Slide 1:
The Dynamics of Homelessness, and the Impact of Supportive
Housing on Services Use and Costs
Dennis P. Culhane
University of Pennsylvania
Slide 2:
Point and period prevalence of Public Shelter Utilization: New York
and Philadelphia
- Percentage of individuals entering shelter on the day data was
collected was .25% for New York and .4% for Philadelphia.
- Using historical data from 1992 – 1% of total number of
homeless had been in the shelter for one continuous year in New York
City compared to slightly more in Philadelphia.
- Using historical data from 1990 – 1992 – 2% of the
homeless in New York had been in shelters continuously for 2 years
compared to 2.6% in Philadelphia.
- Using historical data from 1990- 1995 3% of the homeless in New
York had been homeless for 5 years. Philadelphia did not indicate
individuals homeless for five years.
Slide 3:
Annual Rates of Shelter Utilization for Selected Populations
- General Population < 1.3%
- Poor Persons 4.5%
- Poor Children 9.36%
- Poor Black Children (<5 years) 16.12%
- Poor Black Women (18-29) 12.28%
- Poor Black Men (30-49) 19.57%
Slide 4:
Cluster Distributions: Persons and Shelter Days Consumed (Single
Adults in Philadelphia)
- Three types of homelessness are graphed.
- Of the homeless nearly 80% are considered transitionally
homeless with an average of 1.9 stays a year. They stay an
average of 20.4 days and use 30% of the total bed/days available
in a given year.
- Approximately 11% of the persons homeless in Philadelphia
are episodically homeless with an average of 3.84 stays a single
year with a cumulative total of 72.8 days. The episodically
homeless use 18% of the available bed/days.
- The chronically homeless represent approximately 9% of the
total number of homeless with only 1.53 stays but the duration
of those stays is 252.4 days. These extended stays use 50%
of the total available bed/days.
Slide 5:
Disability Condition and Veteran Status by Cluster (Single Adults
in Philadelphia)
- Mental Illness: 8% for transitional homeless, 12% episodic homeless,
20% chronic homeless
- Medical Condition: 12% transitional homeless, 20% episodic homeless,
25% chronic homeless
- Substance Abuse: 28% transitional homeless, 40% episodic homeless,
38% chronic homeless
- Veterans: 8% transitional homeless, 11% episodic, 15% chronic
Slide 6:
Implications
- Transitionally Homeless: Prevention and Relocation Assistance
- Episodically Homeless: Low Demand Residences (Safe Havens), Harm
Reduction, Transitional Housing, Residential Treatment
- Chronically Homeless: Permanent Supportive Housing
Slide 7:
The Impact of Supportive Housing on Services Use
for Homeless Persons with Mental Illness in New York City
Dennis Culhane, Ph.D.
Stephen Metraux, M.A.
Trevor Hadley, Ph.D.
Center For Mental Health Policy & Services Research
University of Pennsylvania
Slide 8:
NY/NY: Background
- Agreement between NYS and NYC
- Funds capital, operating, and service costs for 3,600 supportive
housing units in NYC
- Placement recipients must have an SMI diagnosis & a record
of homelessness
- Data available on 4,679 NY/NY placement records between 1989-97
Slide 9:
Research Question
How do NY/NY housing placements affect the use of:
- City shelters
- State psychiatric hospitals
- State Medicaid services
- City hospitals (HHC)
- Veterans Administration hospitals
- State prisons
- City jails
Slide 10:
Research Method #1
Pre-Post Test Analysis
- From a single point in time, data was collected two years before
the NYC shelter placement and two years after the placement.
Slide 11:
Research Method #2
Matched Pair Case-Control Design
- A total of 4,679 persons with NYC placement were matched with
a control pool of users from the services system and matched on race,
sex, age, substance abuse usage and mental health issues. The resulting
pairs were matched on the pre-intervention services used.
Slide 12:
The Cost of Homelessness
Service Provider |
Mean Days
Used (2-year
pre-NY/NY) |
Per Diem Cost |
Annualized
Cost |
NYC DHS - Shelter
NYC OMH - Hospital
NYC HHC - Hospital
Medicaid - Hospital
Medicaid - Outpatient
VA - Hospital
NYS - DCJS - Prison
NYC DOC - Jail
|
137
57.3
16.5
35.3
62.2 (visits)
7.8
9.3
10
|
$68
$437
$755
$657
$84
$467
$79
$129
|
$4,658
$12,520
$6,229
$11,596
$2,612
$1,821
$367
$645
|
Total
|
$40, 449
|
Slide 13:
Cost of Homelessness #2
This slide shows a pie chart with the following information:
- DHS Shelter $4658
- Mental Hospital $12,520
- NY Health and Hospitals Corporation $6229
- Medicaid Inpatient $11,596
- Medicaid Outpatient $2612
- VA Hospital $1821
- State Prison $367
- City Jail $645
Slide 14:
Reductions in Shelter Use
Source: the NYC Department of Homeless Services
Slide 15:
Reductions in Inpatient Hospital Use
Source: the NYS Office of Mental Health
Slide 16:
Reductions in Public Hospital Use
Source: the NYC Health and Hospitals Corporation (non-Medicaid)
Slide 17:
Reductions in Medicaid-Reimbursed Inpatient Hospital Use
Source: the NYS Department of Health
Slide 18:
Increases in the Use of Medicaid-Reimbursed Outpatient Services
Source: NYS Department of Health
- Persons – 13.1%
- Days -75.9%
Slide 19:
Reductions in VA Inpatient Hospital Use
Source: US Departmentt of Veterans Affairs
Slide 20:
Reductions in Incarceration in State Prison
Source: NYS Department of Criminal Justice Services
Slide 21:
Reductions in Incarceration in City Jails
Source: NYC Department of Corrections
Slide 22:
NY/NY Savings: Per Housing Unit Per Year
Serivces |
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
|
Slide 23:
Cost Savings #2
- DHHS Shelter $2819
- Mental Hospital $6162
- HHC Hospital $1321
- Medicaid Inpatient $2825
- Medicaid Outpatient – (negative) $2657
- VA Hospital $444
- NY Prison $312
- NY Jail $245
Slide 24:
NY/NY Housing Costs
Housing Type
|
Number of Units
|
Unit Cost
|
Net Cost per Housing Unit (% of total)
|
Net Cost of Housing Initiative
|
Community
Residence
|
1,384
|
$20,534
|
$4,252
(20.7%)
|
$5,884,768
|
Supportive
Housing
|
2,231
|
$17,276
|
$994
(5.8%)
|
$2,217,614
|
All NY/NY
(weighted mean)
|
3,615
|
$18,523
|
$2,241
(12.1%)
|
$8,101,215
|
Slide 25:
NY/NY Housing Costs and Savings
- Savings per unit from reduction = $16,282
- Annual Per Unit Cost of Housing for Community Residence = $19,662
- Supportive Housing = $17,277
- Weighted Mean = $18,190
Slide 26:
Summary of Findings
- Homeless mentally ill are heavy service users (37% of last 2 years
spent in institutional settings)
- Providing services for homeless mentally ill is expensive ($40,449
per person per year)
- Providing NY/NY housing for homeless mentally ill reduced costs
by 30% ($12,145 in savings per person)
- 94% of supportive housing costs offset by service reductions
Slide 27:
Policy Implications
- HUD should continue permanent housing set-aside; strengthen commitment
by moving renewals out of McKinney appropriation
- HHS, states and VA should fund services on a matching basis
- Mechanisms and partners needed for capital costs
- Study replication needed in other geographic areas
Slide 28:
Conclusion
- 95% of supportive housing costs offset by service reductions
- Study underestimated savings associated with program-funded services
and crime
- Study did not quantify benefits to consumers
- NY/NY was a sound public investment
|