Boston Medical Center has long known that a stable place to call home is a critical component in one’s journey toward health. For 35 years, the Elders Living at Home Program (ELAHP) has addressed a key social determinant of health—housing—by helping more than 5,000 elderly men and women who are homeless or at risk of homelessness transition to and maintain permanent housing.
The Elders Living at Home Program was launched in 1986 to help tackle a burgeoning housing crisis in Massachusetts. With rent prices soaring across the city, local and national housing foundations noticed an alarming new trend: elderly men and women were becoming displaced from their apartments and forced to live in local shelters or on the streets. “It was the beginning of the first wave of gentrification in Boston and access to affordable housing was a really big barrier,” explains Eileen O’Brien, director of ELAHP.
The program receives a vast majority of its patient referrals—many of whom have low incomes, are non-English speaking or suffer from complex health issues—from the hospital and credits its long-term success in large part to its hands-on approach. Staff help patients by: walking them through the housing application process and gathering proper documentation; locating and securing housing; and ensuring patients who are placed in permanent housing have access to the services they need to remain stable. The team also performs considerable follow-up with each of the 250 to 300 patients they serve annually, staying in close contact for at least six to 12 months after placement to confirm they are doing well.
To ensure the success of their long-term housing arrangements, the team facilitates self-sufficiency by identifying, connecting (or even reconnecting) patients to support systems, such as their families, community organizations, food services including BMC’s Food Pantry and Meals on Wheels America, and legal aid. The group also builds trust and health literacy among patients with complex health issues.
“A lot of the folks that we’ve worked with have been failed, quite frankly, by other systems of care and that’s why they’re in the situations they’re in. So they don’t necessarily have a lot of trust in service providers,” explains O’Brien. “Our job is very much based on building relationships, which allows us to help our patients navigate these tricky and often overwhelming situations.”
In recent years, the program rolled out community wellness teams based at two elderly housing developments, which consists of a part-time nurse and full-time community wellness advocate. The team helps patients with care adherence, socialization and, with the help of external health care providers like discharge planners, safe home transitions after hospital stays. “People have said, ‘I would be going into a nursing home if I didn’t have this service.’ So it’s a way to better stabilize housing by helping to coordinate their health care and, in turn, improving their health outcomes,” notes O’Brien.
Like many services at BMC, ELAHP ramped up its efforts to address the growing needs and challenges brought on by the COVID-19 pandemic. Given the increased risk of contracting the virus or spreading it when living in shelters or on the street, the team sought ways to quickly place patients in stable housing over the last several months.
“We’re able to expedite the process a little bit and get people housed a little bit faster, but by and large it’s been really challenging,” says O’Brien. “People are at greater risk because family members have lost income due to the pandemic. Many are stretched thin in all kinds of ways. Those who have had stable housing prior to the pandemic are now in desperate need of finding something that’s safe and affordable.”
With the 35-year anniversary of the program upon them, O’Brien reflects on its many successes and the people they have helped along the way: “What we’re most proud of is that we’ve really made a difference for people who we’ve housed in the eighties, the nineties and over the last many decades—all whom are still stable, housed and healthy. A lot of people have passed on, but they passed on while being stably housed. They had a safe place to live. That’s something that makes me very proud.”
As for the next 35 years, the team hopes to see more options for long-term housing so there will be less of an urgent need for the type of services ELAHP provides. They also plan to continue to work alongside BMC in the fight for health equity. When stable housing is available for all patients, O’Brien believes anything is attainable. “If you don’t have a stable place to live, you really are struggling to access any other type of care or service,” O’Brien concludes. “By helping people stabilize their housing and adequately access health care services, we are giving everyone an equal chance to succeed.”
