Ending Homelessness: What Will It Take?

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Ending Homelessness What Will It Take?

• Dennis P. Culhane
• University of Pennsylvania

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Proportion of NYC Population That Experienced a
Shelter Stay in 1995, by Age
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Cluster Distributions Persons and Shelter Days
Consumed(Single Adults in Philadelphia)

• Transitionals
• 1.19 stays
• 20.4 days
• Episodics
• 3.84 stays
• 90.8 days
• Chronics
• 1.53 stays
• 320.4 days

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Disability Condition Veteran Status By Cluster
(Single Adults in Philadelphia)
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The Cost of Homelessness
Service Provider Mean Days Used (2-year pre-NY/NY) Per Diem Cost Annualized Cost
NYC DHS Shelter 137 68 4,658
NYS OMH Hospital 57.3 437 12,520
NYC HHC Hospital 16.5 755 6,229
Medicaid Hospital 35.3 657 11,596
Medicaid Outpatient 62.2 (visits) 84 2,612
VA Hospital 7.8 467 1,821
NYS DCJS Prison 9.3 79 367
NYC DOC Jail 10 129 645
Total 40,449
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NY/NY Savings Per Housing Unit Per Year
Service Annualized Savings per NY/NY Unit
DHS Shelter 3,779
OMH Hospital 8,260
HHC Hospital 1,771
Medicaid Inpatient 3,787
Medicaid - Outpatient (2,657)
VA Hospital 595
NYS Prison 418
NYC Jail 328
Total 16,282
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NY/NY Housing - Costs and Savings
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What is Needed?

• 150,000 units of housing to End Chronic
  Homelessness today
• Rental subsidies (4k-6k each)
• Service supports (6-13k each)
• Capital costs in some cities

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What has been done?

• Congress and President have increased funding
  400 million since 2004 35 increase
• 50,000 units created
• 2005-2006, HUD reports 12 decline in CH

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UNITED STATES INTERAGENCY COUNCIL ON
HOMELESSNESS
RESULTS IN REDUCING STREET AND CHRONIC
HOMELESSNESS
Portland, ME 49 decrease
Seattle/King County 20 decrease
Duluth 15 decrease
Nashua, NH 64 decrease
Quincy, MA 55 decrease
Yakima 15 decrease
Tacoma 65 decrease
Madison 30 decrease
Portland 70 decrease
Danbury, CT 10 decrease
New York City 15 decrease
Chicago 9 decrease
Philadelphia 50 decrease
Contra Costa 35 decrease
Nashville, TN 21 decrease
St. Louis 34 decrease
Denver 36 decrease
DC 6.5 decrease
San Francisco 38 decrease
Norfolk 17 decrease
Asheville, NC 23 decrease
Shreveport 15 decrease
Monterey, CA 11 decrease
Raleigh/Wake County, NC 11 decrease
Fort Worth 42 decrease
Augusta 16decrease
Montgomery 14 decrease
Dallas 43 decrease
Atlanta 8 decrease
Gainesville 18 decrease
Mobile 26 decrease
For the year 2006 2007.
Miami 50 decrease
www.usich.gov
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Varying Service Intensity By Client Types Over
Time, Illustrations
Client Type/Time 1st Nine months 10-24 months 25 to 36 months
Type A 15K 10K 5k
Type B 25K 15K 10K
Type C 10K 6K 2K
Transition to mainstream services for maintenance
support
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NonChronic Homelessness

• Assessment
• - Centralized intake and referral process
• - Universal, standardized benefits eligibility
  screening
• - Triage to mainstream services, with incentive
  payments to providers for linkage
• - Unconditional placement for 15 days

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NonChronic Homelessness People Exiting
Institutions

• Step-down care or transitional residences
• Population-targeted, program-focused,
  outcome-oriented and time-limited (end
  indiscriminate, bed-only, no-results shelter)
• Conversion Strategy
• Emergency shelters operate 7 PM 7 AM
• Create companion or co-located Day Programs
  administered by mainstream institutions (SA, MA,
  CW, Corrections)
• Partial Hospital for MH and MA eligible SA
  populations

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NonChronic Homelessness Transitionally Needy

• Renewed GA or Emergency Assistance program for
  singles Temporary cash assistance
• Time-limited, with work and training requirements
• 6 months cash assistance conditional on
  participation
• Transition to tax credit programs (like EITC)
  targeted to this group
• Emergency shelter for 30 or 60 days

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Family Homelessness
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Background

• Singles typology experience
• But families are different
• - much lower MH/SA rates
• - not different from poor housed families
• - relatively homogeneous
• Potential confounders policy/program factors
• - use of shelter system as queue for subsidies
• - transitional shelter as a reform movement

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Results Cluster Solution(Massachusetts, family
shelter users)

• Transitionals
• 1.0 stays
• 105 days
• Episodics
• 2.0 stays
• 195 days
• Long-Stayers
• 1.0 stays
• 444 days

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Intensive Service Histories of Families
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Income Sources
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The Average Cost of Shelter Stays by
Type(Massachusetts)

• Transitional 11,550
• Episodic 21,450
• Long-term 48,440
• Average per family 19,511
• Does not include McKinney-Vento funding or
  non-DTA public service contracts.

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Summary

• Cluster patterns are robust across sites
• Most families (75) leave quickly and dont
  return
• A small number (5-8) return repeatedly
• 20-25 of families have long stays, using 50 of
  resources
• BUT unlike singles long stays do not indicate
  personal barriers to housing stability

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Conclusions

• Policies and programs driving long stays
• Characteristics of graduates may reflect
  selection effects of policies and programs
• Most needy families get fewest system resources,
  and least needy families get most system
  resources
• Need for reform A new conceptual framework
  required

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New Conceptual Framework Considerations

• Least needy families should get least intensive
  intervention, and most needy families should get
  most intensive intervention
• Most families have few service histories, and
  exit quickly policies should support this
  preference (rapid relocation)
• Various service and housing assistance packages
  for remainder (including transitional rental
  assistance), based on level of barriers
• Convert existing facilities to supportive housing
  for corrections, addictions treatment and family
  unification

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Model Cost by Volume Service System for
Addressing Housing Emergencies
Shelter Admission
Diversion, Relocation and Transitional Rental
Assistance
Volume
Prevention
Supportive Housing
Cost per Case
Community- Based programs
Mainstream systems
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Future Research

• Develop assessment tools for classifying families
• Develop housing assistance models to relocate
  families and test efficacy by type of family
• Use HMIS for assessment and tracking outcomes,
  possibly routinely check for service histories of
  families
• Study selection behaviors of facilities, role of
  policies

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