Living in an unsafe environment, struggling to pay the rent or having to bounce from shelter to shelter are just some of the challenges that make up the term “unstable housing,” the most studied social factor impacting a person’s health, and most significant obstacle impeding the well-being of Bronx residents. For 15 years, Montefiore’s Housing at Risk Program (H@RP), has been at the forefront of establishing new ways to secure and preserve safe, affordable housing and prevent evictions, while also helping to coordinate care and empower people to get back on their feet.

Since 2009, H@RP has delivered highly coordinated health and housing support from the moment a person with, or who is at risk of, unstable housing arrives at Montefiore’s Bronx hospitals.

Results of H@RP’s interventions, include:

• A decrease in emergency department visits among people unstably housed by 45%
• Helping more than 1,000 people, including securing permanent housing for 65 individuals, more than a dozen of whom are high need utilizers of Medicaid
• Preventing almost 40 evictions and decreasing hospital inpatient visits by 60% among people who are unstably housed

“We’re fortunate to be in a state that invests in housing and financial assistance, but navigating services is complicated and getting resources takes time,” said Deirdre Sekulic, LCSW, associate director, Social Work, Montefiore Heath System. “For example, disability can take more than a year to come through and it could take several weeks for someone who is medically complex to get into a shelter. This is where the skills we’ve learned and partnerships we’ve established make an impact. When people come to Montefiore, they know they’ll have advocates focused on long-term illness prevention and health promotion, rather than short-sighted treatments. This is the future of healthcare.”

Not Just a Bronx Tale

Though the Bronx contains half of the 10 communities in New York City that experience the highest incidences of family homelessness – University Heights, Morris Heights, Sound View, South Bronx and Tremont – housing instability affects millions of people across the country. According to a Harvard University study, approximately 580,000 people experienced homelessness in the U.S. on a single night in 2020.

U.S. housing and home rentals have also soared to all-time highs. Nationally, a single-family home costs 5.3 times more than the median household income. In New York City, rent has increased 7x more than wages been 2022 and 2023 alone. Even when someone is making a good salary, they can be a job loss or one illness away from finding themselves without a place to live. That was the case for 38-year-old mother of two, Natasha Harris.

After Harris’s diabetes took a turn for the worse, requiring both a pancreas and kidney transplant, she had to give up her position as a breast surgery supervisor at a NY hospital. Harris’s doctors stressed she couldn’t work outside of her home for health reasons and bills piled up, leading to rent being past due. The H@RP team secured a NYC Department of Housing Preservation and Development Mainstream Voucher to help Harris receive supplemental income, search for an apartment and submit applications to landlords. With Harris they met with approximately two dozen realtors leading to an apartment that Harris and her children moved into this past March.

“Life doesn’t take a straight road,” said Harris. “I got sick, my parents passed away and then I was evicted from my home. During this time, the H@RP team would email, text and call every day until we found a suitable place for my family to live. They never left my side.”

In addition to partnering with patients on their paperwork and reaching out to landlords and community partners to identify resources people qualify for, H@RP social workers even go to housing court, fighting tooth and nail for people with chronic illnesses like cancer, because they know stable living conditions can quite literally be a life-or-death situation.

“By removing stigma and caring for people when they need it most, we aren’t just impacting housing statistics, we’re changing the trajectory of people’s lives", said Kareemah Benbow, MPA, project manager, Housing at Risk Program. “Our achievements over the past 15 years demonstrate that secure housing equals health. Only by being attuned to factors like where and how people live can we begin to truly improve the health and wellbeing, of not just individuals, but our country.”