Housing & Case Management

Quanda was frequently hospitalized, most recently with multiple strokes while residing in a Durham, NC, rescue shelter. Quanda was caught in a cycle of health problems and housing insecurity that made her life infinitely more challenging — at a significant cost to providers and taxpayers.

It also made her a candidate for the Health and Housing Case Management Program at RHD North Carolina, a partnership between Duke University, Alliance Health (which serves hundreds of thousands of North Carolinians in the state’s public behavioral health system), and RHD. Today Quanda is in her own apartment, managing her health, and going back to school.

“RHD helped me a lot,” Quanda said. “Having a place of my own, I’m able to take care of myself, and take care of my responsibilities. Before, I didn’t like my life. But this has given me a motivation to live.”

Quanda is just one of many success stories of this unique partnership at RHD North Carolina. An Alliance study of health care costs at Duke University Hospital found that the vast majority of costs were driven by a fairly small number of people. After identifying those “heavy users,” RHD provided housing and case management — and quickly reduced hospitalizations by more than 40 percent. One individual recorded more than 20 hospitalizations in 12 months prior to attaining housing through RHD. With housing and case management, that individual was hospitalized only once.

“It’s been tremendously successful,” said RHD NC director Nicholas Hobbs. “Chronic homelessness creates such instability that it becomes harder to manage any other issue — including, of course, health care. By providing housing and case management, we can make other challenges more manageable.”

Led by RHD Case Manager Rodney Daniel, RHD attains housing for an average of four people per quarter. Since January, RHD has housed 27 people and 22 have retained their housing.

“It’s very helpful,” said Julia Gamble, nurse practitioner at Duke Outpatient Clinic. “People need help navigating this process, at a time when patients are very vulnerable. Rodney does a great job working with us; he’s very responsive and compassionate and connects with the patients. We’ve seen people who were really heavy utilizers of our health care system become much more stable.

“It’s traumatizing for patients to experience homelessness, and to feel that vulnerability — because what you see is a sense of helplessness, that the system isn’t working for them. Rodney helps people access the system and helps make the system work for them, when they’re in position where they could really give up hope.

“That is life-changing. It really takes trauma-informed care to the next level.”

“RHD helped me a lot. Having a place of my own, I’m able to take care of myself, and take care of my responsibilities. Before, I didn’t like my life. But this has given me a motivation to live.”
– Quanda, RHD North Carolina client

This project had been a dream of Alliance Senior Vice President for Community Health and Well-Being Ann Oshel for years. Crafting an intake system that established eligibility criteria, incorporating technology, and engaging the right partnerships created the framework. When Durham Housing Authority made vouchers available for this population, The Health and Housing Case Management program was born.

“It lets doctors essentially write a prescription for housing,” Oshel said.

RHD was the choice to provide essential case management to make it all work.

“RHD’s leadership lives the mission of supportive housing,” Oshel said. “RHD has always been a willing partner to go above and beyond. There is a leap of faith to something like this; there will be issues that come up that you just have to work out. RHD’s ability to be innovative and take risks was really important. That’s the spirit of our partnership with RHD — a commitment to do the right thing, first, and go from there.”

While Duke, Alliance Health and RHD are still working to develop data on cost savings to the hospital, Oshel is confident the program will show significant savings.

“There is a humongous cost impact,” Oshel said. “One of the things I’m most proud of is the grass roots nature of this partnership. It was sweat equity and perseverance that made it happen; it wasn’t like we just dumped millions of dollars into this.”

After years of being in and out of the hospital, Quandas’ health is stable. She is also able to care for her granddaughter.

“I don’t think there are words for what Rodney does,” Quanda said. “It’s not just housing assistance; he’s there for me. He’s a real backbone in my life. I appreciate him, and all he’s done for me. I don’t think you can find anybody better.”

Gary is in a wheelchair, and had been living in the woods for months. Now in housing with RHD, Gary has seen just one hospital visit in the last six months.

“One time a lady gave me an electric blanket, but I didn’t have any place to plug it in,” Gary said. “I didn’t have any more faith, I was down in the gutter. I was just living day-to-day, just ‘how am I going to make it to tomorrow?’ I never thought about next year, or even next week.

“Rodney came like an angel and rescued me. If it hadn’t been for RHD, I wouldn’t have made it. This is the first time I’ve ever had my name on a lease. It’s just a burden off me. To be able to come home to my own place, it’s just awesome.”

Charlene had been homeless for two years, living in her car. With support from RHD, she’s in her own apartment with her son.

“I love it,” Charlene said. “ When I got this place, I cried. I’m the happiest person in the world right now.”

Charlene has Chronic Obstructive Pulmonary Disease, and climbing stairs is difficult for her. In an effort to secure housing quickly, Daniel found her a third-floor apartment. Now that her health has stabilized, Daniel is working to move Charlene into an apartment without stairs.

“There’s never a dull moment with me, but he’s always there,” Charlene said.

“He’s a one-name person, like ‘Oprah,’ or ‘Beyonce,’” Oshel said. “In Durham, you just say ‘Rodney’ and everyone knows who you’re talking about.”

“When you work with someone who is homeless, and you give them a set of keys and watch them sign a lease? Nothing matches that,” Daniel said.

“Without RHD, I wouldn’t have made it. To be able to come home to my own place, it’s just awesome.”
– Gary, RHD North Carolina client