Hospital to Home

People experiencing long-term homelessness often have significant barriers to good health.  While more vulnerable to major health crises, people discharged from hospitals with no housing options can end up sleeping outside or in shelters, making treatment ineffectual and recovery incredibly

Hearth Connection is working to break this cycle.  More cost-effective and use of medical services is possible by ensuring people with chronic conditions have a home and someone to help connect them to health services.

Our Hospital to Home projects improve care coordination for individuals who are using a disproportionate amount of emergency and hospital resources. Targeting people with chronic medical conditions and long histories of homelessness, the projects aim to improve participants’ access to services, housing, and health care while reducing unnecessary health care expenditures.

Hospital to Home – Regions Hospital

In 2009, Guild Incorporated and Hearth Connection started Minnesota's first Hospital to Home project to demonstrate the effect of supportive housing on health outcomes and medical care usage. In partnership with Regions Hospital and the Minnesota Department of Human Services, the initiative offered supportive housing to seven individuals.

A two-year report released in 2012 revealed outcomes and systems use for the seven participants in this Hospital to Home project. The independent report conducted by Wilder Research showed:read Hospital to Home report

  • Reduction in emergency department use (down 81% in two years); 
  • Improved housing stability (stably housed within three months of enrollment);
  • Higher self-sufficiency ratings (including areas of housing, healthcare, safety, and family relations)
  • Improved consistency in accessing care (stabilized use of primary clinics and medications)

Though based on a small sample size, the Hospital to Home two-year report shows potential in improving access to health care, housing, and services for people with serious medical conditions and histories of homelessness.  The project partners continue to work on expanding the sample size and sharing outcomes of this project. Click here to see the one- and two-year reports on Hospital to Home, or the most recent three-year report and factsheet on project outcomes and expansion.

Hospital to Home - Hennepin County Medical Center

Hearth Connection began its second Hospital to Home project in 2010. Partnering with Hennepin County Medical Center and a special team of service providers, Hearth Connection worked to connect systems around a shared goal: improve outcomes for vulnerable people and the public systems who serve them.

While the Hospital to Home project with HCMC and the COHR service team targets the same population as the project at Regions—people with high barriers to stability, long histories of homelessness, and chronic medical conditions—this project has a very unique structure. Supportive services are funded by the health care provider (HCMC), and services are delivered by the Collaboration of Housing Resources team, a group comprised of service providers from various agencies (Spectrum Community Mental Health, St. Stephen’s Human Services, and Simpson Housing Services).