Government Public Housing Health Needs Assessment: Focus on Race, Ethnicity, and the Older Adult: Background, Methods, and Demographics

Article excerpt

St. Vincent's Catholic Medical Centers of New York initiated a study in 2009 to assess the health needs of residents of New York City (NYC) municipal housing at the Robert Fulton public housing complex in Manhattan. The aim of this project was to provide valid data on perceived health services needs of the residents of a NYC housing project. These data may also be used to support hospital and community collaborative strategic decisions for developing resident-appropriate health and social services and would be valuable for use in formulating policies and programs by other interested nonprofit health and social services organizations and government. We designed a 28-item instrument and pilot tested it with our research team and members of the population under study.

The English and Spanish surveys were designed as an inperson surveyor-administered instruments addressing four domains: demographics, access and barriers to health care services, risk behaviors, and perceived health needs. The sampling was an apartment-level stratified random sampling. A 20%, 188 apartment sample was drawn from the population of 944 housing units. Our response rate was 92% (173/188 apartments).

Background, methods, and demographic results are reported in this article. A second article will report on the needs assessment results.

Public housing tends to concentrate groups of racially and ethnically diverse residents who are living at or below the federal poverty level, with many older adults living alone. As the United Nations Committee on the Elimination of Racial Discrimination (2008) states, "It is now widely recognized that racial and ethnic disparities in health outcomes in the U.S. are caused not only by structural inequities in our health care systems, but also by a wide range of social and environmental determinants of health." We extend this assessment to the older adults who face similar social and environmental barriers. To evaluate health status, primary care penetration, health care needs and access, and barriers to health care of the residents of an NYC housing project in the Chelsea area of Manhattan, we designed a survey study using a 28-question health and social needs survey assessment tool to gather data.

NYC has 354 public housing complexes, with approximately 420,000 residents, or approximately 5% of the city's population. Persons living in public housing are more likely to have low income, be of an ethnic or racial minority, and be older than 65 years old. These factors are strongly associated with poorer health, higher chronic disease incidence and prevalence, mortality, and preventable hospitalizations (Digenis-Bury, Brooks, Chen, Ostrem, & Horsburgh, 2008). Located in Manhattan's Chelsea/Clinton neighborhood, the Robert Fulton Houses (Fulton Houses) has 944 units with 30.5% in low-rise and 69.5% in high-rise buildings. It is home to more than 2,000 residents. According to NYC Housing Authority (NYCHA) data, approximately 70% of the residents are Latino or Black; 64% are one-parent families with minors on public assistance; 33% are 50 years or older; 19% are 62 years or older, of whom 43% live alone. Current residents have lived in public housing an average of 21 years (New York City Department of Health and Mental Hygiene [NYCDOHMH], 2010).

Fulton Houses was in the St. Vincent's Hospital catchment area and, of the institution's primary goals, increasing neighborhood involvement in health care planning and expanding its communityfocused services through evidence-based processes was paramount. Over a 10-week period in 2009, we surveyed Fulton Houses residents gathering data on respondents' perceptions; attitudes; and behaviors related to health care needs, access, primary care and its penetration, and barriers to health care and social services.

There is scant published research on the perceived health care needs of public housing residents. A systematic review of the medical literature focusing on public housing residents revealed that most published research is disease specific. …