through Healthcare
An urban hospital system reduced non-medical emergency department utilization by providing stable housing to patients experiencing chronic homelessness.
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The Problem
The University of Illinois Hospital and Health Sciences System (UI Health) serves as more than just an emergency department (ED) for patients experiencing homelessness. In 2015, nearly half of UI Health’s 100 most frequent ED utilizers were individuals experiencing homelessness. Many of these patients were utilizing emergency services for non-emergency issues like leg pain or diarrhea, and even non-clinical needs such as obtaining food and a warm bed for the night.
Providing emergency care for non-emergency services can be costly for health systems. Thirty-two percent of patients experiencing homelessness (about 200 total patients) utilizing UI Health for medical care were in the top 10th decile of the most expensive patients. On average, the cost of patient care for patients experiencing homelessness was 76 times that of patients with stable housing, with annual costs ranging from $51,000 to $533,000 per patient. Additionally, 11 to 14% of these costs were uncompensated, accounting for $636,000 to $855,000 in unpaid medical costs annually.
ED providers and UI Health leadership understood that it is difficult to provide medical care that treats a patient’s underlying condition effectively when basic health-related social needs, such as stable shelter, are not met.
The Intervention
To reduce healthcare costs and provide stable housing for patients experiencing homelessness, UI Health partnered with the Center for Housing and Health (CHH) through their Better Health Through Housing (BHH) collaborative.
UI Health screens patients for BHH eligibility during medical encounters. Eligible patients include individuals who are chronically unhoused (experiencing homelessness for at least 12 months or having had at least four instances of homelessness in the past three years), visited the ED at least three times in the last year, and have a disabling condition such as substance use disorder, mental illness, or physical illness. BHH utilizes the Housing First Model where participants receive housing regardless of sobriety status or adherence to mental health treatment. Once screened eligible, candidates are reviewed by a committee of providers, including emergency medicine physicians and social workers, and are then referred to CHH for housing placement.
As the lead agency of BHH, CHH convenes the multi-agency collaborative, creating a network of supportive housing options for eligible individuals. Once the referral is received, the CHH team connects with the patient to identify housing preferences and case management needs. Patients choose from available apartments across Chicago and receive intensive case management to support daily activities, such as navigating medical appointments and paying bills. Patients are able to utilize the rental subsidies and case management provided by BHH for up to three years.
Costs And Funding Structure
- $250,000 – $350,000 invested annually by UI Health
- $1,000 estimated investment per patient per month
UI Health’s initial partnership and investment aimed to support 26 patients experiencing homelessness who frequently utilized ED services. UI Health initially provided BHH with $1,000 per month for each patient, representing an initial investment of approximately $250,000. This investment was significantly lower than the average $3,000 per patient per day that UI Health was spending when those patients utilized ED services.
As a result of BHH’s success, CHH created the Flexible Housing Pool of Chicago and Cook County in 2018 to assemble and coordinate funds for stable housing solutions. Additional funders of the Flexible Housing Pool now include the City of Chicago, Cook County, managed care organizations, hospital systems, Healthcare Transformation Collaboratives, private philanthropy, the Department of Housing & Urban Development, and the State of Illinois. Since 2015, UI Health has helped stably house 130 individuals while contributing $350,000 annually to the Flexible Housing Pool.
Value
Financial
- 67% reduction in costs accrued by the health system during the pilot phase
- 35% reduction in emergency department visits
- Higher rates of patients accessing primary care clinics for routine care
Economic
- Two additional hours saved per encounter for staff who previously managed non-clinical social crises in the ED
- Increased ED clinical capacity due to decreased non-emergent caseloads
- Improved ED provider morale and satisfaction resulting from meaningful social support options
Social
- 80–90% of participants retained stable housing for more than one year
- Improved quality of life reported by participating patients
UI Health observed a noticeable decrease in non-medical care utilization and realized substantial cost savings as a result of BHH. Because a significant share of the ED’s most frequent utilizers were individuals experiencing homelessness, reducing visits for non-medical reasons improved ED operational efficiency, lowered overall utilization, and reduced system-wide expenditures. Supporting an individual’s rent for a month proved far more cost-effective than absorbing multiple ED visits over the same time frame.
Staff satisfaction and capacity also increased. Prior to the program, staff spent an average of two hours more per visit addressing the complex needs of patients experiencing homelessness compared to patients with stable housing. Staff previously reported low morale when treating returning patients experiencing homelessness because they could not resolve the underlying social conditions driving the medical visits. With fewer repeat visits for non-medical needs, clinical teams reclaimed time, expanded capacity for acute care, and experienced higher job satisfaction. Furthermore, BHH reported that 80 to 90% of participants retained stable housing for one year or more, assisted by intensive case management covering daily living, medical appointment adherence, and financial management.
Lessons Learned
- Housing First requires intensive case management to achieve long-term stability. Providing patients with stable housing regardless of sobriety or mental health treatment coupled with dedicated case management is essential in supporting long-term housing stability.
- Partnering with multiple community organizations allows patients to choose where they live. Working with a diverse group of housing partners ensures a wider variety of options across the city, centering patient preferences such as living or staying in their preferred neighborhood.
Resources and Continued Learning
American Hospital Association. (2018, March). Case Study: University of Illinois Hospital & Health Sciences System’s Better Health Through Housing Program. https://www.aha.org/news/insights-and-analysis/2018-03-06-case-study-university-illinois-hospital-health-sciences
Center for Housing and Health. (n.d.). Flexible Housing Pool. https://housingforhealth.org/our-work/flexible-housing-pool/
Cook County Government. (2026, August). City of Chicago and Cook County Health Release Report Demonstrating Health and Social Benefits of Flexible Housing Pool and Need to Diversify Funding Support. https://www.cookcountyil.gov/news/city-chicago-and-cook-county-health-release-report-demonstrating-health-and-social-benefits
Healthcare Financial Management Association. (2017, December). UI Health Cuts ED Homeless Patient Costs by 45 Percent. https://www.hfma.org/operations-management/cost-reduction/57148/
UI Health. (n.d.). Better Health Through Housing. https://hospital.uillinois.edu/about-ui-health/community-relations/better-health-through-housing
University of Illinois College of Medicine. (2024, September). Innovative Housing Solutions Aim to Improve Patient Outcomes and Decrease Unnecessary Hospital Visits. https://chicago.medicine.uic.edu/emergency-medicine/news-stories/innovative-housing-solutions-aim-to-improve-patient-outcomes-and-decrease-unnecessary-hospital-visits/
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