Gotham Gazette Opinion: Health and Housing are inextricably linked; My patients need Home Stability Support


March 17, 2020

As a doctor in the hospital, I bear witness to some of the most severe downstream effects of health inequity in our community. In my field, I care for any person who presents to the emergency room and is then deemed too sick to be discharged. Through years of clinical service, I have come to appreciate housing as the most vital component of a person’s ability to stay well.

More recently, research surrounding individuals experiencing homelessness has highlighted the increased risk of trauma, rapid aging and development of geriatric syndromes, and increased risk of death at an earlier age compared to people who have stable housing.

In essence, people in our community who are experiencing homelessness are becoming sicker faster and dying at an alarming rate. Compounded with the fact that we are facing the worst homelessness crisis since the Great Depression, our state needs to act now.

A proposed statewide rent subsidy program known as Home Stability Support would be a critical step forward in changing the trajectory of so many people and families struggling with one of the most basic human needs. The proposal would help individuals and families who are homeless or at risk of becoming homeless in providing realistic rental assistance that would result in successful housing.

The majority of my patients are highly medically complex and experiencing social struggles that complicate their recoveries. I have the privilege and honor of hearing people’s stories while working in my field and am humbled each time a person describes the painful experience of attempting to maintain their health while concurrently managing an unstable living situation or navigating the shelter system.

Being discharged from the hospital with a new list of medications and follow-up instructions after a severe disease state can be complicated in otherwise ideal situations. For a person experiencing homelessness, who is tasked with the additional worry of safety, exposure, or navigating the housing system, we can easily see their diseases rapidly worsen after leaving the hospital and see them end up back in the emergency room. This is no cycle that any human being should experience.

Even if not homeless at the time, my patients have additionally asked to leave the hospital before medically treated because missing another day of work would put their ability to pay rent in jeopardy. As a doctor, tasked with attempting to alleviate suffering and treat disease, it pains me to witness people having to choose between keeping their housing and their health. With 23,000 more New Yorkers becoming homeless than leaving homelessness each year, Home Stability Support would critically address people at risk of eviction in addition to people currently homeless, preventing so much of the endless suffering and potential health complications that accompany losing your home.

Homelessness, while not officially recognized as an Adverse Childhood Experience (events linked to increased risk of numerous conditions including cancer, lung disease, heart disease and early death), does place children at higher risk of ACE exposure and poor health outcomes later in life. In hearing frequent stories of childhood trauma amongst my patients with high biopsychosocial complexity, I can only think of the needless suffering that a program like Home Stability Support would prevent. We already know, but clearly don’t fully appreciate, the potential risk we take allowing 150,000 children in our state to experience homelessness, as was the case in the last two years.

In hearing the critical steps this statewide proposal would take to effectively alleviate and prevent immediate homelessness, this is our chance to speak out as citizens and urge our State Legislature and Governor to work together to pass, fund, and quickly implement this initiative and help move people from the shelter systems to homes where they can begin to heal. I encourage any healthcare provider who has had the privilege of caring for patients with unstable housing to speak out similarly and support the Home Stability Support proposal.

Amanda Ramsdell, M.D., is an Internal Medicine Physician at New York Presbyterian in New York City and Assistant Professor of Clinical Medicine at Weill Cornell Medical College. On Twitter @ARamsdell3.

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