# Presentation: 293262

## Housing Options for Ending Chronic Homelessness

- Carol Wilkins
- Director of Intergovernmental Policy
**Corporation for Supportive Housing**
**www.csh.org**

**Notes:**
Overview
Housing Needs and Choices for Persons With Mental Illness
Models That Work: Supportive Housing 
To end and prevent homelessness
To expand opportunities for community participation
Impact of Supportive Housing on Health Access and Costs
Policy Implications
Housing Needs and Choices for Persons With Mental Illness
Models That Work: Supportive Housing 
To end and prevent homelessness
To expand opportunities for community participation
Impact of Supportive Housing on Health Access and Costs
Policy Implications

## People With Disabilities Are Often Priced Out of Housing

*In 2000, people with disabilities receiving SSI needed to pay – on a national average – 98% of their SSI benefits to rent a 1-bedroom apartment*
*In 2000, there was not one single housing market in the country where a person with a disability receiving SSI benefits could afford to rent a modest efficiency or 1-bedroom unit*
*Because of their extreme poverty, the 3.5 million non-elderly people with disabilities receiving SSI benefits cannot afford decent housing anywhere in the country without some type of housing assistance*
- Source: Technical Assistance Collaborative *Priced Out in 2000: The Crisis Continues*

## Federal, State, and Local Leaders are Making a Commitment 

- To create 150,000 units of supportive housing to end long-term homelessness in our country within 10 years
- To improve access to housing opportunities and choices for homeless people and people with disabilities

## Strategies for Expanding Housing Opportunities and Choices

- Strengthen partnerships between agencies that finance and deliver housing and services
- Target resources to create permanent housing for homeless and disabled people
- Improve access to housing created or subsidized through “mainstream” housing programs
- Enforce Fair Housing protections against discrimination and provide reasonable accommodations
- Build community acceptance for housing for people with special needs

## Supportive Housing	= Housing + Services

**Housing **
- Permanent: not time limited
- Affordable: generally tenants pay 30% of income for rent
- Independent: private living space and lease with normal tenant rights & responsibilities
**Services **
- Flexible and responsive to tenants’ needs
- Maximize independence and housing stability
- Participation is not a condition of tenancy
**Services + Property Management + Tenants =**
** ****Effective Partnerships **

## Target Population(s)

- Individuals and families who:
- Are very poor;
- Have persistent health conditions or multiple barriers to housing stability;
- Are homeless and/or do not have access to appropriate and stable housing in the community; *and*
- Would be unable to access or retain housing without tightly linked services

## Supportive Housing for the people who

***But for housing*** cannot access and make effective use of treatment and supportive services in the community; and
***But for supportive services*** cannot access and maintain stable housing in the community

## A Range of Models & Strategies

- Apartment or SRO buildings developed by non-profit owners for people with special needs
- Single family homes – may be shared
- Rent subsidized apartments leased in the private market
- Units set aside for people with special needs in mixed income housing developments
- Units secured by project sponsors through long-term ‘master lease’ with private owners
- Services integrated within existing affordable housing

## A range of services to support tenants in their goals

- A broad array of services available
- Mental health and substance use management and recovery
- Vocational and employment
- Money management & benefits advocacy
- Coordinated support/case management
- Life skills
- Community building and tenant advocacy
- Medical and wellness

## “Services are voluntary for the tenants – not the staff”

- Tenants choose as many or as few services as they desire – without having to move as their service needs change
- Engagement is an ongoing activity to establish and sustain relationships
- Begin with tenants’ practical needs and personal goals
- Service strategies anticipate and help to manage the risks and consequences associated with substance use and relapse
- Building a strong and safe community to reinforce norms of behavior and hope for recovery and growth

## Supportive housing tenants must pay rent and meet other lease obligations 

- Participation in services can help tenants meet their obligations, solve problems, and avoid eviction
- Money management & representative payee services may be offered
- Evictions are for failure to pay rent or for problem behavior – not for choices about participation in services

## Supportive housing provides opportunities for tenants to 

- Achieve housing stability
- Access appropriate care for and manage chronic health and mental health conditions
- Take steps toward achieving and maintaining sobriety
- Work
- Socialize
- Be leaders in their community
- Connect with the wider world
- Pursue goals and interests

## Expanding housing opportunities for people who are chronically homeless 

- Eligibility criteria for housing (or subsidies) targets people with disabilities and those who are homeless for the long-term
- Outreach, marketing and tenant selection procedures and program rules facilitate access
- Supportive services and property management practices are designed to help people achieve housing stability and reduce reliance on emergency care
- Requires strategies for effectively engaging and housing people with ongoing or relapsing substance use problems

## Supportive Housing Worksas documented by researchers across the country

- 80% of tenants coming from streets and shelters achieve housing stability for at least a year
- Emergency room and hospital visits drop by more than 50%
- Increase use of primary care and services to address substance abuse problems
- Increase participation in work and employment services

##  The Impact of Supportive Housing for Homeless Persons with Severe Mental Illness on Use of Public Services in New York City 

-  Dennis Culhane, Ph.D., Stephen Metraux, M.A., and Trevor Hadley, Ph.D.
- Center For Mental Health Policy & Services Research
- University of Pennsylvania

- Study analyzed patterns of service utilization in shelters, state mental health facilities, hospitals, VA, Medicaid, jails, and prison – before and after housing placement for 4,679 individuals
- The cost of homelessness for persons with serious mental illness was more than $40,000 per year – with 86% of costs in health care and mental health systems
- Costs of creating and operating supportive housing are offset by savings in other public systems

## The Cost of Homelessness in NY

| 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  |

## Savings in Services UsePer NY/NY Placement 

| Service | Per Diem Cost | Reduction
(days) | Annualized Cost Reduction |
| --- | --- | --- | --- |
| Municipal Shelter  | $68  | 82.9 | $2,819  |
| Psychiatric Hospital | $437  | 28.2 | $6,162  |
| Municipal Hospital | $755  | 3.5 | $1,321  |
| Medicaid – Inpatient | $657  | 8.6 | $2,825  |
| Medicaid - Outpatient | $84  | -47.2 (visits) | ($1,982) |
| Veterans Hospital | $467  | 1.9 | $444 |
| NYS Prison | $79  | 7.9 | $312  |
| NYC Jail | $129  | 3.8 | $245  |
| Total |   |  | $12,145  |

##  NY/NY Housing - Costs and Savings