# Presentation: 696924

## The Dynamics of Homelessness, and the Impact of Supportive Housing on Services Use and Costs

**Dennis P. Culhane**
**University of Pennsylvania**

## Point and Period Prevalence of Public Shelter Utilization:  New York and Philadelphia

## Proportion of NYC Population That Experienced a Shelter Stay in 1995, by Age

## Annual Rates of Shelter Utilization for Selected Populations

## Cluster Distributions: Persons and Shelter Days Consumed (Single Adults in Philadelphia)

**Transitional:**
**1.19 stays**
**20.4 days**
**Episodic:**
**3.84 stays**
**72.8 days**
**Chronic:**
**1.53 stays**
**252.4 days**

## Disability Condition & Veteran Status By Cluster (Single Adults in Philadelphia)

## 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**

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

**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**

## Funding Sources:

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** **
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**Fannie Mae Foundation **
** **
**The United Hospital Fund of New York**
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**The Conrad N. Hilton Foundation **
** **
**The Rhodebeck Charitable Trust**
** **
**The Corporation for Supportive Housing**
** **
** **

## NY/NY: Background

**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 **

## Research Question

** **

**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**

## Data Sources

**  **
**NY/NY Housing Placements: 1989-97**
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**Singles Shelter Users and Stays: 1987-99**
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**State Hospital Users & Stays: 1990-96**
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**Municipal Hospital Users & Stays (non-Medicaid): 1989-96**
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**Medicaid-Reimbursed Inpatient Hospital Stays: 1993-97**
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**Medicaid-Reimbursed Outpatient Visits: 1993-97**
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**Veterans Hospital Stays: 1992-99**
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**State Criminal Justice Prison Use & Convictions: 1987-97**
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**City Jail Use: 1987-99**

## Research Method #1

## Research Methods #2

**Research Methods #2**

## Days Spent in Institutional Care before NY/NY Placement

## The Cost of Homelessness

## The Cost of Homelessness #2

## Reductions in Shelter Use (NYC Dept. Of Homeless Services)

## Reductions in Inpatient Hospital Use (NYS Office of Mental Health)

## Reductions in Public Hospital Use (NYC Health & Hospitals Corporation – non-MA)

## Reductions in Medicaid-Reimbursed Inpatient Hospital Use (NYS Department of Health)

## Increases in the Use of Medicaid-Reimbursed Outpatient Services  (NYS Department of Health)

## Reductions in VA Inpatient Hospital Use (US Department of Veterans Affairs)

## Reductions in Incarceration in State Prison (NYS Dept. Of Criminal Justice Services)

## Reductions in Incarceration in City Jails (NYC Department Of Corrections)

## NY/NY Savings: Per Housing Unit Per Year

## Cost Savings #2

## NY/NY Housing Costs

##  NY/NY Housing - Costs and Savings

## 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 associated with services use by 30% **

## Policy Implications

**HUD should continue to support and expand the creation of permanent housing**
**HHS, states and VA should fund services **
**Mechanisms and partners needed for capital costs**

## 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**