Rutgers researchers outline strategies to improve health care for people experiencing homelessness

Partnerships between health care providers and homeless service organizations can improve access to medical care for people experiencing homelessness, according to a new study by Rutgers University researchers.

The study, published in The Milbank Quarterly, examined how cross-sector collaboration can help address the complex health needs of people without stable housing by combining medical care with housing-related services.

“Our paper describes how homeless services and health care providers are working together to tackle the challenge of providing healthcare to the unhoused,” said Joel Cantor, director of the Rutgers Center for State Health Policy, a distinguished professor at the Edward J. Bloustein School of Planning and Public Policy and a co-author of the study.

“With the right organizational and financial arrangements, organizations are demonstrating that it is possible to make effective use of limited resources,” Cantor said.

The findings come amid uncertainty for housing and health care providers, as advocates warn that potential delays in federal assistance and changes to harm-reduction policies could worsen health outcomes for people experiencing homelessness. An estimated 770,000 people nationwide — including about 14,000 in New Jersey — lack stable housing, researchers said.

People experiencing homelessness face higher risks of infectious diseases, injuries, overdoses, violence and premature death. Although the study was completed before recent federal policy shifts, Cantor said its findings remain relevant.

Despite the scope of the problem, the researchers noted that limited academic attention has been paid to the practical challenges of collaboration between housing and health care providers. To address that gap, Cantor and Michael Yedidia, a research professor at the Center for State Health Policy, conducted structured interviews with 24 administrators and frontline providers involved in eight New Jersey-based programs that integrate health and housing services.

The interviews, conducted between October 2023 and July 2024, explored why organizations chose to collaborate, how they sustained partnerships and how they financed services across institutional boundaries.

Cantor said that while the sample size was limited, the participants “are representative, not in a statistical sense, but in a qualitative sense of what’s going on in this field.”

Researchers identified several strategies linked to more effective collaboration, including matching services to client preferences, maintaining frequent interaction among partner organizations and co-locating health and housing services.

Meeting people where they are was especially important, Cantor said.

“Asking someone who hasn’t been able to shower for weeks to come to a clinic isn’t going to work,” he said. “Having nurses available in shelters is far more effective.”

The study found that many partnerships were driven by recognition of the strong link between housing and health, as well as the high cost and limited effectiveness of addressing medical needs without stable housing.

“There’s not much you can do if someone doesn’t have a place to live as they’re struggling with their own depression or anxiety or serious mental illness,” said one hospital program director interviewed for the study.

Cantor said significant challenges remain, including a shortage of affordable housing and resistance to homeless facilities in some communities.

“The availability of affordable housing is a longstanding and growing problem for a variety of reasons, from restrictive zoning and affordability to the NIMBY factor – people not wanting facilities for the homeless in their neighborhoods,” Cantor said.

He also cited cultural challenges within the health care system.

“Health care providers are used to dealing with people who are deeply focused on their health, and that’s not always the case with the unhoused,” Cantor said. “If I don’t have a place to sleep or enough to eat, how can I possibly think about seeing a doctor?”

Still, Cantor said collaboration remains essential as resources tighten.

As he put it, such partnerships are increasingly necessary as “money is going to get tighter everywhere.”

The study, Providing Health Care to People Experiencing Homelessness: Strategies and Challenges for Cross-Sector Initiatives, was funded by the Robert Wood Johnson Foundation.