LegiStorm

Summary:

Chronically homeless individuals are those who spend long periods of time living on the street or other places not meant for human habitation, and who have one or more disabilities, frequently including mental illnesses and substance use disorders. In the 2015 Department of Housing and Urban Development (HUD) point-in-time count of people experiencing homelessness, more than 83,000 individuals met the definition of chronically homeless, down from nearly 120,000 in 2008. In part the decline is due to the federal government's plan, announced in 2002, to end chronic homelessness within 10 years. The target date has since been extended to 2017. Among the federal programs focused on ending chronic homelessness are the HUD Homelessness Assistance Grants, the HUD and Veterans Affairs Supported Housing Program (HUD-VASH), and several HUD demonstration programs. One of the reasons that federal programs have devoted resources to ending chronic homelessness is studies finding that individuals who experience it, particularly those with serious mental illness, use many expensive services often paid through public sources, including emergency room visits, inpatient hospitalizations, and law enforcement and jail time. Even emergency shelter resources can be costly. In addition to potential ethical reasons for ending chronic homelessness, doing so could reduce costs in providing assistance to this population. For years, ending chronic homelessness was thought to be a multi-step process, with individuals receiving treatment for addictions and illnesses, perhaps while living in transitional or temporary housing, before being found capable of living on their own. However, the strategy for ending homelessness has changed, largely due to research pioneered by housing providers. Instead of requiring chronically homeless individuals to be "housing ready" by first addressing issues thought to underlie homelessness, the new strategy allows chronically homeless individuals to move into permanent supportive housing without preconditions. Permanent supportive housing (PSH) is not time-limited and makes services available to residents. A particular PSH, called Housing First, focuses on resident choice about where to live and the type and intensity of services and does not require abstinence or medication compliance. Housing First has been embraced by HUD and the Department of Veterans Affairs as a way to end chronic homelessness. Many researchers have examined PSH, including Housing First, as a way to reduce homelessness. Some researchers have also examined related outcomes, including changes in the use of services, and the costs of those services, by formerly homeless individuals after they move into housing; whether drug and alcohol use decreases; if there are improvements in mental health outcomes; and resident satisfaction after moving to housing. Overall, based on a review of the research, PSH helps increase days spent in housing and reduce days spent homeless, showing that PSH can be a successful way to end homelessness. The outcomes in other areas are not as clear, perhaps evidence that reductions in service use and costs, reductions in substance use, and mental health improvements may depend on individual needs and circumstances and require more than a successful move out of homelessness. When reductions in service use result from chronically homeless individuals moving into PSH, any commensurate cost reductions are largely seen in public spending on health care. Medicaid funds can be used to pay for housing-related services, and increasingly housing advocates are encouraging this as a way to help chronically homeless individuals gain and maintain housing. In addition, with limited funding available for new units of housing through HUD programs, some states are using their own shares of Medicaid funds to finance permanent supportive housing for chronically homeless individuals. Another possible funding source is Pay for Success initiatives, where private investments in PSH are paid back if certain outcomes are attained.