Organizations aiming to help homeless people with either housing or health care can be more effective when they form partnerships with other service groups, a Rutgers study has found.
"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 coauthor of the paper published in The Milbank Quarterly.
"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 at a time of anxiety for health and housing providers. Advocates warn that possible delays in federal aid for people experiencing homelessness, along with changes to harm reduction strategies, could have severe health consequences for the roughly 770,000 people nationwide – including about 14,000 in New Jersey – who are unhoused.
People experiencing homelessness face elevated risks for infectious diseases, traumatic injuries, overdoses, violence and early death.
Although findings from the study were published before federal policy changes, Cantor said it can still serve as a blueprint for service-oriented organizations searching for ways to adapt.
Despite the critical need, little academic attention has been paid to the practical challenges and opportunities facing housing and health care organizations trying to collaborate on care for people without housing.
To address this gap, Cantor and Michael Yedidia , a research professor at the Center for State Health Policy, conducted structured interviews with 14 administrators and 10 frontline providers in eight New Jersey housing and health programs to better understand the challenges of cross-sector work.
To be included in the study, programs needed to demonstrate significant involvement of both health and housing organizations in their implementation. Participants were identified through extensive outreach.
The interviews, which lasted about 75 minutes each, took place between October 2023 and July 2024. Participants were asked about their motivations for cross-sector collaboration, their strategies for sustaining partnerships and operations and the mechanisms they used to finance services across institutional boundaries.
Cantor said that while only 24 interviews were conducted, the participants "are representative, not in a statistical sense, but in a qualitative sense of what's going on in this field."
After coding and analyzing the responses, the researchers identified several effective strategies for navigating differences in organizational culture, mission and financing.
The most impactful collaborations were those that matched client preferences with achievable options, maintained intensive interaction between partners and co-located health and housing services.
Meeting clients where they are, both literally and figuratively, also was a winning formula for bringing health care to people without housing, said Cantor.
"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."
Partnerships were often motivated by the powerful effect of housing on health and the high costs and limited effectiveness of trying to meet medical needs without first addressing homelessness, the researchers found.
As one respondent, a program director in a hospital, put it, "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."
But even with these insights, Cantor said the path forward for collaborations in health care and housing delivery remains challenging.
"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," said Cantor, referring to the phrase "not in my back yard."
Another challenge will be changing attitudes within the health care sector itself.
"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 effective collaboration could help organizations stretch limited resources and meet patients where they are.
As he put it, such partnerships are not only necessary, but increasingly essential 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.
