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

• Persons 49.8%
• Days 60.5%

Slide 15:

Reductions in Inpatient Hospital Use
Source: the NYS Office of Mental Health

• Persons 25.4%
• Days 60.8%

Slide 16:

Reductions in Public Hospital Use
Source: the NYC Health and Hospitals Corporation (non-Medicaid)

• Persons 19.2%
• Days 21.2%

Slide 17:

Reductions in Medicaid-Reimbursed Inpatient Hospital Use
Source: the NYS Department of Health

• Persons 8 %
• Days 24.4%

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

• Persons 12%
• Days 24.4%

Slide 20:

Reductions in Incarceration in State Prison
Source: NYS Department of Criminal Justice Services

• Persons 64.1%
• Days 84.8%

Slide 21:

Reductions in Incarceration in City Jails
Source: NYC Department of Corrections

• Persons 26.9%
• Days 38.0%

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