SENTARA HEALTHCARE: PROMOTING HEALTH THROUGH HOUSING SUPPORT

The Issue

ACAP member Sentara Healthcare of Virginia has many enrollees who face housing instability, which can make it hard to keep up with preventive care and exacerbate existing health issues. A large number of Sentara enrollees qualify for Federal housing, disability and income assistance, but the applications are often hard to navigate—leaving many without the support they need.

Promoting Health Through Housing Support

Sentara members are screened for housing needs as part of their health assessments. When a need is identified, the enrollee is referred to a care manager, who can connect patients to community-based housing organizations. For those who need more support, case managers can make a referral to Sentara’s dedicated Social Determinants of Health (SDOH) team, which provides ongoing, one-on-one assistance.

Navigating the housing system can feel like a maze, especially when enrollees are trying to balance finding a safe place to live with working, caring for their family and staying on top of their health. The SDOH team helps enrollees find open shelter spots, fill out applications for Federal housing assistance, reach out to landlords, and more. Many people in need of housing support qualify for Supplemental Security Income and Social Security Disability Insurance (SSI/SSDI), and the SDOH team helps them with that process as well. 

Sentara expanded its services through staff training. One social worker recently became certified to assist with applications in the SSI/SSDI Outreach, Access and Recovery (SOAR) program, which provides income support for people experiencing or at risk of homelessness who have a serious health condition. Two enrollees have already been matched successfully to housing with their help, after years of waiting for assistance. Sentara’s staff knows that this extra support can make a world of difference for enrollees, and the plan looks forward to having more staff become SOAR-certified. 

Outcomes

  • 175 enrollees were successfully housed from January to August 2024.
  • 220+ enrollees received support applying for disability, food and other benefits from January to August 2024.
  • 2/3 of enrollees who received application support successfully obtained needed benefits.

Lessons Learned

  • Create clear lines of responsibility. Having a dedicated SDOH team and clear referral processes allows dedicated time to be spent with each member, reducing stress on the case management staff and limiting the chance of enrollees falling through the proverbial cracks.
  • Invest in staff capacity. Sentara’s investment in SOAR and other training helps staff stay current on the latest policy developments and expand services to more enrollees.
  • Cultivate community relationships. Sentara’s SDOH team has strong relationships with private landlords and housing providers, enabling them to connect enrollees to stable housing quickly.

Helping People Stay Housed When They Need It Most

Stephanie had stage four cancer when her landlord notified her that she was facing eviction. Unable to work while undergoing cancer treatments, she had fallen behind on her rent. Stephanie had applied for SSI/SSDI, but her application was rejected, despite the fact that she met the criteria to qualify for benefits. Stephanie’s care manager connected her to one of Sentara’s SOAR coordinators, who helped her gather the right paperwork and guided her through the SSI/SSDI appeals process. With their guidance, Stephanie won her appeal and gained access to vital income support that enabled her to stay housed throughout her cancer treatment.