“It doesn’t matter why someone doesn’t have housing, what matters is that they need housing.”

Healthcare outcomes are tied to housing. So shouldn’t we include adequate, autonomous housing as a way to improve the overall health of our communities, and reduce the burden on strained health care resources? How can we, as business leaders and community members, achieve this goal and similar ones?

Mina Raver and the 2000 Days Project:


Transcript and notes:


Recorded 26 July 2022


Hi, everyone. Thanks for tuning in.

I saw a tweet this morning that talked about health care and housing teaming up. And I was really curious, because a couple of weeks ago, one of my partners and I spent- I don't know, a couple of hours in the evening- just daydreaming ourselves into a world where we could do whatever we wanted to, to alleviate the housing crisis. And we kind of sketched out a whole map of what a housing-first strategy might look like. One that was actually effective, one that actually address the needs of the people who were being served. You know, that kind of thing.

And it was so invigorating for me, it was so nourishing and hopeful and healing for me to imagine a world where that was possible. Because it is possible. Like, none of the things we imagined are weird, or outlandish, or out of technological reach. They're all very concrete. And so anytime I see something with a strategy, especially a housing-first strategy, I'm very intrigued.

So I read this thread about Kaiser, of all companies. Or maybe it was an article- about Kaiser, of all companies, teaming up in several places in the US, and then a couple of other healthcare- major healthcare- institutions, teaming up with housing folks to link the data about good health care outcomes with housing. Which I think should be obvious, right?

It shouldn't take any explaining, to figure it out that health care and housing are linked. That if you receive someone in the emergency room, and you offer them treatment, and then you discharge them onto the street, that that's a problem. And they're probably going to have trouble maintaining whatever healthcare outcome you managed to achieve for them. Or the people end up in the hospital because they don't have housing in the first place. Or, I mean- so much. And it's so obvious.

So I was thinking about that thread and thinking about the ways in which that ties into this work, because of course- I am... and the idea that an institution like Kaiser, right? Kaiser is a huge healthcare institution. I had never heard of it before I talked to my mom about healthcare, and she had heard of it because she grew up on the west coast. But it wasn't really a thing on the East Coast when I was growing up. So I had to kind of learn about Kaiser and Kaiser's model.

And I mean- they provide very good middle of the road care for some people. They don't deal with exceptions well. They don't deal with kind of erratic idiosyncrasies well. There's a lot that could be improved. So don't take this as an endorsement of Kaiser and their health care. However, the idea that we could get major institutions all working together, because one outcome affects the other outcome.

Having housing means that there's less load on the hospitals. Having hospitals discharge people into housing means that their work is more successful. They have fewer repeat patients.

I did my internship for chaplaincy, as part of my ministerial training, in a hospital that was not a trauma 1 hospital- some of my peers did their internships in places like Rush Memorial, which is a trauma 1 hospital. They deal with all the major trauma cases. My hospital didn't deal with that. So we had a lot of the kind of lingering challenges. The less urgent cases that people who just came back over and over again.

Sometimes people called them frequent fliers at the hospital. Just people who have a condition that's deteriorating, because they don't have the resources to not have it deteriorate. Not because it necessarily had to deteriorate. Some diseases, we don't know how to treat really well. And so they do get worse over time. But other diseases, other conditions, if you treat them right, they stabilize. They don't get any worse. And someone can live for a very long time without having the consequences of that condition getting worse.

And most of the people we saw didn't have the resources to back themselves up like that. Most of the people we saw had to make do with what they could. They were doing that thing where they ration their medications when they're not supposed to, because they weren't sure if they would be able to afford the next round of meds. Or they would come to the hospital because they couldn't afford to do the care they were supposed to be doing at home. And so it would get worse. And they'd come in and we treat them and they'd leave. And it would get worse, and they'd come in.

And we also had people- I was primarily on the oncology and long-term condition ward. And so we also had people who just had, you know, cancer or kidney failure or something else that that kept them coming back. And there was nothing that anyone could do about it. It was better for them to be home when they could be home, but they had to come in.

But thinking about the ways in which we, as business owners, as heads of institutions, as power holders in larger institutions, can impact major issues, is, I think- a really- to me, it's really nourishing. Because so much of our existence, even when we do hold power, and we're aware of it, even when we do run a company, even when we do make life better for our employees and our clients or customers- taking it that extra step and saying, "Okay, how can this impact the world?" Mina Raver is doing some incredible work around this with the 2000 Days Project. Shout-out to her, you should definitely check her work out as well.

When we think about how we, as leaders, can impact the world as leaders. Not just by affecting the people that we have direct contact with. But by, you know- imagine if the entire health care lobby got behind Housing First. Just imagine. Or even two thirds of it. Or even just Kaiser. Even just Kaiser. Imagine if they started promoting housing-first policies in government. Because we know that they're lobbying. And I'm not thrilled that they're probably lobbying against universal health care.

But if they are going to lobby, let's get them lobbying for something good. So I'm actually excited about the possibility here, even though I don't really trust large healthcare institutions to do what's best for the people, because I think there's too much of a profit motive behind them.

But, but Okay, fine. Here we are in this timeline, where I don't really trust the government to distribute equitable care and support either. And at least here's an institution that's recognizing that their effectiveness in the community and their ability to support the community and their ability to have the right number of beds for the communities that they serve, hinges on the community's ability to support itself, to take care of itself. People's ability to have the kinds of environments that will nourish them and support them outside of the hospital. That's food, that's housing.

And that's housing with autonomy, I want to be really clear: that's housing with autonomy. Because so often, housing supports come with these absolutely asinine restrictions. You have to, you know, arrive by a certain time and you can't leave all night. You have to leave by a certain time and you can't be there all day. That's true of a lot of shelters. You can't keep stuff in your room, you can't eat in your room, you can't do this, you can't do that.

You can't have pets. There's a whole- I got into this on a Twitter thread- there's a whole thing about pets, right? Because pets are often people's companions. They're family members. And you can't, like- people will choose not to be housed, if it means that they have to give up their pets. And a lot of folks will say, "well, then they're choosing not to be housed." And No. No. They're choosing not not to give up their family member. It's a kind of Sophie's Choice, and it's absurd. And we have to recognize that.

So when we create solutions, and when my partner and I were dreaming solutions, we were dreaming solutions that were based in autonomy. That were based in humanity. That were based in treating people like they are in fact, whole adults, with whole capacities to have opinions and want to make their own decisions and want to keep their own schedules. Also, a lot of the easiest jobs to get are nightshift jobs. And if your shelter only allows you to sleep at night, you've completely lost the ability to apply for any job that requires you to travel there or be there overnight.

So the number of kind of ridiculous in loca parentis mechanisms that get put in place- I mean, I know that people have reasons that they think they're doing that. But those, those ends aren't actually served by those rules.

So when we think about this, bringing it back to us, when we think about this as leaders, and especially if you are at the head at the top of a large organization- when we think about this, we have to really examine not just- in the case of Kaiser, you know- "we're good for our patients, we're good for our stakeholders across the board, and we're good for our employees..." All of those are important things to consider, especially if you're large institution, that's a lot of impact right there.

But then also, like, we could turn our considerable lobbying power to getting housing for our community. That helps us all. We could turn our considerable power to changing people's attitudes about people who are houseless. We could change from making it an identity thing or a moral blame judgment thing, which it is so often, into: it doesn't matter why someone doesn't have housing, what matters is that they need housing.

We can solve the other problems, once they have stable housing. Once they're no longer afraid that the paperwork that they've spent months accumulating will be seized and destroyed in a police raid. That their, you know, precious few belongings will be, you know, torched. That their little tiny community will be disrupted and ripped apart. We need to not do that to people.

Moving house, just moving house, is considered a major stressor. It's like moving house, house fires, you know, relationship ending; those kinds of things are all on the same level in terms of how disruptive they are to your life. Now imagine if you moved house, but you didn't know what was going to happen to your staff. And you didn't know when it was going to happen. And it wasn't something that you wanted, planned or chose, and potentially all of your stuff would be destroyed.

If you get arrested, all your stuff gets destroyed. If you get hospitalized, all your stuff gets destroyed. If you're in a tenuous housing situation, and you get hospitalized, you get evicted. If you get arrested, you get evicted. And suddenly you have somebody who's not able to even scrape together the little tiny bit of a dignified life that they had had before. Because the system keeps setting them back and setting them back and setting them back. It's like if you're Chutes and Ladders board had like 25 chutes, and only one ladder. And you were trying to make your way up this board. So what can we do?

As influential members of our community, as public figures, as institutions that are themselves public figures? How can we move this forward? How can we make a difference? It's not- I mean, Kaiser and housing is an obvious match for some reasons, because health outcomes and housing outcomes are tied to each other.

What are- what is tied to your business? What is tied to your leadership role? What, if it were different in the big world, would make you more effective? Would make you a better leader? Would make your company more successful and make everybody else's lives better? What would that look like?

Thanks for tuning in.