♪ ♪ >> IF PROVIDING HOUSING FOR THE UNHOUSED WOULD REDUCE HEALTHCARE COSTS, WOULD YOU BE IN FAVOR OF THE ALLOCATION OF SUCH FUNDS?

STAY WITH US AS WE TALK ABOUT HOUSING AS HEALTHCARE WITH OUR GUEST TOM WALTON, NEXT ON "KENTUCKY HEALTH."

"KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

THE RELATIONSHIP BETWEEN HOMELESSNESS AND POOR HEALTH IS A CLASSIC EXAMPLE OF WHICH COMES FIRST?

THE CHICKEN OR THE EGG.

I WILL NOT SUPPOSE THAT ALL FOLKS WHO ARE IN POOR HEALTH WILL BECOME HOMELESS, NOR WILL I SUGGEST THAT ALL UNHOUSED PEOPLE ARE IN POOR HEALTH.

BUT SADLY, IN MANY CASES, HOMELESSNESS AND POOR HEALTH ARE INTEREST INTIMATELY RELATED IN THE PRESENCE OF ONE OFTEN LEADS TO THE EMERGENCE OF THE OTHER.

DURING RONALD REAGAN'S 1976 PRESIDENTIAL CAMPAIGN, HE COINED THE TERM "WELFARE QUEEN" THOUGH THIS DER RICIVE TERM WAS APPLIED TO ONE INDIVIDUAL, HE CAST ASPERSIONS AMONG MANY PUBLIC AID RECIPIENTS AND FOREVER TAINTED OUR PERSPECTIVE ON GOVERNMENT AID TO HELP OUR LESS FORTUNATE CITIZENS.

SUCH RETICENCE IN AIDING THOSE IN NEED IS NOT WITHOUT COST.

FROM A PURELY FINANCIAL PERSPECTIVE AS THIS SEEMS TO BE THE WAY MANY OF US SEE THE WORLD, HOW MANY OF US APPRECIATE THE ACTUAL COST OF THE UNHOUSED?

IN A 2006 NEW YORKER ARTICLE, THEY WROTE ABOUT MILLION DOLLAR MURRAY.

MURRAY WAS UNHOUSES AND OVER THE COURSE OF 10 YEARS, ACCUMULATED A MILLION DOLLARS IN HOSPITAL BILLS.

SADLY, WE THOUGH THAT PROVIDING HOUSING FOR THE MURRAYS OF THE WORLD DECREASES HEALTHCARE SPENDING, THUS SAVING US MONEY BECAUSE OF FEWER EMERGENCY ROOM VISITS AND GENERAL HOSPITAL ADMISSIONS.

TODAY, I WANT TO TALK ABOUT HOUSING AS HEALTHCARE.

AND WE ARE FORTUNATE TO HAVE Mr. TOM WALTON AS OUR GUEST.

HOPEFULLY HE CAN HELP ME AND YOU SEE HOW HOUSING AND OTHER SOCIAL PROBLEMS AFFECT WELLNESS.

Mr. WALTON IS AN EXECUTIVE IN RESIDENCE IN THE UNIVERSITY SCHOOL OF PUBLIC HEALTH AND INFORMATION SCIENCES.

HE HAS EXPERTISE IN POPULATION HEALTH AND HAS WORKED WITH A VARIETY OF LOCAL, STATE AND NATIONAL ORGANIZATIONS, INCLUDING DIRECTOR OF POPULATION HEALTH FOR KENTUCKY ONEHEALTH.

DIRECTOR OF BUSINESS DEVELOPMENT FOR KENTUCKY ONEHEALTH PARTNERS.

NATIONAL GOVERNORS ASSOCIATION SUPER UTILIZED THE POLICY ACADEMY, CATHOLIC HEALTH INITIATIVES, TOTAL HEALTH TASK FORCE AND THE JEFFERSON COUNTY AFFORDABLE CARE ACT IMPLEMENTATION STEERING, ENROLLMENT, HEALTH LITERACY AND OUTCOMES COMMITTEE.

AS WELL AS THE BOARD OF KENTUCKY ANA HEALTH COLLABORATIVE.

YOU ARE A BUSY GUY.

>> IT'S GREAT WORK.

>> THANK YOU VERY MUCH FOR BEING WITH US TODAY.

WHY IS IT THAT WE DON'T SEE THINGS, YOU KNOW, LIKE HOMELESSNESS AND OTHER SOCIAL FACTORS AS BEING PART OF HEALTHCARE?

WHERE IS THE DISCONNECT?

>> SO I'M GOING TO TALK ABOUT THE WRONG POCKET PROBLEM.

>> OKAY.

>> AND WHAT THAT IS, IS WE KNOW THAT TO CARE FOR PEOPLE WHO LIVE IN OUR COMMUNITIES, WE HAVE TO, YOU KNOW, PROVIDE SERVICES.

LIKE THERE IS HEALTHCARE SERVICES, YOU KNOW, THE HEALTH PLANS, WHICH IS THE INSURANCE COMPANIES WE ARE TALKING ABOUT MEDICAID MANAGED CARE ORGANIZATIONS, MEDICAID, COMMERCIAL, METRO GOVERNMENT, ET CETERA, THEY ALL HAVE SEPARATE BALANCE SHEETS AND FINANCIAL AND FUNDING STREAMS.

AND WE ARE NOT VERY GOOD, AS A COMMUNITY, AT VIEWING THOSE FUNDING STREAMS HOLISTICALLY.

WE LIKE TO BLEND AND BRAID FUNDING.

SO IN OTHER WORDS, WHAT WE SEE IS THAT, YOU KNOW, WE ARE LOOKING AT THE EFFICACY OF ONE PROGRAM BUT NOT ANOTHER PROGRAM.

WE DON'T REALLY COME TOGETHER.

AGAIN, THIS IS WHAT MALCOLM GLADWELL IN THE MILLION DOLLAR MURRAY STORY, WHEENT BACK AND PULLED ALL THE DATA TOGETHER.

SO WE HAVE DONE SOME WORK LIKE THAT IN LOUISVILLE BACK IN 2008, ROD BARBER AND A TEAM FROM THE KENT SCHOOL OF SOCIAL WORK LOOKED AT COHORT, WE ARE JUST GOING TO TALK ABOUT THE 2005 DATA.

FOUND IT WAS LIKE 35 MILLION-DOLLAR SPEND.

SO IN TODAY'S DOLLARS.

IT WOULD BE AROUND AND WE CURRENTLY HAVE AROUND 10,000 PEOPLE EXPERIENCING HOMELESSNESS IN THE LOUISVILLE COMMUNITY 118 MILLION-DOLLAR EXPENDITURE IF WE BLEND ALL THESE TOGETHER AND TOE ANSWER YOUR QUESTION SPECIFICALLY, YOU THINK ABOUT HOSPITAL, YOU HAVE SPECIFIC JOINT COMMISSION ACCREDITATION REQUIREMENTS AND STUFF SO THAT'S REALLY WHAT IT THINKS ABOUT.

NOT SO MUCH AND I SHOULD SAY THERE IS ALMOST A SEISMIC SHIFT GOING ON WHERE THE HEALTHCARE SECTOR IS STARTING TO THINK IN A WHOLE PERSON VIEW.

>> WE SEEM TO DISASSOCIATE THE INDIVIDUAL ON ORANGE STREET WHO GOES TO AN EMERGENCY ROOM TO GET CARE AND WE JUST THINK THAT'S IT!

BUT THERE ARE COSTS INVOLVED.

AGAIN, WE GO BACK TO THE MURRAY STORY SOMEBODY IS PICKING THAT TAB UP.

WHO IS AND WHERE ARE THEY PICKING THE TAB UP?

>> SO WE, AS TAXPAYERS, ARE PICKING UP THE TAB.

>> I THOUGHT YOU MEANT YOU.

WE ARE REALLY PICKING UP THE TAB.

LET ME WALK YOU THROUGH A PATIENT JOURNEY AND THE TERM THAT WE ARE USING IN LOUISVILLE FOR PEOPLE WHO ARE HIGH UTILIZERS OF THE EMERGENCY ROOM, FAMILIAR FACES.

WE WENT FROM THE TERM OF FREQUENT FLYERS TO FAMILIAR FACES AND THAT'S TO PERSONALIZE THE EXPERIENCE IF YOU THINK ABOUT THE JOURNEY AND SO WE'LL PRESENT A SCENARIO THAT I'VE SEEN DOZENS AND DOZENS OF TIMES.

AND THAT IS A PERSON EXPERIENCING HOMELESSNESS IS FOUND DOWN SO THEN WHAT USUALLY HAPPENS IS AN AMBULANCE IS CALLED.

THE POLICE DEPARTMENT ARE CALLED.

THE PERSON IS PICKED UP, BROUGHT TO THE EMERGENCY ROOM THERE ARE COSTS INCURRED THERE.

THEY'RE EITHER DISCHARGED BACK TO THE STREETS AND AGAIN THIS IS ONE THING, THE SHIFT THAT'S OCCURRING THAT HOSPITALS ARE THINKING A LOT MORE ABOUT THE CONTINUUM OF CARE, LIKE WHAT HAPPENS AFTER THE PERSON IS DISCHARGED.

HOPEFULLY THEY GO BACK INTO YOU KNOW, A PRIMARY CARE PRACTICE OR SPECIALIST CARE PRACTICE IF THAT'S APPROPRIATE.

SO AGAIN IF YOU THINK ABOUT ALL OF THOSE COSTS, YOU KNOW, AGAIN BUT EXAMPLES HAS ITS BUDGET, THE HOSPITAL HAS ITS BUDGET, YOU KNOW, HOPEFULLY THERE IS A PAYER INVOLVED.

THEY HAVE THEIR BUDGET, BUT AGAIN THEY'RE NOT LOOKING ACROSS THE ENTIRE CONTINUUM OF THE CARING FOR THE INDIVIDUAL.

>> WE BRING THE PERSON IN.

WE PROVIDE THEM ACUTE CARE.

AND WE DISCHARGE THEM BACK TO THE STREET.

>> YES.

>> HOW RIDICULOUS IS THAT?

>> YEAH, SO LET ME TELL YOU ABOUT ONE VERY SPECIFIC CASE, SO BACK IN 2012 THE HOSPITAL I WORKED FOR AT THE TIME FORMED A POPULATION HEALTH COMMITTEE AND WHAT WE DECIDED TO DO WAS LOOK AT THE FAMILIAR FACES TO OUR EMERGENCY ROOM SO AGAIN WE HAD OUR PEOPLE RUN THE NUMBERS AND IDENTIFIED AND IDENTIFIED ONE INDIVIDUAL WHO HAD BEEN IN THE BUDGET ROOM OVER 500 TIMES IN A TWO-YEAR PERIOD.

223 TIMES IN WHAT WE LABELED THE BASE PERIOD.

AND THEN WE LOOK THE VERY OBSERVATION THAT YOU JUST MADE THAT WHAT WE ARE WERE DOING WAS NOT WORKING.

IT WASN'T WORKING FOR US AS A HOSPITAL AND IT WASN'T WORKING FOR THE INDIVIDUAL.

HIS HEALTH AND WELL-BEING WAS NOT IMPROVING.

SO WHAT WE DECIDED TO DO AND WE DID THIS IN THE CONTEXT OF THE COMMUNITY.

WE INVITED MULTIPLE ORGANIZATIONS ACROSS LOUISVILLE.

SEVEN COUNTIES, PEACE HOSPITAL, EMS, COALITION FOR THE HOMELESS.

LOTS OF DIFFERENT GROUPS TO COME TOGETHER AND WE PRESENTED THIS INDIVIDUAL AND WE DID IT FOR MULTIPLE PEOPLE, AND WE CAME DOWN TO THIS OPINION, LIKE WHAT CAN WE DO-- OR SOME FORMAT, LIKE WHAT CAN WE, AS A COMMUNITY DO FOR THIS INDIVIDUAL IN THE NEXT MONTH TO IMPROVE HIS QUALITY OF LIFE?

>> SURE.

>> SO FOR THIS INDIVIDUAL, WE DECIDED IT WOULD BE BEST TO-- HE HAD ALCOHOL USE DISORDER SO WE THOUGHT IT WOULD BE BEST IF WE ALLOWED HIM TO REMAIN IN OUR EMERGENCY ROOM UNTIL HE SOBERED UP.

AND THEN KENTUCKY HAS A LAW CALLED CASEY'S LAW THAT ALLOWS YOU TO INVOLUNTARY COMMIT SOMEBODY TO DRUG OR ALCOHOL TREATMENT IF YOU AGREE TO PAY FOR IT.

SO WE HAD HIM SERVED CAN CASEY'S LAWS, THE JUDGE KIND OF THREW IT OUT AND SAID TO THE INDIVIDUAL, IF I SEE YOU IN MY COURTROOM AGAIN, I'M GOING TO REHAB YOU IN JAIL SO HE CONSENTED TO GO TO A TREATMENT CENTER IN NORTHERN KENTUCKY, WHICH THE HOSPITAL PAID FOR FOR THREE MONTHS, WHILE HE WAS AWAY, WE ARRANGED FOR PERMANENT SUPPORTIVE HOUSING.

YOU COMMONLY HEAR IT CALLED THE HOUSING FIRST MODEL.

ANYWAY, WHEN HE CAME BACK, IN THE WHAT WE CALL THE INTERVENTION YEAR, HE HAD 10 VISITS.

SO JUST ROUGHLY DOING THE MATH, THE HOSPITAL AVOIDED THE SPEND, THIS IS PRE-MEDICAID EXPANSION.

SO THE HOSPITAL AVOIDED THE SPENDING $150,000 BECAUSE WE THOUGHT ABOUT HOW TO CARE FOR THE INDIVIDUAL; THAT INDIVIDUAL DIFFERENTLY AND THERE IS AN EFFORT UNDER WAY TO REVISE, YOU KNOW, REVISE THAT GROUP AND AGAIN, THE WHOLE IDEA IS HOW DO WE, AS INDIVIDUAL ORGANIZATIONS BUT ALSO AS THE COMMUNITY, THINK DIFFERENTLY ABOUT HOW TO CARE FOR OUR NEIGHBORS WHO ARE NOT HOUSED.

>> I SEEM TO RECALL THERE WAS AN EFFORT AT LOOKING AT, IF YOU LOOK AT A PERSON WHO WINDS UP BEING HOMELESS IN A LOT OF CASES, $500 WAS A COMMON NUMBER THAT SHOWED UP.

IF THAT INDIVIDUAL HAD $500 TO PAY FOR A CAR NOTE THAT THEY MISSED, A RENT OR SOMETHING, SO YOU ARE SAYING THAT IF WE MAKE AN INVESTMENT LIKE THIS, WE CAN ACTUALLY REVERSE THAT EXPENDITURE, WHICH WILL BANKRUPT THE HEALTHCARE SYSTEM IN ALL HONESTY.

IT'S A SIMPLE THING.

WHY DON'T WE DO IT?

>> WELL, WE ARE GOING TO HAVE A GREAT DEBATE WHETHER IT'S A SIMPLE THING OR NOT.

[LAUGHTER] AND PART OF THE ISSUE IS WHAT I ALLUDED TO EARLIER, IS FUNDING STREAMS AND HOW DO DIFFERENT ORGANIZATIONS DEFINE SUCCESS.

YOU KNOW, ONE OF MY INTERVENTIONS IS, LET'S ALL GET IN A ROOM TOGETHER AND MAKE SURE THE FINANCE PEOPLE ARE THERE AND LET'S, YOU KNOW, DEVELOP SHARED INTERVENTIONS AND THEN PRESENT THEM TO THE INDIVIDUAL WHO IS UNHOUSED AND LET THEM MAKE SOME DECISIONS ABOUT THE PATHWAY TO FOLLOW.

AND AGAIN, THERE IS SOME WORK NATIONALLY THAT'S HAPPENING.

IN LOS ANGELES, THEY CALL IT A FLEXIBLE HOUSING POOL.

AND WHAT THEY DO IS THEY PUT MONEY TOGETHER.

THEY BLEND-- THIS IS WHAT I WAS TALKING ABOUT BEFORE.

AND THEY HELP PEOPLE PRIMARILY PEOPLE WHO HAVE MOVED INTO HOUSING CHOICE VOUCHERS OR SECTION 8 VOUCHERS, YOU KNOW, STAY IN THEIR HOUSING, SO THAT YOU DON'T, SO LANDLORDS DON'T HAVE THE EXPENSIVE TURNING OVER APARTMENTS AND THINGS LIKE THAT.

IT'S THAT JOINT THINKING THAT COLLABORATIVE THINKING, WHICH I THINK WE ARE GOING TO HAVE TO COME TO.

AND YOU KNOW, AND AGAIN, IT IS SIMPLE CONCEPTUALLY, BUT YOU KNOW, THERE ARE ALL SORTS OF, YOU KNOW, COMPETING INTERESTS THAT MAKE THAT SOMEWHAT DIFFICULT.

I THINK WE ARE AT A POINT NOW, AS A COUNTRY, AND AS A STATE WHERE WE CAN START THINKING LIKE THAT MORE.

I THINK WE ARE BECOMING MUCH MORE HOLISTIC IN OUR APPROACH.

THERE IS ALSO A QUESTION OF DATA.

I'VE SPENT A LOT OF TIME ON HEALTHCARE INFORMATION SYSTEMS WORK.

AND THE ABILITY TO, YOU KNOW, LOOK AT INDIVIDUALS ACROSS MULTIPLE SECTORS, LIKE HOW DO WE LINK, YOU KNOW, CRIMINAL JUSTICE DATA, EDUCATION DATA, EMPLOYMENT DATA, HEALTHCARE DATA TOGETHER SO THAT WE CAN, YOU KNOW, REALLY IDENTIFY THE KEEP THE KEY POINTS OF INTERVENTION THAT CAN CHANGE THE QUALITY OF LIFE FOR THE INDIVIDUALS WE ARE WORKING WITH.

>> I RR A STUDY THAT CAME OUT OF U OF L, WHEN WE PUT THE MONEY INTO HOUSING PEOPLE, SURPRISE.

HEALTHCARE COSTS WENT DOWN, AND CRIMINAL JUSTICE INVOLVEMENT ALSO WENT DOWN.

AND WE WERE SAVING MONEY ON BOTH ENDS.

>> YES.

SO THAT WAS THE DUAL DIAGNOSIS CROSS FUNCTIONAL TEAM.

>> YOU CAME UP WITH THIS NAME?

>> I THINK THE CITY CAME UP-- THE CITY SORT OF SPONSORED THIS COLLABORATIVE EFFORT.

BUT IT WAS VERY SUCCESSFUL AND AGAIN, WE DID TRACK THE DATA ACROSS INDIVIDUALS, AND IT WORKED.

>> BUT LIKE SO MANY THINGS.

RIGHT NOW AS WE DO THIS TAPING, IN KENTUCKY STATE LEGISLATURE, WE HAVE TWO BILLS.

HOUSE BILL 18 AND SENATE BILL 25, WHICH EFFECTIVELY WANT TO LIMIT WHERE LANDLORDS HAVE TO TAKE SECTION 8 HOUSING, WHETHER OR NOT THEY CAN OR CANNOT.

I BELIEVE IN THE CITY OF LOUISVILLE MANDATED THAT EVERYONE, YOU KNOW, OTHERWISE ELIGIBLE, YOU CANNOT DISCRIMINATE BASED ON HOW AN INDIVIDUAL IS GOING TO PAY FOR THEIR HOUSING.

AT THE SAME TIME WE ARE DOING THIS, THERE IS LEGISLATION MOVING FORWARD TO CRIMINALIZE INDIVIDUALS FOR SLEEPING OUT IN TENTS.

WHICH ONE ARE WE GOING TO HAVE?

TELL ME?

THIS SEEMS TO BE GOING AGAINST THE VERY MODEL WHICH YOU SEM GREAT-- WHICHY YOU SAID FROM CALIFORNIA, THE DATA WE HAVE THAT SHOWS TO BE A BENEFIT IN HELPING PEOPLE'S HEALTH AND DECREASING COSTS.

>> RIGHT.

SO I'LL DEFER TO MY, AGAIN, I'M A HEALTHCARE OPERATIONS GUY, THINKING ABOUT HOUSING.

SO I WILL DEFER TO MY HOUSING FRIENDS TO GIVE YOU AN EXACT EXPLANATION OF WHAT THE ISSUE IS ABOUT BUT LET ME TELL YOU FROM A HOUSING LAY PERSON'S PERSPECTIVE, HOW I READ THE SITUATION.

AS I UNDERSTAND IT, IN THE LOUISVILLE ORDINANCE, REALLY JUST SAYS THAT YOU CAN'T DISCRIMINATE BASED ON SOURCE OF INCOME.

THAT THERE ARE OTHER THINGS THAT A LANDLORD SHOULD ANT CONTINUE TO LOOK AT WHEN MAKING DECISION WHETHER TO RENT, SO IT'S SOURCE OF INCOME IS THE THING.

WHEN I READ THE PROPOSED LEGISLATION, I HAVE TO TELL YOU THAT MY INITIAL REACTION IS THAT THE LEGISLATORS ARE DEFINING PEOPLE WITHOUT RESOURCES AS "OTHER" AND IN ESSENCE WHAT THEY'RE DOING IS SAYING WE DON'T WANT OTHER IN OUR NEIGHBORHOOD.

SO AGAIN, I'LL GO BACK TO WHAT I SAID EARLIER, I THINK WE WOULD BE MUCH MORE PRODUCTIVE AS A STATE IF WE GOT TOGETHER AND HAD AN AUTHENTIC HEARING OF EVERYBODY'S CONCERNS AND BIASES.

AND I MEAN LANDLORDS, DEVELOPERS, FUNDING AGENCIES, MEDICAID, EVERYBODY NEEDS TO BE IN THE ROOM.

AND IT NEEDS TO BE SO STRUCTURED THAT EVERY PERSON'S VOICE, YOU KNOW, IS HEARD.

THEN I THINK WE CAN COME UP WITH SOME CREATIVE SOLUTIONS THAT DON'T DEFINE OTHER PEOPLE WHO LIVE IN THE STATE WITH US AS "OTHER" AND WE CAN, IN FACT, BE A LITTLE MORE CREATIVE IN OUR SOLUTIONS.

THAT'S ONE THING.

IN THE FORUMS, I TALK ABOUT, I'M NOT SURE IN KENTUCKY WE HAVE EMBRACED ALL OF THE HOUSING MODELS THAT ARE AVAILABLE TO US.

I DO SOME WORK WORKING WITH OLDER ADULTS, YOU KNOW, AND WE ARE LOOKING AT SHARED HOUSING.

I MEAN IF YOU HAVE, YOU KNOW, FOUR OR FIVE PEOPLE WHO ARE OLDER ADULTS-- AND AGAIN, YOU MIGHT CALL THIS THE GOLDEN GIRLS MODEL GOING BACK TO THE OLD TELEVISION SHOW, BUT BASICALLY HAVE YOU FOUR WOMEN SHARING ONE HOME, LIVING SUCCESSFULLY.

THERE WAS AN ARTICLE IN THE NEW YORK TILES NOT TOO LONG AGO TALKING ABOUT ROOMING HOUSES, WAS IT TIME FOR THEM TO RETURN.

JUST BECAUSE AND AGAIN THEY GO THROUGH ALL THESE EXAMPLES OF SOMEBODY PAYING $150 A WEEK FOR A ROOM.

THAT'S $600 A MONTH.

THE AVERAGE RENT IN LOUISVILLE AS ROUND 1100 A MONTH.

SO IT MAKES IT MUCH MORE AFFORDABLE.

SO AGAIN, YOU KNOW, ROOMING HOUSES, THE CITY HAS, YOU KNOW, A NEW HOUSING PLAN THAT TALKS ABOUT, YOU KNOW, COMMUNITY LAND TRUST, AND ALL SORTS OF THINGS THAT CAN PRESERVE HOUSING.

SO AGAIN, I THINK THE LEGISLATOR IS JUMPING TO A CONCLUSION WITHOUT REALLY AN AUTHENTIC HEARING OF ALL THE VOICES IMPACTED BY IT.

>> THAT'S VERY DELICATE THE WAY YOU DID THAT.

>> THANK YOU.

>> VERY DELICATE.

I THINK WE'LL HAVE TO DUMB BACK TO THAT-- HAVE TO COME BACK TO THAT ONE LATER.

TELL ME ABOUT ASSET BASED APPROACHES.

>> OKAY.

SO IN MY HOME OFFICE, I HAVE A MAP OF KENTUCKY THAT I LOOK AT EVERY DAY.

CONSTANTLY THROUGHOUT THE DAY.

AND WHEN YOU LOOK AT IT, IT'S A MAP OF THE AREA DEPRIVATION INDEXES.

>> WHAT DO YOU MEAN BY THAT?

>> THE CDC HAS GONE BACK AND THEY DEVELOPED THESE INDICATORS, THEY CALL THEM A SOCIAL VULNERABILITY INDEX.

IT'S BASICALLY LIKE HIGH POVERTY AREAS, YOU KNOW, AREAS THAT ARE DEPRIVED.

AND EASTERN KENTUCKY IS BRIGHT RED.

NOW, A DEFICIT-BASED APPROACH WOULD SAY OF THOSE POOR PEOPLE IN EASTERN KENTUCKY, YOU KNOW, OR WHAT DID THEY DO WRONG THAT THERE IS SO MUCH POVERTY THERE?

AN ASSET-BASED APPROACH GOES AND LOOKS AT THAT SAME MAP AND SAYS WHAT ARE THE ASSETS, THE RESOURCES THE PEOPLE IN THOSE COMMUNITIES, THAT COULD BE UTILIZED, WHICH THEY COULD UTILIZE, TO IMPROVE THEIR OWN HEALTH AND WELL-BEING?

AND IT'S NOT-- AGAIN, IT BUILDS ON THE STRENGTH, FOR EXAMPLE, YOU KNOW, COMMUNITY IS VERY, VERY STRONG.

AND YOU KNOW, IN EASTERN KENTUCKY.

AND HOW DO YOU BUILD ON COMMUNITY NORMS AND TO REALLY IMPROVE THE HEALTH AND WELL-BEING?

THAT'S WHAT AN ASSET BASED APPROACH IS.

THERE IS A WHOLE THEORY OF COMMUNITY BASED ASSET DEVELOPMENT AND THE FIRST QUESTION YOU ASK IS WHAT PROBLEMS HAVE THE PEOPLE IN THIS COMMUNITY SOLVED THEMSELVES WITHOUT OUTSIDE INTERPEERNS?

>> HOW DOES THAT RELATE TO THE HEALTHCARE CONUNDRUM WE ARE NOW FACING?

>> WELL, WE ARE LOOKING AT SOME MORE ASSET-BASED APPROACHES.

THERE IS A GROUP IN TOWN THAT HAS A PRODUCT WHERE THE INDIVIDUAL EXPERIENCING HOMELESSNESS WORKS WITH A CASE MANAGER AND THEN THEY DEVELOP A CASE PLAN.

AND IT'S FOUNDED ON THE IDEA THAT THE INDIVIDUAL REALLY DOESN'T WANT TO BE HOMELESS.

SO WHAT THEY DO IS DEVELOP A CASE PLAN AND THEN THEY REALIZE THAT SOMETIMES, LIKE YOU ALLUDED TO EARLIER, $500 MIGHT BE THE DIFFERENCE BETWEEN BEING HOUSED AND UNHOUSED AND IT ALLOWS THE PERSON, YOU KNOW, SOME RESOURCES TO, YOU KNOW, FIX A BROKEN CAR, TO PAY FOR AN I.D., PERHAPS PAY FOR EXPUNGE PUNKMENT OR THINGS LIKE THAT.

AND THEN AS THE INDIVIDUAL COMPLETES THESE AGREED UPON ACTIVITIES AND MOVE THEM TOWARD HOUSING, MONEY IS DEPOSITED TO THE CARD-- WE ARE NOT TALKING ABOUT THOUSANDS OF DOLLARS, $25, $15, SOME OF THE THINGS THAT SEEM INCONSEQUENCE CONSEQUENTIAL, THOSE CAN HAVE A HUGE IMPACT ON THE HEALTH AND WELL-BEING SO WHAT THEY'RE DOING THERE IS THEY'RE CAPITALIZING ON THE ASSET OF THE INDIVIDUAL, WHICH IS, YOU KNOW, THEIR MOTIVATION TO CHANGE.

>> AND SO WHEN YOU THINK ABOUT THE GROUP HOUSE, YOU USED THE GOLDEN GIRLS EXAMPLE AND I GUESS YOU COULD SAY HOT IN CLEVELAND BECAUSE IT WAS THE SAME THERE.

YOU NEVER SEE THAT WITH GUYS.

IT'S ALWAYS WOMEN.

AND THAT'S BECAUSE MORE WOMEN LIVE LONGER THAN MEN.

DO WE GET INTO REGULATORY ISSUES WHERE YOU HAVE SOMEONE COMING IN AND SAYING, OKAY, IF YOU ARE GOING TO HAVE THIS GROUP HOME, YOU HAVE TO HAVE THIS, THIS AND THIS.

DO WE GET INTO ALMOST GOVERNMENT INTERFERENCE OR OVERREACH?

>> THAT'S A POSSIBILITY.

AGAIN, THIS IS WHERE WHEN I TALK ABOUT EVERYBODY GETTING IN THE ROOM, DEVELOPING INTERVENTIONS TOGETHER.

I READ SOMETHING RECENTLY, AND I SHOULD DO A PLUG FOR HEALTH AFFAIRS.

ON MONDAY OF THIS WEEK, THEY DROPPED A WHOLE FEBRUARY ISSUE IS ON HOUSING AND HEALTH.

AND IT HAS A LOT OF GREAT ARTICLES IN IT.

AND ONE OF THEM ADDRESSED THIS KIND OF ISSUE OF REGULATORY INVOLVEMENT.

AND THEY SPECIFICALLY WERE TALKING ABOUT PARKING SPACES.

YOU KNOW, WHEN YOU BUILD SOMETHING, HAVE YOU TO HAVE A CERTAIN NUMBER OF PARKING SPACES.

THAT WHAT THAT DID IS AREY DEUCE THE AMOUNT OF LAND IN WHICH YOU CAN BUILD HOUSING SO TO GO BACK AND LOOK AT THESE ISSUES THAT SEEM TORE UNCONNECTED BUT HAVE A VERY SUBSTANTIAL IMPACT ON THE ABILITY TO INCREASE DENSITY THROUGH MORE HOUSING.

>> PAVED PARADISE AND PUT UP A PARKING LOT.

THAT IS A BIG, BIG PROBLEM.

WHAT ARE SOME OF THE BIG HEALTH ISSUES, AS YOU SAW AND HOW WERE THEY ADDRESSED?

SO BIGGEST THINGS I ALWAYS THINK ABOUT FOR THE UNHOUSED.

HOW DO YOU MANAGE DIABETES, HOW DO YOU MANAGE WOUND CARE AND INFECTIOUS DISEASES?

>> LET ME START WITH WOUND CARE.

I AM A HUGE ADVOCATE FOR MEDICAL RESPITE, RECOOP RATIVE CARE AFTER SOMEBODY IS DISCHARGED FROM THE HOSPITAL.

WE HAVE TAKEN A DEEP DIVE INTO THIS ISSUE IN KENTUCKY.

AND ONE OF THE ISSUES THAT I WAS WORKING WITH A NURSE WHO DID STREET OUTREACH AND SHE IDENTIFIED AN INDIVIDUAL WHO WAS RECOVERING FROM SURGERY LIVING IN A TENT NEXT TO A CREEK AND HE WAS USING CREEK WATER TO CLEAN HIS WOUND.

SO YOU CAN IMAGINE, AS A SURGEON, HE WAS READMITTED SO THAT IS A CONTRIBUTION.

AND PLUS THE IMMOBILITY THAT COMES FROM-- THAT'S A HUGE ISSUE.

DIABETES, AGAIN, WE KNOW THAT NUTRITION IS A SIGNIFICANT IMPACT.

SO STABLE NUTRITION IS VERY IMPORTANT.

ALSO MEDICATIONS, YOU KNOW, ACCESS TO MEDICATIONS.

YOU KNOW, WE'VE HAD INSTANCES WHERE WE'VE OBSERVED WHEN THE INSULIN HAD TO BE REFRIGERATED.

IT WAS PRESCRIBED BUT IF YOU LIVE IN A TENT, THERE IS NO ELECTRICITY, HOW DO YOU-- IT'S REALLY BASIC THINGS.

AND THEN THE ABILITY, YOU KNOW, TO EXERCISE AND JUST DO THINGS TO HELP THE DIABETES.

INFECTIOUS DISEASES, WE SAW THIS EXACERBATE DURING COVID WHEN YOU HAD THIS CONGREGATE HOUSING AND, YOU KNOW, THE ABILITY TO SPREAD INFECTION VERY QUICKLY.

>> GIVE ME ONE MINUTE ANSWER.

WHICH IS COMING FIRST?

IS IT THE MEDICAL DEBT LEADING TO HOMELESSNESS OR IS IT THE HOMELESSNESS GIVING RISE TO THE MEDICAL PROBLEMS?

>> IT'S A CIRCLE.

>> IS IT?

HARD TO SAY THIS IS THE STARTING POINT?

>> YES.

SO MEDICAL DEBT IS A REALLY SIGNIFICANT CONTRIBUTOR TO HOMELESSNESS.

YOU KNOW, AS IS INTERPERSONAL VIOLENCE.

VERY SIGNIFICANT.

SO, YEAH, IT'S REALLY HARD TO SAY LIKE, YOU KNOW, THIS IS THE FIRST THING.

>> IS THAT RIGHT?

SO BRIEF ANSWER FOR ME.

IS THIS A SOLVABLE PROBLEM IF WE ALL KIND OF SHOW A LITTLE MORE EMPATHY OR WHAT DISM?

>> YES.

YOU KNOW, THE NUMBER ONE THING IS GET TOGETHER AND HAVE A-- I CALL IT A RELENTLESS FOCUS ON OUTCOMES.

; YOU KNOW, HOW DO YOU DEFINE SUCCESS, YOU AND YOUR ORGANIZATION, HOW DOES MY ORGANIZATION DEFINE IT AND AGAIN, I TELL PEOPLE ALL THE TIME.

I CHOOSE TO BE NAIVELY OPTIMISTIC ABOUT THIS.

I THINK FUNDING, IF PEOPLE BELIEVED STUFF WHICH THEY DID YIELDED AN OUTCOME, WHICH THEY VALUED, THEY WOULD BE WILLING TO FUND IT.

>> I'M GOING TO LEAVE WITH THAT.

I LOVE IT; TOM.

THAT'S WHY I LOVE TALKING TO YOU MAN, LOVE TALKING TO YOU.

THANKS FOR BEING WITH US AND THANK YOU FOR BEING WITH US TODAY.

WHEN WE SEE THE UNHOUSED, HOW MANY OF US THINK, BUT THERE FOR THE GRACE OF GOD GO I, OR DO YOU THINK WHY ARE THEY DOING SOMETHING-- WHY AREN'T THEY DOING SOMETHING FOR THEMSELVES.

I HOPE YOU CAN APPRECIATE HOW THE HEALTH AND FINANCIAL WELL-BEING OF OUR COMMUNITIES CAN BE IMPROVED BY ADDRESSING OUR HOUSING NEEDS.

IF YOU WISH TO WAS MUCH THIS SHOW AGAIN OR AN ARCHIVED VERSION OF PAST SHOWS PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KY HEALTH@CLOR.

I LOOK FORWARD TO SEEING YOU ON THE COLLECTION "KENTUCKY HEALTH" AND THE NEXT TIME YOU PASS SOMEONE HOMELESS ON THE STREET, THINK A LITTLE MORE OPTIMISTICALLY ABOUT THAT PERSON.

WHAT CAN WE DO TO HELP THEM.

THANK YOU FOR BEING WITH US AND I'LL SEE YOU AGAIN NEXT WEEK.

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.