I believe the author Marjorie Holmes said that. The concept of home is vastly different depending on who you are, what you do and where you come from. It is indeed an extension of oneself--an abode to uphold or a victim of our neglect, and ideally a source of nourishment. The neighborhood is an even broader encapsulation of one's existence.
At this festive holiday season, allow me to transgress to bring the realities of homelessness into our consciousness. We all agree that it has been a stormy year in health care. The one aspect of the ACA that is relatively popular is the Medicaid expansion and subsidies that allow low-income Americans to obtain affordable health insurance. Many states are looking for innovative solutions to cut rising Medicaid costs. New York State is implementing an ambitious supportive housing program targeting Medicaid patients who have high health care costs under the motto Housing as Health Care.
Providing supportive housing for those who experience homelessness and mental illness has been shown to reduce hospital use, decrease health care costs and improved health parameters especially for high utilizers. Tenants in supportive housing programs have affordable apartments and easy access to a network of professionals to help them stay housed and healthy. Numerous studies have quantified the disproportionately high service utilization of homeless people with disabilities including hospital-based acute care such as emergency rooms, psychiatric hospitals as well as shelters, jails and prisons. As mentioned above, a significant and growing burden of this cost is borne by Medicaid funding.
Studies have shown that supportive housing helped save taxpayers millions of dollars but upfront investment costs lead state and federal governments to embrace these programs less enthusiastically. Evidence of cost effectiveness is not yet available from the NYS program.
We know that housing quality and neighborhood sociodemographic characteristics are associated with mental health. A study by McKenzie in Europe suggests that neighborhood physical quality could counteract the adverse impact of substandard housing. Lower income individuals and families rely on strong social networks and support in the neighborhood to maintain psychological well-being. Put it bluntly, even if you place is a dump, having access to positive social interactions (safe green space, gardens, shops, fitness facilities and other community amenities) provides respite and stress relief.
For 2014, if wishing for everyone to have a cozy home comforted by loved ones is too starry-eyed then we should work to build neighborhoods, develop social ties and safe play areas for our children. Then the world will be a better place and wishes for good health will come true. Of course, we need to first end and prevent homelessness.
Joy and peace to all.
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"