SEATTLE — King County had two goals when it purchased more than a dozen hotels to convert into housing for people living on the streets — end homelessness for a bunch of people and improve their health.

Officials say it has been a success on both fronts, publishing data collected in the first two full years of the Health through Housing program.

The program created more than 900 units of housing with services on-site tailored for formerly homeless people, with about 500 more on the way. And data shows the people staying in those units visit emergency rooms and are hospitalized substantially less than when they were on the streets.

Officials say they’re not surprised.

“That was the premise from the beginning,” said Kelly Rider, director of King County’s Department of Community and Human Services.

While converting hotels was an innovative approach born out of the pandemic, the health benefits of providing housing and wraparound support services to homeless people are supported by decades of research.

There are more than 7,700 permanent supportive housing units in King County, but it’s expensive to build and operate, and with more than 16,000 homeless people in the region, there aren’t enough spots for everyone who could use one.

The county’s program launched in 2022 and officials say the recently released data shows some of the costs of housing homeless people are being recouped with savings in the health care system.

Experts say there are myriad reasons why use of emergency rooms and hospital beds decreases when people move in off the street, but caution against drawing overly strong conclusions from just King County’s data, which wasn’t subject to a rigorous study.

“There’s no question in my mind that people’s health improves dramatically once they’re housed,” said Margot Kushel, a physician and homelessness researcher at the University of California, San Francisco. “It just can be a little hard to show.”

Homeless people and ER visits

For seven years until July 2024, Craig Santos, 72, lived in a van in Redmond.

During that time, he used a catheter to urinate due to a chronic bladder condition he developed during years of alcohol dependence. But working as a contractor and living without running water, it was nearly impossible to keep his hands completely clean.

“I kept getting infection after infection after infection,” Santos said.

Each time, he visited hospital emergency rooms or urgent care and was prescribed antibiotics. But on a visit last year, his doctor told him he had become resistant.

“It scared me,” he recalled. “I worried about dying.”

Homeless people visit hospital emergency rooms much more frequently than the average person.

According to a large study published in 2025, almost 40% of homeless people in California had visited an emergency department in the previous six months, and more than a fifth had been admitted to a hospital.

Kushel, one of the authors of that study, said that when someone’s homeless, “small problems become big.”

For example, cuts turn into infections if they’re not cleaned. Antibiotics to treat them are lost or stolen, and people struggle to take them on schedule. Then, infections travel to critical areas in the body where they become life-threatening.

A 2003 study found that more than a quarter of homeless people in San Francisco had been physically or sexually assaulted in the previous 12 months.

A 2021 report found that 70% of pedestrians killed by cars in Portland were homeless.

And people are subject to extreme heat, cold and other harsh outdoor elements.

Homeless people also commonly end up in the emergency room for mental health crises. Studies show about a quarter to a third of people experiencing homelessness suffer from severe mental illness. Many of those conditions are treatable with medications, but that is difficult living outside, culminating in crises in public view.

Once homeless people show up in the emergency room, they have a higher rate of being admitted to the hospital.

April Gerard, a psychiatric nurse at Downtown Emergency Service Center, a Seattle homelessness services and behavioral health provider, said people often don’t need to be hospitalized. She said staff at Health through Housing buildings, of which the nonprofit operates several, are trained to de-escalate crises and support the people experiencing them.

“Those crises are averted through those interventions alone, probably hundreds of times a day, just in our buildings,” Gerard said.

Kushel, a practicing physician, said the higher rate of hospitalization is because homelessness throws a wrench into the complex calculations hospital providers do to determine if someone needs to be in more intensive care or if their issues can be dealt with through outpatient appointments.

“If someone's homeless, we literally throw those algorithms out the window and we just admit them into the hospital,” Kushel said.

Moving inside

Once Santos moved into a Health through Housing building in Redmond, operated by the Salvation Army, he was able to wash his hands regularly before using the restroom and had a clean living space.

“All of a sudden, I didn't have any kind of infections, Santos said.

Health through Housing buildings also have nurses or physicians on-site who offer physical and behavioral health services.

For example, Gerard said residents can sign up for medication reminders and staff will knock on their door with a cup of water when it’s time to take their pills. That can prevent chronic physical conditions from turning into emergencies and reduce the likelihood of mental health crises, she said.

In the year before moving into Health through Housing buildings, residents like Santos visited a hospital emergency room an average of 1.5 times and were hospitalized for about five days, according to health records people shared with the county.

After moving in, residents went to the emergency room 17% less in their first year inside compared with the year before, according to county officials. Residents also spent a third fewer days hospitalized in inpatient care, according to an analysis of medical records of about 1,000 people who stayed in Health through Housing buildings and shared that information.

Experts say a reduction in those numbers could benefit everyone within the health care system.

First, it indicates people who moved into Health through Housing are less acutely ill, said Dr. Herbert Duber, a professor at the University of Washington and emergency physician at Harborview Medical Center. That represents potentially thousands of dollars of savings in public health costs per person.

And it also frees up hospital beds so the next person with an emergency can access the care they need more quickly.

“That's actually been shown to reduce overall mortality,” Duber said.

But experts say there are caveats.

Kushel said it's possible people who moved into Health through Housing would have used emergency rooms and inpatient beds less often even if they hadn’t moved in. She said studies have shown people who use emergency services at high rates for a period usually tend to use those services less over time naturally, but are often selected for housing resources while their health needs are most acute.

And she said people sometimes use health care more after moving off the street as they’re able to consider treatments that may have seemed too difficult to receive while living outside.

That was the case for Santos, who received several surgeries he had put off while living in his car. In the past year, he had bladder stones taken out, a cataract removed and multiple hernia repairs. But for him, more health care was a positive.

“I’m in way better shape,” Santos said. “There’s no comparison.”

He said he’s ready to get back to work in a few weeks and has already received several offers to start on construction projects. His goal now is to be able to support himself and move out on his own.

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