People Experiencing Chronic Homelessness
Providing permanent supportive housing for people experiencing chronic homelessness is highly cost effective. Permanent supportive housing leads to dramatic drops in utilization rates for hospitals, ERs, and other major services as well as drops in arrest rates.
In 2011, on a single night, there were 107,148 adults experiencing chronic homelessness in America; three-quarters are men with the average age approaching 50. Almost one-third are Veterans. Most go unsheltered and, despite disabling conditions, are not enrolled in Medicaid or other insurance programs.
The cost to individuals and society is high. The mortality rate for those experiencing chronic homelessness is four to nine times higher than for the general population. Rates of severe mental health disorders and substance abuse are high. In a wide range of communities, the extraordinarily high costs associated with the use of public services by those experiencing chronic homelessness have been documented. Health care is the major expense due to frequent and avoidable emergency room visits, inpatient hospitalizations, sobering centers, and nursing homes. People experiencing chronic homelessness have high rates of incarceration often for offenses that are non-violent and are related to mental illness or the realities of living on the street. This adds an additional burden to a justice system that, in many communities, is already stretched to its limit. The physical and mental health needs of this population are prevalent and acute, and must be addressed if we are to end chronic homelessness.
In order to improve outcomes for individuals experiencing chronic homelessness, strategic action should be concentrated in three key areas:
- Provide Permanent Supportive Housing
- Reduce Financial Vulnerability
- Improve Health and Housing Stability
Research from many communities has shown that permanent supportive housing is a cost-effective solution for chronic homelessness. The cost of the housing subsidy and supportive services is more than offset by less frequent use of costly public services such as jails and emergency rooms. This growing body of research has helped to motivate significant federal and local investments in permanent supportive housing, increasing the national inventory by 40 percent -- or approximately 57,000 -- in the last five years.
The Affordable Care Act will help many individuals, including people experiencing chronic homelessness, who were not eligible for Medicaid previously. Medicaid will be expanded to all individuals under the age of 65 with incomes currently up to about $15,000 for a single individual in FY 2010 in the continental United States (133 percent of the federal poverty level). Although many in this group will become Medicaid eligible due to the passage of Health Reform, a key to their enrollment will be providing them with transition assistance and permanent supportive housing solutions.
One of the four goals of Opening Doors is to finish the job of ending chronic homelessness by 2015. Working together to implement proven solutions, we can continue to make progress towards our goal.
Below you will find information and resources focused specifically on improving outcomes for individuals experiencing chronic homelessness.
Blog
Housing First: a movement goes mainstream
Fact Sheets
Opening Doors: Chronic Homelessness
In 2009, on a single night, there were 110,917 adults experiencing chronic homelessness in America; three quarters are men with the ...
Programs
Services in Supportive Housing
The Services in Supportive Housing (SSH) program was created to help prevent or reduce chronic homelessness by funding services for ...
Related Research
Barriers to employment for people with schizophrenia
Robert A. Rosenheck 2006 There is growing interest in identifying and surmounting barriers to employment for people with ...
Homes Not Handcuffs: The Criminalization of Homelessness in U.S. Cities
National Law Center on Homelessness and Poverty and The National Coalition for the Homeless July 2009 This joint report by ...
Homelessness, substance misuse, and access to public entitlements in a soup kitchen population
Peter C. Nwakeze, Ph.D., Stephen Magura, Ph.D., C.S.W., Andrew Rosenblum, Ph.D., and Herman Joseph, Ph.D. 2003 This study examines ...
Tenant Outcomes in Supported Housing and Community Residences in New York
Carole E. Siegel, Judith Samuels, Dei-In Tang, Ilyssa Berg, Kristine Jones and Kim Hopper July 2006 This study examines whether ...
A Narrative Approach to the Evaluation of Supportive Housing Stories of Homeless People Who Have Experienced Serious Mental Illness
Geoffrey Nelson , Juanne Clarke, Angela Febbraro, and Maria Hatzipantelis Fall 2005 In this study, researchers employ a narrative ...
Taking Health Care Home: Baseline Report on PSH Tenants, Programs, Policies
Martha R. Burt July 2005 In 2003, the Robert Wood Johnson Foundation awarded CSH $6 million over two years for the Taking Health ...
The Evidence on Supported Housing
Debra J. Rog May 2006 This study reviews the evidence base for supported housing that was initially prepared for the Texas ...
Outcomes of Homeless Adults with Mental Illness in Housing
Colleen Clark and Alexander R. Rich January 2003 This study compares the effectiveness of two types of service programs in ...
An Evaluation of an Initiative to Improve Coordination and Service Delivery of Homeless Services Networks
Greg A. Greenberg and Robert A. Rosenheck Feburary 2007 In 2003, the Department of Housing and Urban Development, the Department ...
An evaluation of an initiative to improve coordination and service delivery of homeless services networks. Preliminary Report: Draft 2.
Greg A. Greenberg 2007 In 2003, the Department of Housing and Urban Development, the Department of Health and Human Services, and ...
The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness.
Carol L. Pearson, Gretchen Locke, Ann Elizabeth Montgomery, and Larry Buron July 2008 In recent years, increased public ...
Evaluability Assessment of Discharge Planning and the Prevention of Homelessness: Final Report
Garrett Moran, Rafael Semansky, Elizabeth Quinn, Rebecca Noftsinger and Teresa Koenig September 22, 2005 Past research has ...
Medicaid-Financed Services in Supportive Housing for High-Need Homeless Beneficiaries: The Business Case
Michael Nardone, Richard Cho and Kathy Moses The Corporation for Supportive Housing and The Center for Health Care Strategies June ...
Treating Homeless Clients with Severe Mental Illness, Substance Use Disorders
Gary A. Morse, Robert J. Calsyn, W. Dean Klinkenberg, Thomas W. Helminiak, Nancy Wolff, Robert E. Drake, Robert D. Yonker, Gyanesh ...
Comparison of ACT and Standard Case Management For Delivering Integrated Treatment For Co-Occurring Disorders
Susan M. Essock, Kim T. Mueser, Robert E. Drake, Nancy H. Covell, Gregory J. McHugo, Linda K. Frisman, Nina J. Kontos, Carlos T. ...
Long-Term Effectiveness of the ACCESS Program
Aileen B. Rothbard, So-Young Min, Eri Kuno and Yin-Ling Irene Wong October 2004 This study examined the long-term effectiveness of ...
A Modified Therapeutic Community for Homeless Persons
Darren C. Skinner January 2005 This article, "A Modified Therapeutic Community for Homeless Persons with Co-Occurring Disorders of ...
Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults: A Randomized Trial
Laura S. Sadowski, Romina A. Kee, Tyler J. VanderWeele, and David Buchanan May 2009 The Chicago Housing for Health Partnership ...
Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems
Mary E. Larimer, Daniel K. Malone, Michelle D. Garner, David C. Atkins, Bonnie Burlingham, Heather S. Lonczak, Kenneth Tanzer, Joshua ...
Frequent Users of Health Services Initiative: Final Evaluation Report
Karen W. Linkins, Jennifer J. Brya, and Daniel W. Chandler, PhD August 2008 The Frequent Users of Health Services Initiative was a ...
Denver Housing First Collaborative Cost Benefit Analysis and Program Outcomes Report
Jennifer Perlman and John Parvensky December 11, 2006 The Colorado Coalition for the Homeless created the Denver Housing First ...
Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults
Tia E. Martinez and Martha R. Burt July 2006 This analysis examined the impact of permanent supportive housing on the use of acute ...
Estimated Cost Savings Following Enrollment in the Community Engagement: Program Findings from a Pilot Study of Homeless Dually Diagnosed Adults
Thomas L. Moore June 2006 This report discusses the estimated cost-benefits of providing community-based therapeutic care and case ...
Impact of the San Diego Serial Inebriate Program
James V. Dunford, Edward M. Castillo, Theodore C. Chan, Gary M. Vilke, MD, Peter Jenson and Suzanne P. Lindsay January 2006 The ...
Capitated Assertive Community Treatment Program Savings: System Implications
Daniel Chandler and Gary Spicer September 2002 In a California county of one million people, 4% of all clients served in 1994 were ...
Costs and Effectiveness of Substance Abuse Treatments For Homeless Persons
Joseph E. Schumacher, Stephen T. Mennemeyer, Jesse B. Milby, Dennis Wallace and Kim Nolan June 2002 This study presents a cost ...
Public Service Reductions Associated with Placement of Homeless Persons with Severe Mental Illness
Dennis P. Culhane, Stephen Metraux, and Trevor Hadley January 2002 This article assesses the impact of public investment in ...
Cost-Effectiveness of Services For Mentally Ill Homeless People
Robert Rosenheck October 2000 About one-quarter of homeless Americans have serious mental illnesses. This review synthesizes ...
Characteristics of Individuals With Severe Mental Illness Who Use Emergency Services
Alexander S. Young, Matthew J. Chinman, Julie A. Cradock-O’Leary, Green Sullivan, Dennis Murata, Jim Mintz and Paul ...
An Empirical Investigation of the Determinants of Street Homelessness
Dirk W. Early March 2005 This study examines the determinants of street homelessness by developing and estimating a model that ...
Prevalence and Risk Factors For Homelessness and Utilization of Mental Health Services Among 10,340 Patients With Serious Mental Illness in a Large Public Mental Health System
David P. Folsom, William Hawthorne, Laurie Lindamer, Todd Gilmer, Anne Bailey, Shahrokh Golshan, Piedad Garcia, Jürgen ...
Homelessness among persons with serious mental illness
Erik Kuno 2000 Homelessness and patterns of service use were examined among seriously mentally ill persons in an area with a ...
Homelessness Among Persons With Serious Mental Illness
Eri Kuno, Aileen B. Rothbard, June Avery and Dennis Culhane August 2000 Homelessness and patterns of service use were examined ...
USICH Webpages
HHS Releases 4 New Issue Briefs from Researchers on Chronic Homelessness
The Assistant Secretary for Policy and Evaluation (ASPE) at the Department of Health and Human Services recently released four issue ...
Implementing a Community-Wide Supportive Housing Registry: UNITY of Greater New Orleans
After Hurricane Katrina, the City of New Orleans began to experience a large increase in the number of individuals living unsheltered. ...
The Chicago Housing for Health Partnership's Approach to Housing and Health Care Integration
One of the challenges of serving individuals experiencing chronic homelessness is effectively integrating physical and behavioral ...
Thought Leaders to USICH: How to Accelerate Progress on Chronic Homelessness
As a part of the April 2012 Council meeting on chronic homelessness, USICH sought input from leaders in the field: Professor and ...
Chronic Homelessness In Focus
On April 5, 2012, Department of Health and Human Services Secretary Kathleen Sebelius convened her first meeting as Chair of the U.S. ...
