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Preface Preface P–11 

 

 

 

 

 

 

 

 

 

Preface 

This study examines costs associated with the use of homeless and mainstream service delivery 

systems by families and individuals experiencing homelessness for the first time in six study 

communities. Assigning costs to public programs is a first step toward developing measures of the 

value of public interventions compared to the public costs incurred by ignoring or avoiding the

problems those interventions are intended to address. The study finds that the experience of 

homelessness is diverse and the associated costs vary tremendously depending on the pattern of 

homelessness and family or individual status. It is not, however, a study of either cost-effectiveness 

or quality of care, but rather a calculation of costs associated with homelessness. 

Homeless Program Costs 

The study examines average costs per month across sites for emergency shelter, transitional housing, 

and permanent supportive housing. It finds that: 

•	 For individuals, overnight emergency shelter has the lowest cost per day (and provides the 

fewest services and often limited hours). 

•	 For individuals, transitional housing proves more expensive than permanent supportive 

housing, since services for transitional housing were usually offered directly by the homeless 

system rather than by mainstream service providers. 

•	 For families, emergency shelters are usually equally or more expensive than transitional 

housing and permanent supportive housing, because families are often given private rooms or 

apartments. Emergency shelters for families are also likely to be open 24-hours, provide 

supportive services, and have fewer units, yielding higher fixed costs. 

•	 In almost all cases, the costs associated with providing housing for individuals and families

who are homeless within a program exceeds the Fair Market Rent cost of providing rental 

assistance without supportive services. 

•	 Homeless system and mainstream service costs were difficult to calculate, largely due to 

challenges in accessing local administrative data. 

Costs Associated with First-Time Homelessness 

Average homeless system costs for individuals ($1,634 to $2,308) are much lower than those for 

families ($3,184 to $20,031), who usually have higher daily costs and stay much longer. The 50 

percent of individuals with the lowest homeless system costs incurred only 2 to 3 percent of the total 

system costs; whereas the 10 percent of individuals with the highest daily costs incurred up to 83 

percent of total costs. The distribution of costs for families is also quite skewed, though less so than 

for individuals. 

The emergency shelter system may be an “adequate” response to an immediate housing crisis for

most individuals, but is an expensive solution to family homelessness. More than half of individuals 

studied used only emergency shelters, yet the costs of this facility type represent less than one-third of 

total costs for individuals. 

Individuals and families who remain in homeless programs for extended periods incur the highest 

percentage of costs, presenting the greatest opportunity for homeless system cost savings. Cost 

savings may be realized if permanent supportive housing were more readily available to these

households. Permanent supportive housing tends to be less expensive to the homeless system than 

transitional housing because most service costs are borne by mainstream systems. 

Preface P–1 
P–2 2 Preface Preface

 

 

 

 

 

 

 

Individuals and families who use homeless programs multiple times with long gaps between stays 

represent less than one-fifth of those studied. Although costs for this group are proportionately 

smaller than for those with extended uses of homeless programs, the episodic homelessness of these 

households indicates that resources currently may not be used effectively. These individuals and 

families tend to have high levels of interaction with the criminal justice system (though gaps were not 

explained exclusively by incarceration), and a majority of families with long gaps also experience 

changes in household composition between stays. 

Demographics 

Nearly three-quarters of first-time homeless individuals in the communities studied were male. Perperson costs for first-time homeless women are 97 percent higher than for men, due largely to greater 

privacy arrangements in female emergency shelters and a higher proportion of women in transitional 

or permanent supportive housing. Women also stay in homeless programs 74 percent longer than 

men (this is controlled for in the cost differential above). In all sites but one, African-Americans are 

over-represented among first-time homeless individuals in comparison to the general population of 

people in poverty. 

The first time homeless family in the study most frequently has one adult member (usually female) 

and an average of 3 to 3.5 members. Homeless families headed by younger persons tend to use less 

expensive program types, stay for shorter periods, and, consequently, incur lower costs than those 

headed by older persons. 

Patterns of First-Time Homelessness 

The majority of households studied, 50 to 65 percent of individuals and 58 to 72 percent of families, 

stayed in a homeless program only one time during the 18-month period the study covered. Families 

cycled less in and out of homeless facilities, but remained in programs longer. Extended stays were 

associated with escalating costs; each additional month in a program is associated with 35 percent 

higher costs for individuals and 22 percent higher costs for families. 

Mainstream System Costs 

The question of whether mainstream service costs can be offset by appropriate housing interventions 

is left open by this study. However, consistent with past research, significant mainstream system cost

savings may be achieved by targeting individuals or families with high levels of involvement in 

mainstream systems prior to homelessness. Most first-time homeless individuals in the study do not 

have high involvement in mainstream systems, and less than 10 percent received care in these 

systems during the period of homelessness. At two sites, criminal justice and mental health 

involvement increased substantially immediately before first-time individual homelessness. This 

finding suggests a need for discharge planning to ensure that individuals leave mainstream programs, 

such as inpatient treatment or jails, with adequate housing. In contrast, first-time homeless families 

had very high enrollment in Medicaid and low to moderate use of other mainstream systems. 

Conclusions 

The study concludes that communities should explore strategies to: 

•	 Avoid extensive use of high-cost homeless programs (i.e., transitional housing) for 

individuals or families who primarily need permanent housing without supports or those

whose service needs can be met by mainstream systems. 

•	 Alter the way that homeless assistance systems respond to households that are unable to 

remain stably housed and face repeated instances of homelessness. Communities could 

consider models such as Homeless Prevention and Rapid Re-Housing. 

P–2 Preface 
Preface Preface P–33 

•	 Work with mainstream systems (especially criminal justice, mental health, and substance 

abuse systems) to design appropriate discharge planning strategies and ways to identify

clients at-risk of homelessness to prevent homelessness. 

Preface P–3 
P–4 P–4 Preface Preface 
4 Preface Acknowledgments Preface P–5 A–1

 

 

 

 

 

Acknowledgments 

This study was conducted by Abt Associates Inc. for the Department of Housing and Urban 

Development under Task Order C-CHI-00838, CHI-T0001 (“The Costs of Homelessness Study”) and 

CD-TA Cooperative Agreement MAMV-001-06. 

The authors of this report wish to acknowledge the assistance provided to the study by many

individuals. First, we appreciate the guidance and support of Paul Dornan, the study’s Project Officer 

in HUD’s Office of Policy Development and Research, who has provided sensible and thoughtful 

insight, as well as tremendous support, throughout the study. We are also thankful to HUD’s Office 

of Special Needs Assistance Programs for funding follow-up analysis and writing. 

We are especially grateful to the individuals who assisted us in the six study sites: Des Moines, Iowa; 

Houston, Texas; Jacksonville, Florida; Kalamazoo, Michigan; Upstate South Carolina; and 

Washington, DC. These individuals—leaders and members of the Continua of Care (CoC); Homeless 

Management Information System administrators; program and administrative staff of homeless 

service providers; mainstream agency staff; and other local champions—contributed their time, data 

and ideas to make this study possible. In particular, we would like to highlight the contributions of 

Julie Eberbach, Eileen Mitchell, and David Eberbach, Des Moines, Iowa; Tuan Nguyen, Clarissa 

Stephens, Anthony Love, Cathy Crouch, Julia Thompson, Buddy Grantham, Brandon LeBlanc, 

Horace Robinson, Houston, Texas; Molly Petersen, Melissa Pociask, Thomas Shull, and David 

Anderson, Kalamazoo, Michigan and Barbara Ritter, Michigan Coalition for the Homeless; Wanda 

Lanier, Bob Arnold, Stephen Caravella and Diane Gilbert, Jacksonville, Florida and Dr. Annette 

Christy and Kristen Turner, University of South Florida; Michael Chesser and Kay Perry, Upstate 

South Carolina CoC and Diana Tester and Charles Bradberry, State of South Carolina; and Darlene 

Mathews, Sue Marshall, Steve Cleghorn and Laura Zeilenger, Washington, DC. 

We also appreciate the guidance of the leading researchers who participated in a research design 

expert panel meeting: Martha Burt, Dennis Culhane, Joe Harkness, David Long, Lori Megdal, and 

Sandra Newman. Denise DiPasquale advised the study team on development of appropriate methods 

to calculate nightly unit costs associated with capital investments for homeless programs. 

At Abt Associates, a number of staff members played important roles in designing the study and in 

collecting, assembling, analyzing, and interpreting the data and writing the report. The authors of this 

study are Brooke Spellman, Jill Khadduri, Brian Sokol, and Josh Leopold. Dr. Jill Khadduri was the 

Principal Investigator, and Brooke Spellman was the Project Director for the study; both were 

involved in all aspects of the study. Dr. Larry Buron, Project Quality Advisor, provided thoughtful 

and constructive input throughout all phases of the research. Brian Sokol led the HMIS and 

mainstream data analysis, with analytical support from Josh Leopold and Evan Volgas. Ken Lam 

conducted the multivariate cluster analysis of the study cohort and regression analysis of cost and 

cohort data. Megan Tiano and Nichole Fiore assisted with document review and cross-checking the 

data. Eileen Fahey and Katheleen Linton provided production support. Jill Khadduri, Josh Leopold, 

Pedram Mahdavi, Louise Rothschild, Matt White, and Erin Wilson were responsible for collecting the 

programmatic and cost data on the homeless systems for each of the sites and writing portions of the 

case studies, with support from subcontractors and consultants, Martha Burt, Kat Freeman, Ann Oliva 

and Daria Zvetina. Consultants Eric Jahn and Heidi Burbage played significant roles in researching 

and coordinating access to mainstream data. 

Acknowledgments Preface P–5 A–1
P–6 A–2 A–2 P–6 Acknowledgments Acknowledgments Preface Preface 
Contents C–1

v 

 

 

 

Table of Contents 

Preface ............................................................................................................................................... P-1 

Acknowledgments.............................................................................................................................A-1 

Executive Summary .......................................................................................................................ES-1 

Methodology .................................................................................................................................... ES-2 

Homeless Program Costs.................................................................................................................. ES-3 

Characteristics of First-Time Homeless Individuals and Families in this Study and 

Costs to the Homeless Services System ...................................................................................... ES-5

Patterns of First-time Homelessness for Individuals and Families in this Study ............................. ES-6 

Costs Associated with First-Time Homelessness............................................................................. ES-7 

Costs for Groups of Households with Common Patterns of System Utilization.............................. ES-8 

Costs Associated with Mainstream System Use By First-Time Homeless Individuals 

 and Families .............................................................................................................................. ES-12 

Conclusion...................................................................................................................................... ES-15 

1. Introduction ...................................................................................................................................1-1 

2. Methodological Framework for Analysis of Costs Associated with Homelessness .................2-1 

2.1. Research Questions ......................................................................................................................2-1 

2.2. Research Domains........................................................................................................................2-2 

2.3. Study Sites, Period, and Population .............................................................................................2-3 

2.4. Data Sources.................................................................................................................................2-5 

2.5. Data Analysis Approach for Case Studies....................................................................................2-8 

2.6. Cross-Site Analysis ....................................................................................................................2-17 

2.7. Limitations of the Study .............................................................................................................2-18 

3. Homeless Program Costs ..............................................................................................................3-1 

3.1. Homeless Program Costs for Individuals.....................................................................................3-2 

3.2. Homeless Program Costs for Families ...................................................................................... 3-10

3.3. Policy Implications of Program Costs .......................................................................................3-19 

4. First-Time Homelessness for Individuals and its Associated Costs .........................................4-1 

4.1. Existing Research ........................................................................................................................4-2 

4.2. Characteristics of First-Time Homeless Individuals ....................................................................4-5 

4.3. Patterns of First-Time Homelessness and Associated Homeless System Costs...........................4-6 

4.4. Costs Associated with Mainstream System Use.........................................................................4-22 

4.5. Homeless System and Mainstream Costs for First-Time Homeless Individuals 

During the Period of Homelessness ..................................................................................................4-36 

4.6. Policy Implications and Recommendations for Further Research .............................................4-39 

5. First-Time Homelessness for Families and its Associated Costs ..............................................5-1 

5.1. Existing Research ........................................................................................................................5-1 

5.2. Characteristics of First-Time Homeless Families ........................................................................5-4
 

5.3. Patterns of Family Homelessness and Associated Homeless System Costs ................................5-5 

5.4 Costs Associated with Mainstream System Use by First-Time Homeless Families..... ............5-23 

5.5. Policy Implications and Recommendations for Further Research .............................................5-30
 

Contents C–1 
C–2 vi Contents

 

 

6. Implications for Policy and Future Research............................................................................. 6-1 

6.1. Policy Implications Related to Different Patterns of Homeless System Use............................... 6-2 

6.2. Policy Implications Related to Individuals and Families with Different 

Demographic Characteristics ............................................................................................................. 6-5 

6.3. Ideas for Future Research ............................................................................................................ 6-8 

Appendix A: Costs Associated with First-Time Homelessness: Individuals in 

Jacksonville, FL................................................................................................................................ A-1 

A.1. Overview.................................................................................................................................... A-1 

A.2. The Homeless Services System for Single Adults in Jacksonville-Duval, Clay

Counties ............................................................................................................................................. A-4 

A.3. Homeless System Costs ............................................................................................................. A-9 

A.4. Mainstream System Costs ............................................................................................ ........... A-14 

A.5. Total Homeless and Mainstream Costs......................................................................... ........... A-23
 

A.6. Implications................................................................................................................... ........... A-26 

References............................................................................................................................. ........... A-29 

Appendix B: Jacksonville Tables.....................................................................................................B-1 

B.1. Demographic Characteristics of Homeless Path Groups.............................................................B-1 

B.2. Homeless Service Utilization by Homeless Path Group .............................................................B-2 

B.3. Multivariate Analysis of Total Costs, Homeless Costs, and Total Mainstream 

Costs ...................................................................................................................................................B-3 

B.4. Multivariate Analysis of Costs by Domain, with Homeless Utilization as 

Covariates ...........................................................................................................................................B-7 

B.5. Multivariate Analysis of Costs by Domain, with Path Groups as Covariates.............................B-9 

B.6. Multivariate Analysis of Costs by Domain, with Total Homeless Costs as a 

Covariate ..........................................................................................................................................B-12 

B.7. Mainstream Involvement and Per Person Mainstream Costs by Homeless Path 

Group and Time Period.....................................................................................................................B-13 

Appendix C: Individual Data.......................................................................................................... C-1 

C.1. Cohort Summaries.......................................................................................................................C-1 

C.2. Cross-Site Individuals Multivariate Analyses.............................................................................C-4

C.3. Multivariate Analysis of Costs by Domain in Houston Individuals ...........................................C-7 

Appendix D: Family Data .............................................................................................................. D-1 

D.1. Family Cohort Summaries ........................................................................................................ D-1 

D.2. Cross-Site Family Multivariate Analysis .................................................................................. D-5
 

Bibliography of Cost of Homelessness Case Studies..................................................................... R-1 

References......................................................................................................................................... R-3
 

C–2 Contents 
Contents C–3

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List of Exhibits 

Exhibit 1: Average Cost Per Household Per Month for Homeless Program Types ........................ ES-4 

Exhibit 2: Study Cohort Characteristics .......................................................................................... ES-5 

Exhibit 3: Homelessness System Utilization ................................................................................... ES-7

Exhibit 4: Average Homeless System Cost per Household ............................................................. ES-8 

Exhibit 5: Households that Use Only Emergency Shelter for Brief Periods ................................... ES-9 

Exhibit 6: Households that Use Homeless Programs for Extended Periods .................................. ES-10 

Exhibit 7: Households that Use Homeless Programs Multiple Times with Long Gaps 

Between Stays ................................................................................................................................ ES-11 

Exhibit 8: Average Mainstream System Costs per Person Incurred “During” 

Homelessness ................................................................................................................................. ES-13 

Exhibit 9: Total Mental Health Encounters Each Month by First-Time Homeless 

Individuals in Houston Shown Relative to First Day of Homelessness ......................................... ES-14 

Exhibit 10: Rate of Mainstream System Involvement and Costs Per Family Per Month .............. ES-15 

Exhibit 2.1: Research Questions and Outputs for the Study ...............................................................2-2 

Exhibit 2.2: Case Study Sites and Study Population ..........................................................................2-3

Exhibit 2.3: Mainstream Domains included in the Study....................................................................2-8 

Exhibit 3.1: Average Cost Per Person Per Day of Homeless Residential Programs Serving 

Individuals by Program Type and Site a .............................................................................................3-3 

Exhibit 3.2: Average Cost Per Person Per Month for each Homeless Program Type for 

Individuals and FY2006 One-Bedroom Fair Market Rents ................................................................3-4 

Exhibit 3.3: Average Cost Per Day of Emergency Shelter for Homeless Individuals ........................3-5 

Exhibit 3.4: Average Cost Per Day of Transitional Housing for Homeless Individuals ....................3-8 

Exhibit 3.5: Average Cost Per Day of Permanent Supportive Housing Programs for 

Homeless Individuals..........................................................................................................................3-9 

Exhibit 3.6: Average Cost Per Family Per Day of Homeless Residential Programs Serving 

Families by Program Type and Site ..................................................................................................3-11 

Exhibit 3.7: Average Cost Per Family Per Month for Each Homeless Program Type for 

Families and FY2006 Two-Bedroom Fair Market Rents .................................................................3-13 

Exhibit 3.8: Average Cost Per Day of Emergency Shelter for Homeless Families...........................3-15 

Exhibit 3.9: Average Cost Per Day of Transitional Housing for Homeless Families.......................3-17 

Exhibit 3.10: Average Cost Per Day of Permanent Supportive Housing for Homeless 

Families .............................................................................................................................................3-19 

Exhibit 4.1: NY/NY Cost Study Service Use during Two Year Period prior to Placement 

in Permanent Supportive Housing ......................................................................................................4-3 

Exhibit 4.2: Characteristics of the Study Cohort of Individuals Who Became Homeless 

between July 1, 2004 and June 30, 2005 as compared with National Estimates ................................4-6 

Exhibit 4.3: Use of the Homeless System by the Study Cohorts of First-Time Homeless

Individuals During an 18-Month Period .............................................................................................4-7 

Exhibit 4.4: Regression Analysis of Lengths of Stay for First-Time Homeless Individuals 

in Des Moines, Houston, and Jacksonville .........................................................................................4-8 

Exhibit 4.5: Average Homeless System Cost per Individual ..............................................................4-9 

Exhibit 4.6: Regression Analysis of Total Homeless System Costs for First-Time 

Homeless Individuals in Des Moines, Houston, and Jacksonville ....................................................4-10
 

Contents C–3 
C–4 viii Contents

 

 

 

Exhibit 4.7: Path Groups Common to All Three Sites and their Relative Sizes ............................... 4-13 

Exhibit 4.8: Proportion of Study Cohort Represented by Common Path Groups............................. 4-14 

Exhibit 4.9: Characteristics of Individuals in Common Path Groups............................................... 4-15 

Exhibit 4.10 Average Homeless System Costs Per Person By Path Group...................................... 4-21 

Exhibit 4.11: 2006 Fair Market Rent for One-bedroom Unit in Individual Study Sites................... 4-22 

Exhibit 4.12 Rates of Involvement with Mainstream System Domains Prior to 

Homelessness, During Homelessness and Overall During the Study Period ................................... 4-23 

Exhibit 4.13: Average Mainstream System Costs per Person Incurred “During” 

Homelessness.................................................................................................................................... 4-25 

Exhibit 4.14: Monthly Mainstream Costs by Domain and Period, 

Jacksonville and Houston ................................................................................................................. 4-26 

Exhibit 4.15: Jacksonville Jail Stays Relative to Homelessness......................................................... 4-2 

Exhibit 4.16: Houston (Individuals) Jail Stays Relative to Homelessness ....................................... 4-28 

Exhibit 4.17: Houston (Individuals) Mental Health Costs by Month Relative to 

Homelessness.................................................................................................................................... 4-29 

Exhibit 4.18: Regression Analysis of Mainstream System Costs for First-Time Homeless

Individuals in Jacksonville................................................................................................................ 4-31 

Exhibit 4.19: Regression Analysis of Mainstream Costs for First-Time Homeless

Individuals in Houston...................................................................................................................... 4-32 

Exhibit 4.20: Jacksonville Cohort’s Average Per Person Monthly Mainstream Costs By

Path Group and Perio ........................................................................................................................ 4-34 

Exhibit 4.21: Modeling Mainstream Costs for First-Time Homeless Individuals in

Jacksonville by Path Groups............................................................................................................. 4-34 

Exhibit 4.22: Homeless and Selected Mainstream System Costs per Person Incurred during 

Homelessness.................................................................................................................................... 4-36 

Groups and Costs from the NY/NY Study Cohort Prior to Placement in 

Permanent Supportive Housing ........................................................................................................ 4-37 

Exhibit 4.23: Comparison of Costs During Homelessness Among Select Jacksonville Path 

Exhibit 5.1: Average Cost per Family to the Homeless Services System, based on Lengths 

of Stay and Shelter Reimbursement Rates for Each Community ....................................................... 5-3 

Exhibit 5.6: Numbers of First-Time Homeless Families using Basic Types of Residential 

Exhibit 5.12: Average Household Cost to the Homeless Services System for Brief Users of 

Exhibit 5.2: Characteristics of the Study Cohort of Families Who Became Homeless 

between July 1, 2004 and June 30, 2005............................................................................................. 5-4 

Exhibit 5.3: Changes in Household Composition among Homeless Families.................................... 5-5 

Exhibit 5.4: Use of the Homeless System by the Study Cohorts of First-Time Homeless

Families during an 18-Month Period .................................................................................................. 5-6 

Exhibit 5.5: Regression Analysis of the Length of Stay for First-Time 

Homeless Families.............................................................................................................................. 5-7 

Programs for Homeless People by the Study Cohorts of First-Time Homeless 

Families............................................................................................................................................... 5-9 

Exhibit 5.7: Regression Analysis of Program Types used by First-Time Homeless Families 

in Kalamazoo, DC, South Carolina, and Houston ............................................................................ 5-10 

Exhibit 5.8: Average Homeless System Cost per Family................................................................. 5-11 

Exhibit 5.9: Regression Analysis of Total Homeless Costs.............................................................. 5-12 

Exhibit 5.10: Common Paths Taken by First-Time Homeless Families........................................... 5-15 

Exhibit 5.11: Selected Characteristics of First-Time Homeless Family Path Groups ...................... 5-16 

C–4 Contents 
Contents C–5

ix 

 

 

Emergency Shelter ............................................................................................................................5-16 

Exhibit 5.13: Cost to the Homeless Services System for Heavy Users of Transitional 

Housing .............................................................................................................................................5-18 

Exhibit 5.14: Patterns of Use of the Residential Homeless System for “Long Gapper” FirstTime Homeless Families ...................................................................................................................5-19 

Exhibit 5.15: Selected Demographic Characteristics of “Long Gappers”.........................................5-20 

Exhibit 5.16: Average Cost Per Family to the Homeless Services System for Repeat Users 

of the Residential Services System with Long Gaps.........................................................................5-20 

Exhibit 5.17: First-Time Homeless Families Using both Congregate and Apartment-Style 

Emergency Shelter (and not transitional housing) in Washington DC..............................................5-22 

Exhibit 5.18: Rates of Utilization of Selected Mainstream Systems by First-Time Homeless 

Families .............................................................................................................................................5-25 

Exhibit 5.19: Average Costs for Selected Mainstream Domains per First-Time Homeless 

Family during the Entire Study Period..............................................................................................5-26 

Exhibit 5.20: Mainstream Costs Per Family Per Month Before, During, and Following 

Homelessness ....................................................................................................................................5-27 

Exhibit 5.21: Mental Health Encounters of First-Time Homeless Families in Houston 

Compared to Date of First Homeless Entry.......................................................................................5-28
 

Appendix A:

Exhibit 1: The Jacksonville Cohort ....................................................................................................A-1 

Exhibit 2: Costs While Homeless.......................................................................................................A-2 

Exhibit 3: Monthly Mainstream Costs in Relation to Homelessness.................................................A-3 

Exhibit 4: The Jacksonville-Duval/Clay Counties CoC.....................................................................A-4 

Exhibit 5: Jacksonville CoC Program Typology................................................................................A-5

Exhibit 6: Homeless Costs by Program Type.....................................................................................A-7

Exhibit 7: Homeless Program Utilization...........................................................................................A-9 

Exhibit 8: Summary of Per Person Homeless System Costs..............................................................A-9 

Exhibit 9: Distribution of Homeless Costs.......................................................................................A-10 

Exhibit 10: Homeless Costs by Gender, Race and Age ...................................................................A-10 

Exhibit 11: Jacksonville Homeless Path Groups..............................................................................A-12

Exhibit 12: Percent of Study Cohort Utilizing Mainstream Systems During the Study

Period ...............................................................................................................................................A-14 

Exhibit 13: Summary of Total Mainstream System Costs...............................................................A-15 

Exhibit 14: Total Monthly Mainstream Costs for the Study Cohort Before, During, and 

After Homelessness..........................................................................................................................A-15 

Exhibit 15: Jacksonville Jail Stays Relative to Homelessness .........................................................A-16 

Exhibit 16: Multivariate Regression Models for Criminal Justice Costs.........................................A-17 

Exhibit 17: Multivariate Regression Models for Income Support Costs..........................................A-19 

Exhibit 18: Multivariate Regression Models for Substance Abuse Costs........................................A-20 

Exhibit 19: Multivariate Regression Models for Mental Health Services Costs..............................A-21 

Exhibit 20: Multivariate Regression Models for Physical Health Care Costs..................................A-22 

Exhibit 21: Summary of Total Costs................................................................................................A-23 

Exhibit 22: Distribution of Costs During Homelessness..................................................................A-23 

Exhibit 23: Average Homeless and Mainstream Costs by Time Period and Path Group ................A-23 

Exhibit 24: Total Homeless and Mainstream Costs by Age.............................................................A-25
 

Contents C–5 
C–6 C–6 Contents Contents 
ES-1 Executive Summary Executive Summary ES–1

 

 

 

 

 

 

Executive Summary 

This study measures costs associated with first-time homeless families and individuals incurred by

homeless and mainstream service delivery systems in six study communities. Unaccompanied 

individuals were studied in Des Moines, Iowa; Houston, Texas; and Jacksonville, Florida. Families 

were studied in Houston, Texas; Kalamazoo, Michigan; Upstate South Carolina; and Washington, 

DC. 

Past research has primarily documented costs associated with homelessness for individuals with 

chronic patterns of homelessness or severe mental illness. Newer work has been published on the 

costs incurred within the homeless system for families experiencing first-time homelessness. This 

study provides additional findings that help to improve our understanding of homelessness and its 

associated costs. It presents ideas about opportunities for cost savings, and it advances an approach 

for measuring costs that, coupled with other evaluation methods, can help communities understand 

the cost-effectiveness of different homelessness interventions. 

The study demonstrates that the experience of homelessness is diverse and the associated costs vary

tremendously depending on the pattern of homelessness. Across the six sites, the study identifies 

three primary patterns of first-time homelessness. Most first-time individuals and families experience 

homelessness only once or twice and use emergency shelter for a limited period of time at fairly low 

cost. Some experience much longer stays, usually in transitional housing, and some have very high 

associated costs. A third group uses the system sporadically, moving in and out of homeless 

programs multiple times during long periods. We recommend that communities consider specific

responses to homelessness that target the needs of those who use the system in different ways. 

We also identified certain demographic characteristics and limited patterns of first-time homelessness 

that were associated with greater mainstream system involvement, but the analysis did not identify

clear opportunities for cost savings in the mainstream systems through the implementation of 

alternative responses to homelessness. However, the results also do not eliminate the possibility of 

mainstream system cost savings. Analysis of more comprehensive client-level data may yield more 

conclusive findings in this area. 

The study does not attempt to isolate which of the mainstream costs are attributable to homelessness, 

and it does not compare the benefits of different programs with the costs of their use. Thus, the study

is not a cost-effectiveness study and is most accurately characterized as a study to measure homeless 

and mainstream costs associated with homelessness. 

The findings from these communities are not intended to be nationally representative. In fact, 

findings presented in this report show that the community in which individuals and families received 

services frequently had a strong effect on both their length of stay and costs. Thus, local factors and 

particular Continuum and program-level decisions can have a large effect on patterns of homelessness 

and associated homeless system costs. Despite these local differences, the study finds trends that cut 

across communities. We hope that policymakers will review these findings and consider whether 

similar conclusions can be drawn about their own communities. Policymakers can also use similar 

methods to help assess: how people who are homeless use homeless and mainstream systems in their 

communities; whether these patterns of use are appropriate; whether their homelessness systems are 

Executive Summary ES–1 
ES–2 Executive Summary

Contents C-3 

 

 

 

 

 

 

efficient in achieving positive outcomes for people who become homeless; and whether there are 

opportunities for cost savings through alternative program models. 

After a brief summary of the methodology used for the study, the remainder of the executive 

summary highlights the key results and policy implications of this research. All of these findings are 

discussed in detail in the main body of the report. 

Methodology 

This study breaks new ground methodologically in homelessness research in the following areas: 

•	 rigorously calculating the costs of providing a family or individual with a day of shelter 

in specific residential programs for homeless people; 

•	 incorporating distinctions among program types and their housing models (e.g., facilitybased transitional housing) into our analysis of both patterns and costs of first-time 

homelessness; and 

•	 analyzing both individuals and families, as well as vastly different types of communities 

or geographic areas, using the same research design, facilitating direct comparisons. 

For purposes of this study, persons were considered homeless if they used a street outreach or 

residential homeless program that is represented in the site’s homeless management information 

system (HMIS) data. People were considered first-time homeless if they did not have a recorded 

encounter with an outreach program or stay in a residential homeless program in the HMIS at any

point prior to the study enrollment period. Periods in which persons were precariously housed, 

doubled up, or staying in a non-participating program are not represented as “during homelessness,” 

with one exception. If study subjects had more than one stay in residential homeless programs during

the study period, then the time between stays, referred to in the study as a “gap,” is also considered 

“during homelessness.” Homeless system costs are based on the actual days stayed in programs, but 

mainstream costs incurred during “gaps” are counted in the “during homeless” period. 

Homeless systems are limited to programs within a community that are designed and dedicated to 

providing housing and services to people who are homeless. The homeless programs accounted for in 

this study are: outreach programs, emergency shelters, transitional housing, and permanent supportive 

housing. Programs that only provide supportive services to homeless people are not included. 

Mainstream service systems are those that are not dedicated exclusively to serving people who are 

homeless, yet provide services that are needed and often used by them. Mainstream system cost data 

examined for this study include: Medicaid primary healthcare, mental healthcare and substance abuse

treatment; state-funded mental healthcare and substance abuse treatment; law enforcement and 

criminal justice; and income supports. 

Using telephone outreach and in-person site visits, we collected information about the homeless 

system within each community. From this information we developed a homeless program typology, 

which sometimes differed from local definitions of homeless program types, as a framework for the 

study. We also derived daily costs for a sample of homeless programs of each type. The homeless 

program costs account for operational and agency overhead costs associated with each program, in

addition to services that are provided as part of the program. Capital costs of facilities owned by

programs or donated to them also are included in daily costs per unit for programs in Jacksonville, 

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Des Moines, and Upstate South Carolina. To account for programs from which we did not collect 

costs directly, we calculated weighted averages for each type of homeless program within each site. 

For each community, we analyzed Homeless Management Information System (HMIS) data to 

identify the individuals and families who accessed homeless programs for the first-time during the 

12-month period between July 1, 2004 and June 30, 2005.1

 We also used HMIS data to examine 

homeless program use for each household in the 18 months (30 months in DC) following the day each 

household (or a member of the household) first accessed a homeless program. Using multivariate 

cluster analysis, we analyzed four aspects of each household’s pattern of homeless system use to 

derive “path groups,” that is groups of households with similar homeless system use, for each 

community. The variables used to define path groups are: total number of days each household 

stayed in homeless programs during the 18-month period in which we analyzed homelessness (across 

all program stays); number of distinct homeless program stays within the 18-month period; types and 

sequences of homeless programs used; and total number of days between all homeless program stays, 

also referred to as total number of “gap” days. 

Combining homeless program usage and daily cost data, we calculated estimated homeless system

costs for each individual or family household in the study. When possible, we also acquired and 

analyzed utilization data for mainstream systems in order to measure how mainstream systems 

interact with people who are homeless and to estimate the costs associated with the use of mainstream

systems by first-time homeless people. Finally, we analyzed homeless and mainstream costs, using 

regression analysis to understand the demographic characteristics, homelessness patterns, and path

groups associated with lower and higher costs. 

Homeless Program Costs 

Among homeless programs serving individuals, overnight emergency shelter for individuals has the 

lowest costs per day, typically offers the fewest services in the least private settings, and is often open 

only during evening hours. Transitional housing is the most expensive model for individuals and 

frequently offers private settings and a range of supportive services. Permanent supportive housing 

also generally offers private living space and supportive services. Permanent supportive housing 

providers indicate that residents are offered services equivalent in intensity to or even greater than 

services offered in transitional housing; however, the types of services provided may differ. In most 

cases, we found that permanent supportive housing programs arrange for residents to receive the 

“support” piece of the supportive housing directly from mainstream systems, and in fact many

residents of the permanent supportive housing projects we examined are believed to be clients of 

mainstream programs prior to being placed in the housing. 2

 Services paid directly by permanent 

supportive housing programs appear to be limited to housing-focused services and basic case 

management. As a result of this structure, permanent supportive housing programs do not have to 

secure resources to fund these services directly, and the costs are on average comparable to the less 

expensive 24-hour emergency shelter programs from the perspective of the homeless system. 

1 In Kalamazoo, we studied families who became homeless for the first-time in calendar year 2005. 

2 Because these clients receive services that they would otherwise be eligible for and could continue to 

receive these services if they moved to alternative housing, we did not include this cost as part of the 

housing program. Services paid for with the program budget and those dedicated to the project are 

accounted for in the program daily costs, when possible. 

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In contrast, emergency shelters for families are as expensive, if not more expensive, than transitional 

housing and permanent supportive housing offered in the four communities in which we studied 

homeless families. This is because families often get private rooms or apartments in emergency 

shelter; the programs are small and have few units over which to prorate fixed costs; and emergency

shelters for families are likely to be open 24-hours and provide supportive services. Permanent 

supportive housing for families is generally less expensive than emergency shelter from the 

perspective of the homeless system. 

More expensive programs typically have higher costs across all major budget categories: housing 

operations, services, agency overhead, and the daily cost equivalent of capital investments. Higher

overall costs may reflect more supervision, more services, increased private space, or lower program

capacity (e.g., decreased economies of scale). 

Exhibit 1 shows the average cost per month incurred by the homeless system for each program type in 

each community in relation to HUD’s Fair Market Rents (FMRs) for a private market unit in the same 

community. The FMR is a way to quantify the value of a rental subsidy for a month and therefore to 

compare the costs associated with providing housing for persons who are homeless within a homeless 

program with the cost of providing rental assistance without supportive services in the private market. 

Except for overnight emergency shelters in Jacksonville and permanent supportive housing in Des 

Moines, the FMR is lower than the average monthly cost of all types of homeless residential 

programs in all six of the communities in which we studied homelessness. 

Exhibit 1: Average Cost Per Household Per Month for Homeless Program Typesa 

Individual Sites 

Emergency 

Shelter 

Transitional 

Housing 

Permanent 

Supportive 

Housing 

2006 Fair Market 

Rent for Onebedroom Unitb 

Des Moines $581 $1,018 – $1,492 $537 $549 

Houston $853 - $1,817 $1,654 $664 – $1,757 $612 

Jacksonville $408 - $962 $870 $882 $643 

Family Sites 

Emergency 

Shelter 

Transitional 

Housing 

Permanent 

Supportive 

Housing 

2006 Fair Market 

Rent for Twobedroom Unitb 

District of Columbia $2,496 - $3,698 $2,146 - $2,188 $1,251 $1,225 

Houston $1,391 $1,940 – $4,482 $799 $743 

Kalamazoo $1,614 $813 $881 $612 

Upstate South $599 $2,269 $1,209 $661 Carolina (Greenville MSA) 

Note: All costs reported in 2006 dollars. 

a Costs shown reflect weighted averages by program type. Ranges represent the averages of different housing models within

a program type. Costs only represent homeless system costs and do not include the value of mainstream system costs that 

may be incurred while individuals or families reside in these programs. 

b Source: (HUD, 2005)
 

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Chapter 3 of this report describes each program type, the costs associated with providing each type,

and the extent to which programs are providing both shelter and supportive services to clients—in 

contrast to the Fair Market Rents, which represent only the cost of housing. Since rental subsidies are 

often permanent or long-term, it may not be realistic to assume that a community would provide a

single month of rental assistance; whereas, it is very common for a household to use emergency

shelter for only one month. It also would be important to assess whether people using rental 

subsidies use mainstream systems to a greater or lesser extent and cost than people who use 

residential programs for homeless people either during or after their period of homelessness. Such an 

examination is outside the scope of this study.. 

Characteristics of First-time Homeless Individuals and Families in 

this Study and Costs to the Homeless Services System 

Among the three sites in which we studied single adult homelessness, we identified 7,502 individuals 

as first-time homeless, with the majority in Houston, Texas. The total number of unduplicated 

families who experienced first-time homelessness across the four family sites was 1,374 households. 

Exhibit 2 includes descriptive information about the individuals and families we studied, focusing in 

particular on demographic characteristics associated with costs. 

Exhibit 2: Study Cohort Characteristicsa 

Individual Sites Family Sites 

Des Moines Jacksonville Houston Houston Kalamazoo Upstate SC Washington, DC 

Total Households 1,124 1,972 4,406 477 342 145 410 

Male Adults 73% 81% 74% 13% 15% 10% 18% 

African American 21% 48% 57% 65% 60% 49% 97% 

Average Age of 

Adults at First Entry 39 yrs 41 yrs 41 yrs 32 yrs 30 yrs 31 yrs 32 yrs 

Adults over 40 47% 54% 53% 16% 12% 12% 20% 

Household Size 3.2 people 3.2 people 3.0 people 3.5 people 

One Adult Household 88% 89% 88% 80% 

Household Changeb 25% 13% 17% 34% 

a Null demographic values are excluded from percentage calculations. 

b Household change reflects a change in household membership from one program entry to another. Household change

usually occurs across multiple program stays. However, household change can also occur when a new member a joins a 

family already staying in a program. 

The first-time homeless individuals in the communities we studied were predominantly male (73 to 

81 percent) and had an average age of 39 to 41 years at program entry. With the exception of

Jacksonville, African-Americans are over-represented among first-time homeless individuals in 

comparison to the general population of individuals in poverty. Multivariate analysis showed that 

among individuals, single women had fewer stays but used homeless programs 74 percent longer than 

single men. And women dominate groups with certain patterns of homelessness, such as those who 

use more expensive types of programs.3

 Even when controlling for length of stay, program type, and 

Data from victim service providers, such as domestic violence shelters, were not available for this study, so

these findings are for other type of homeless residential services. 

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other demographic characteristics, multivariate analysis shows that single women have 97 percent 

higher costs than men. Relatively older adults have longer lengths of stay than younger adults, and 

when controlling for other factors, costs for individuals older than 40 are 10 percent higher than for 

those between 31 and 40 years. African-American individuals are more likely to spend longer 

cumulative periods of time homeless, have a greater number of stays, and to incur 19 percent higher 

homeless system costs than white individuals. 

The first-time homeless families in the study primarily had only one adult member (80 to 89 percent), 

were comprised of female adults accompanied by children (82 to 90 percent), and had on average 3 to 

3.5 members. On average, adults were 30 to 32 years old when they first used a homeless program, 

and 41 to 50 percent of the children were 6 years old or younger. While the majority of families in 

the study cohort at each site had constant membership, a very high percentage of those who used 

more than one program experienced a change in their household membership from one program stay

to another. 

Homeless families headed by people between 18 and 24 use less expensive program types, stay for 

shorter periods, and, consequently, incur costs that are approximately one-third less than those headed 

by 31 to 40 year olds. Unlike results for individuals, African-American families are likely to spend 

shorter periods of time in homeless programs and to be associated with lower costs than white

families. Families with household change are associated with 35 percent greater homeless system

costs than those with stable membership, even when controlling for other factors. 

These findings show that different types of first-time homeless individuals and families use homeless 

system resources differently, which suggests opportunities for communities to develop specific

strategies to meet the needs of each of these types of individuals and families. For example, 

communities may want to reevaluate their systems for serving single women rather than serving them

primarily in programs alongside families with children. Communities should also explore prioritizing 

African-American families for prevention and rapid rehousing interventions that address housing and 

income issues with less focus on services for non-economic issues, since our analysis suggests that a 

large portion of African-American families may be homeless primarily due to extreme poverty rather 

than issues related to mental illness or substance abuse. Finally, we recommend strategies to identify

and refer households with greater needs to lower-cost interventions, such as permanent supportive 

housing for individuals, transitional housing for families, or even alternative program types that have 

not yet been developed. 

Patterns of First-time Homelessness for Individuals and Families in 

this Study 

The majority of households we studied, 50 to 65 percent of the first-time homeless single adults and 

58 to 72 percent of families, stayed in a homeless program only one time during the 18-month period 

in which we studied homelessness (30 months in DC). However, individuals who used homeless 

programs more than once used them frequently; individuals in the study had an average of three 

distinct program stays. The average for individuals was more than double the average number of 

stays for families. Although families had fewer stays, they stayed in programs for longer than 

individuals. Individuals averaged 5 to 10 weeks in a homeless program, whereas families averaged 3 

to 10 months. For both, the median number of days spent in homeless programs was well below the

average number of days. This means that half of the individuals and families stayed for much shorter 

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periods than the average, and that a small number of individuals and families had very long stays that 

substantially increased the average for each group as a whole. Households in the study also had gaps 

averaging 25 to 75 days between all homeless programs stays. Since the majority of households had 

only one stay, this statistic really means that those with multiple program stays had quite lengthy gaps 

between all homeless program stays. Exhibit 3 provides some basic information about the patterns of 

homelessness for the individuals and families within each community. 

Exhibit 3: Homelessness System Utilization 

Individual Sites Family Sites 

Des Moines Jacksonville Houston Houston Kalamazoo Upstate SC Washington, 

DCa 

Households with only 

one stay 

Average Number of 

Stays 

Average Days In 

Homeless Programs 

Median Days In 

Homeless Programs 

Average “Gap” Days 

Between Stays 

53% 50% 65% 

3.0 stays 3.3 stays 3.0 stays 

73 days 57 days 39 days 

24 days 10 days 22 days 

63 days 75 days 44 days 

72% 

1.4 stays 

113 days 

49 days 

31 days 

68% 65% 

1.5 stays 1.4 stays 

94 days 186 days 

31 days 103 days 

61 days 25 days 

58% 

1.2 stays 

309 days 

258 days 

73 days 

a Homeless system utilization was analyzed over a 30-month period for the DC case study.

Greater length of time in homeless programs and (to a lesser extent) longer periods between stays in

homeless programs are associated with greater homeless costs for first-time homeless individuals and 

families. Controlling for other household characteristics and for the type of program used, each 

additional month in a homeless program is associated with 35 percent higher costs for individuals and 

22 percent higher costs for families. The type of program used has an even greater impact on 

homeless system costs, as will be discussed later in this summary. 

Costs Associated with First-time Homelessness 

The average homeless system costs incurred for individuals and families in the communities are 

provided in Exhibit 4. The average costs for individuals ($1,634 to $2,308) are much lower than 

those for families ($3,184 to $20,031). The difference in costs between individuals and families is 

not surprising, since the average daily costs for programs serving individuals are generally much 

lower than for those serving families (Exhibit 1), and the average length of stay for first-time 

homeless individuals is much shorter than for first-time homeless families (Exhibit 3). 

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Exhibit 4: Average Homeless System Cost per Household 

Individual Sites Family Sites 

Jacksonville Houston 

Des 

Moines Kalamazoo 

Upstate 

South 

Carolina Houston 

Washington, 

DCa 

Average 

Cost per 

Household 

$1,634 $2,257 $2,308 $3,184 $9,663 $11,627 $20,031 

Note: All costs reported in 2006 dollars. 

a The DC cost per family does not include families who used only the Community Care Grants program. Including such 

families would drop the average cost per family in DC to $17,962.
 

Average costs offer a general picture of the costs associated with homelessness, but they obscure 

important information about the wide variation in costs associated with first-time homelessness. Only

a small group of households incurred high costs at each site, while the majority had minimal or more 

moderate costs. For individuals, the 50 percent of individuals with the lowest homeless system costs 

incurred only 2 to 3 percent of the total homeless system costs; whereas the highest-cost 10 percent of

the cohort incurred 62 percent of the homeless system costs in Jacksonville, 70 percent in Des 

Moines, and 83 percent in Houston. Transitional housing for individuals is more expensive per day

on average than other program types, and programmatic factors also encourage longer lengths of stay,

which also drive up costs. Thus, it is not surprising that the cost to the homeless services system of 

the most expensive 10 percent of individuals in the study cohort at each site generally reflects

continuous use of expensive transitional housing programs for much or all of the 18-month 

observation period. 

The distribution of costs for families is also quite skewed, but not to the same extent as for

individuals. In the four sites in which we studied first-time homeless families, the lowest-cost half of 

families accounts for less than one-seventh of the total cost incurred by the community for first-time

homeless families. The proportion ranges from 13 percent in Upstate South Carolina to 5 percent in 

Houston. In Upstate South Carolina, the highest-cost 10 percent of the study cohort accounts for 32 

percent of the total cost to the system, while in Houston the 10 percent highest-cost group accounts 

for 57 percent of the total homeless system costs for first-time homeless families. 

Costs for Groups of Households with Common Patterns of System 

Utilization 

The study defined “path groups” as a way to group people who use the homeless system in similar

ways, that is, those who follow similar “paths” through the homeless system. Although path groups 

were derived separately for each community in the study, several broad patterns of use were present 

across all six communities: households that use only emergency shelter for brief periods, households 

that used homeless programs for extended periods, and households that use homeless programs

multiple times with long gaps between stays. 

Households that Use Only Emergency Shelters for Brief Periods 

Households that use only emergency shelter for brief periods represent the majority of all first-time

homeless households in the study, although their costs represent less than one-third of total costs 

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incurred by first-time homeless households, as shown in Exhibit 5. On average, “short-stayer” 

individuals used emergency shelter programs for only 1 to 3 weeks at an average cost per household 

of $321 to $686. The stays for families were on average longer than those of the individuals we 

studied. One group of short-stayer families in South Carolina remained in shelters for only 9 days on 

average, but other short-stayer families in all four communities stayed an average of one to three 

months. The average costs per short-stayer family ranged from less than $1,000 to almost $9,000, 

depending on the average number of days spent in programs and the relative cost of the programs 

used. 

Exhibit 5: Households that Use Only Emergency Shelter for Brief Periods 

Population Utilization description 

% of Each 

Study 

Cohort a 

Average 

Homeless 

System Costs 

Per Householdb 

% of Homeless 

Costs Represented 

by Path Group 

Within Each Site 

Individuals Emergency shelter only, for 1 or 

2 brief stays totaling 1 to 3 

weeks. 

57% - 69% $321 - $686 8% - 28% 

Families Emergency shelter only, for 1 or 

2 brief stays totaling 10 days to 

3 months. 

33% – 66% $784 - $8,890 9% - 30% 

Note: All costs reported in 2006 dollars. 

a In this table, the universe of individuals excludes individuals in Houston who were only contacted by street outreach. 

And the universe of families in DC excludes families who participated only in the Community Care Grant program. b Ranges in this column represent distinct path groups within each site. 

These short-stayers all had much lower costs than other groups of first-time homeless individuals and 

families. We suggest that the emergency shelter system may be an “adequate” response to an

immediate housing crisis for most individuals and a place in which individuals who are not able to 

quickly resolve their housing crisis can be referred to more intensive interventions. It would be very 

difficult to fund a prevention response at such low cost, and it would be difficult to identify up front 

which of the individuals’ homelessness could be prevented with minimal assistance. 

In contrast, we found that emergency shelter is an expensive solution to family homelessness, in 

comparison to transitional housing, permanent supportive housing, and traditional rental subsidies. 

As an alternative, we suggest that communities consider three approaches: 1) offering shelter 

diversion or rapid-rehousing interventions that optimize the use of resources to get families back into 

housing, rather than shelter; 2) examining the cost structure of current emergency shelter programs to 

determine if the environment and services offered can be scaled back and still meet the needs of those 

who are using them; and 3) referring more quickly those who need intensive assistance to transitional 

housing (facility-based or scattered site), permanent supportive housing, or other new interventions. 

Households Who Remain in Homeless Programs for Extended Periods 

Up to one-quarter of first-time homeless individuals and a larger portion of first-time homeless 

families used homeless programs for extended periods at substantial cost per household (Exhibit 6). 

Cumulatively, individuals with extended stays incurred 40 to 73 percent of homeless system costs 

associated with first-time homelessness for individuals. Families with extended use of homeless 

programs incurred 47 to 82 percent of costs associated with first-time family homelessness. 

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Therefore, the greatest opportunities for homeless system cost savings lie with the individuals and 

families who remain in homeless programs for extended periods. Most often, this long-term, highcost use of the homeless system reflects extended use of transitional housing either alone or in 

combination with other programs, which is consistent with the fact that transitional housing is

typically designed for long lengths of stay. 

For individuals, extended use of homeless programs costs an average of $9,000 to $14,000 per

person, with the exception of a group with average costs of $3,103 for use of a low-cost form of 

shared transitional housing in Des Moines. For families, heavy use of transitional housing costs an 

average of $15,500 to $38,800 per family, with the exception of costs for families in Kalamazoo, 

which were $6,574 on average. 

Exhibit 6: Households that Use Homeless Programs for Extended Periods 

Population Utilization description 

% of Each 

Study 

Cohort a 

Average 

Homeless 

System Costs 

Per Householdb 

% of Homeless 

Costs Represented 

by Path Group 

Within Each Site 

Individuals Used emergency shelter, 

transitional housing, or 

permanent supportive housing 

exclusively or in combination for 

average of 4 to 12 months. 

Families	 Used transitional housing 

exclusively or in combination 

with emergency shelter or 

permanent supportive housing 

for average of 8 to 18 months. 

7% - 25% $3,103 – $14,418 40% - 73% 

24% – 42% $6,574 - $38,742 47% - 82% 

Note: All costs reported in 2006 dollars. 

a The universe of individuals in this table excludes individuals in Houston who were only contacted by street outreach, 

and the universe of families in DC excludes families who participated only in the Community Care Grant program. 

b Ranges in this column represent distinct path groups within each site. 

In all cases, the costs to house individuals and families in homeless programs for extended periods are 

significantly higher than rental subsidies based on Fair Market Rents for an equivalent period.

Strategies for identifying cost-savings, include examining: 1) whether patterns of extended use or 

transitional housing or other program types are cost-effective and whether there are opportunities to 

reduce costs without diminishing client outcomes; 2) whether some households are using transitional 

housing as a form of subsidized permanent housing, in which case actual rent subsidies without 

extensive services would be a more cost-effective approach; 3) whether some households should be 

referred more aggressively to permanent supportive housing to address long-term needs at lower

costs; and 4) whether the permanent supportive housing model of leveraging services from

mainstream systems could be used to deliver transitional housing at lower cost to the homeless 

system. 

Households Who Use Homeless Programs Multiple Times with Long Gaps Between Stays 

Our analysis also identified a small group of first-time homeless individuals and families who return 

multiple times for homeless assistance but have long gaps between stays. Their patterns suggest that 

the assistance they receive from the homeless system the first and even second or third time is not 

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sufficient to help them regain stable housing. These households sometimes only use emergency

shelter and sometimes use a combination of program types. As shown in Exhibit 7, costs for 

individuals who repeatedly used homeless programs with long gaps between stays averaged 

approximately $1,000 for groups that only used emergency shelter to as high as $10,705 for a group 

of individuals in Houston who used a range of program types. Costs for families averaged from

$3,295 in Kalamazoo for a group that used only emergency shelter for an average of 38 days across 

all stays to $17,314 for a group in DC that spent an average of 9 months in a range of program types. 

Exhibit 7: Households that Use Homeless Programs Multiple Times with Long Gaps Between 

Stays 

Population Utilization description 

% of Each 

Study 

Cohort a 

Average 

Homeless 

System Costs 

Per Householdb 

% of Homeless 

Costs Represented 

by Path Group 

Within Each Site 

Individuals Used emergency shelter only or used 

a range of programs, returning to 

emergency shelter after using 

transitional or permanent supportive 

housing. Average gaps between all 

stays total 6 months to a year. 

12% - 18% $910 - $10,705 14% - 24% 

Families Repeated use of homeless programs 

with long gaps between stays totaling 

4 to 17 months. 

5% - 16% $3,293 - $12,475 2% - 20% 

Note: All costs reported in 2006 dollars. 

a The universe of individuals in this table excludes individuals in Houston who were only contacted by street outreach, and

the universe of families in DC excludes families who participated only in the Community Care Grant program. 

b Ranges in this column represent distinct path groups within each site. 

Although costs are proportionately not as large for these households as for those with extended use of 

homeless programs, the current system does not appear to be working well and therefore, resources 

currently used to serve these households may not be used effectively. In addition, our analysis of 

mainstream costs shows that these individuals and families had high levels of interaction with 

criminal justice systems. In Jacksonville, Kalamazoo, and Upstate South Carolina, rates of arrest or

incarceration were above 60 percent for individuals and families with long gaps between homeless 

stays. The criminal justice involvement occurred across all time periods relative to homelessness - 

before the first homeless stay, between stays, and in the period following the last homeless stay. By

comparing the number of days between homeless stays and the number of days spent in jail during 

those same times, we know these households are not exclusively staying in jail between homeless 

stays. We surmise that they spent time in many different types of places, including living on their 

own, living doubled up with others, staying on the streets, or in other residential facilities. The high

rates of arrest and incarceration coupled with high levels of housing instability suggest that the 

individuals and families in this group would benefit from targeted assistance to secure and maintain 

housing and reduce criminal justice recidivism. 

A significant percentage (53 to 92 percent) of families with long gaps also had changes in household 

composition from one program stay to the next. These high rates of household change are evidence 

of household instability and may also suggest high involvement in child welfare systems. This theory 

is supported by statistics from DC, the only site in which we obtained rates of child welfare 

involvement, that show that 55 percent of the group with long gaps had child welfare involvement at 

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some point during the study period. The significant housing and family instability experienced by

this group suggests that neither homeless nor mainstream systems are addressing sufficiently the 

needs of these families and that targeted interventions may be needed to achieve positive housing and 

family-related outcomes. Communities should explore whether funds currently used to serve these 

households over repeated stays, in addition to resources from the criminal justice and possibly the 

child welfare system, could be used to fund alternative interventions to meet the specific needs of 

these households. 

Costs Associated with Mainstream System Use By First-time 

Homeless Individuals and Families 

The question of whether mainstream system costs can be offset by appropriate housing interventions 

is left open by this study. Our analysis suggests that there are few opportunities for mainstream cost 

reductions when targeting groups based on their patterns of homelessness. However, consistent with 

past research, significant mainstream system cost reductions may be achievable when targeting 

individuals or families with high levels of involvement in mainstream systems prior to homelessness. 

Most first-time homeless individuals do not have high involvement in mainstream systems. This 

means that there is only a small group of individuals with the possibility of cost offsets. For instance, 

only a quarter of individuals in Jacksonville received publicly funded mental healthcare, only 22 

percent received substance abuse treatment, and only 20 percent had Medicaid physical healthcare 

claims at any point in the approximately three-year period for which we collected cost data. And less 

than 10 percent received healthcare in any of these domains during the period of homelessness. 

Exhibit 8 shows that the total per person costs of mainstream involvement in each domain during 

homelessness for first-time homeless individuals, totaling approximately $1,000 in Jacksonville and 

approximately $500 in Houston. However, when looking only at the costs per person for those who 

were involved in each mainstream domain, costs increase substantially per person as do opportunities

for cost savings. The difference in average costs for mainstream users and the cohort average 

illustrates why narrowly targeted interventions to reduce or shift use by those who are involved with 

each system have the greatest potential to yield cost savings, whereas broadly targeted interventions 

are not likely to realize substantial savings. 

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Exhibit 8: Average Mainstream System Costs per Person Incurred “During” Homelessness 

Jacksonville Houston 

% of 

Cohort 

involved 

in this 

Domain 

Average Costs 

During 

Homelessness 

Per Person 

Involved in this 

Domain 

Average Costs 

During 

Homelessness 

Per Person in 

Cohort 

% of 

Cohort 

involved 

in this 

Domain 

Average Costs 

During 

Homelessness 

Per Person 

Involved in this 

Domain 

Average Costs 

During 

Homelessness 

Per Person in 

Cohort 

Medicaid 

Primary 

Health 

9% $2,436 $219 

Mental 

Health 

8% $1,318 $106 9% $4,157 $391 

Substance 

Abuse 

7% $2,265 $158 

Criminal 

Justice 

13% $3,057 $397 2% $6,520 $157 

Income 

Supports 

22% $627 $138 

We also found that criminal justice and mental health involvement in Jacksonville and Houston 

increased substantially immediately before first-time homelessness, peaking in the period just after 

the individual entered the residential homeless system.4

 Nine percent of the individuals we studied in 

Houston received services from the mental health system at some time in the 12 months prior to 

homelessness or the 18 months following the first day the individual entered a homeless program. 

The total encounters are graphed in Exhibit 9, with the total number of encounters for all of those who 

received services during each month shown in the y axis and the month relative to the start of 

homelessness shown on the x-axis. The exhibit shows that the highest number of encounters occurred 

in the month following the day these individuals became homeless for the first time, followed by the 

second month after that day. These individuals also had a high number of encounters in the month 

immediately prior to homelessness. This finding suggests a need for discharge planning to ensure 

that individuals leave mainstream programs, such as inpatient treatment or jails, with adequate 

housing. It also suggests that that mainstream systems may be able to help identify risk of 

homelessness for their clients and that targeted alternative interventions could avoid costly homeless 

system use. We also conclude that homeless systems should use emergency shelter to proactively 

identify individuals with severe mental illness who would benefit from permanent supportive housing 

before they experience long-term homelessness. 

Other research analyzing rates of homelessness among ex-offenders found that individuals released from

state prisons or jails have a greater risk of homelessness than individuals with similar characteristics who 

have not been recently incarcerated. In the communities studied, risk of homelessness among ex-offenders 

was higher for individuals with certain demographic characteristics. The same research also found that 

longer periods of incarceration were associated with greater risks of homelessness after release. (Graham, 

D., Locke, G., Bass Rubenstein, D. & Carlson, K., unpublished) This finding supports the conclusion

above that discharge planning strategies targeting the ex-offenders most at risk of homelessness, based on

gender, race, age, and length of incarceration, may be effective in preventing homelessness for this group. 

Executive Summary ES–13 

4 
ES–14 Executive Summary

Contents C-3 

 

 

 

 

 

Total Mental Health Encounters Each Month

Exhibit 9: Total Mental Health Encounters Each Month by First-time Homeless Individuals in 

Houston Shown Relative to First Day of Homelessness 

2500 

2000 

1500 

1000 

500 

0 

1st Day in Homeless 

System 

12 Months Prior11 Months Prior10 Months Prior

9 Months Prior8 Months Prior7 Months Prior6 Months Prior5 Months Prior4 Months Prior3 Months Prior2 Months Prior

1 Month Prior

1 Month Post

2 Months Post3 Months Post4 Months Post5 Months Post6 Months Post7 Months Post8 Months Post9 Months Post

10 Months Post11 Months Post12 Months Post13 Months Post14 Months Post15 Months Post16 Months Post17 Months Post18 Months Post 

Time Relative to First Day in Homeless System 

In contrast, first-time homeless families in the communities for which we obtained mainstream data 

had very high enrollment in Medicaid (over 90 percent) and low to moderate use of other mainstream

systems across the entire period for which we collected costs. Medicaid costs across the entire study

period totaled $21,770 per family in Kalamazoo and $15,615 per family in Upstate South Carolina, as 

compared with mental health costs in Houston of $722 per family and criminal justice costs of $175 

to $597 per family. Average monthly mainstream costs per family were highest during periods of 

homelessness, as shown in Exhibit 10. 

ES–14 Executive Summary 
ES-1 Executive Summary Executive Summary ES–15

 

 

 

 

 

 

 

Exhibit 10: Rate of Mainstream System Involvement and Costs Per Family Per Month 

Mental 

Medicaid 

Criminal Financial Food 

Health Justice Assistance Stamps 

Kalamazoo 

Rate of Involvement a 94% 42% > 39% b 

Pre-Homelessness $657.58 $13.33 $5.18 

During Homelessness $929.59 $12.99 $22.05 

Post-Homelessness $471.90 $19.36 $21.55 

South Carolina 

Rate of Involvement a > 90% b 34% 92% 

Pre-Homelessness $319.66 $4.65 $187.30 

During Homelessness $433.70 $4.70 $229.34 

Post-Homelessness $493.28 $4.86 $190.78 

Houston 

Rate of Involvement a 16% 8% 

Pre-Homelessness $13.01 $6.55 

During Homelessness $32.87 $1.57 

Post-Homelessness $20.67 $16.36 

a Percentage of the families studied who were involved in the mainstream domain at any point from 12-months prior 

to the first day of homelessness through December 31, 2006 (June 30, 2007). 

b De-duplicated data across types of involvement with this domain were not available. 

As with individuals, we surmise that families interact with mainstream systems on an ongoing basis, 

but that use rises immediately preceding homelessness and peaks immediately following 

homelessness. Some of the increased Medicaid costs may reflect health crises related to

homelessness or use of expensive acute care systems for routine medical needs during homelessness. 

Increased coordination between homeless and mainstream systems, and potentially some

interventions targeted to specific high-users of mainstream services, could result in more appropriate 

use of mainstream services and potential cost savings. 

Aside from the observations about criminal justice and potential child welfare involvement for 

households with long gaps between homeless stays, we did not find sufficient relationships between 

patterns of homelessness for families and mainstream costs to warrant recommendations related to 

targeting households based on their homeless system use in order to achieve mainstream cost savings. 

It is possible that more complete data would identify additional cost saving opportunities. 

Conclusion 

This study does not show which homelessness interventions are cost-effective or indicate whether 

mainstream systems are appropriately used during periods of homelessness. However, it does 

illuminate the diverse patterns and costs of homeless and mainstream system use that are essential to 

answer two critical policy questions. Are high-cost interventions an appropriate response to 

homelessness for specific subgroups? Are there more efficient and effective ways of meeting 

people’s needs? 

In brief, we conclude that communities should explore strategies to 1) prevent homelessness for the 

majority of families facing first-time homelessness, 2) avoid extensive use of high-cost homeless 

Executive Summary ES–15 
ES–16 Executive Summary

Contents C-3 

 

 

programs for individuals or families who primarily need permanent housing without supports or those 

whose service needs can be met by mainstream systems, 3) alter the way their homeless assistance 

systems respond to households that are unable to remain stably housed and face repeated instances of 

homelessness, 4) work with mainstream systems to design appropriate discharge planning strategies 

and ways to identify clients at-risk of homelessness so their homelessness can be prevented. 

This research also raises a number of additional questions that should be the focus of new research.

These questions center around understanding the cost-effectiveness of different types of homeless 

programs, identifying program features that drive costs and therefore present opportunities for 

reducing costs, and identifying client-level indicators associated with high costs that can be used to 

predict and avoid unnecessary or ineffective high cost system use. 

ES–16 Executive Summary 
ES-1 Executive Summary Chapter 1: Introduction 1–1

 

 

 

 

 

 

 

 

1. Introduction 

This study measures costs associated with first-time homeless families and individuals incurred by

homeless and mainstream service delivery systems in six study communities. Unaccompanied 

homeless individuals were studied in Des Moines, Iowa; Houston, Texas, and Jacksonville, Florida. 

Homeless families were studied in Houston, Texas, Kalamazoo, Michigan; Upstate South Carolina; 

and Washington, DC. 

Past research has primarily documented costs associated with homelessness for individuals with 

chronic patterns of homelessness or severe mental illness. Newer work has been published on the 

costs incurred within the homeless system for families experiencing first-time homelessness. The 

emerging body of research on homelessness piqued the interest of many. It also raised additional 

questions about the comparability of these findings to individuals and families with different

characteristics or patterns of homelessness and about opportunities for savings through alternative 

responses to homelessness. 

This study was designed to allow policy makers at the national and community levels to have a better 

understanding of: 

•	 the comparative costs of different types of homeless programs; 

•	 the wide-ranging experience of homelessness among individuals and families and the 

costs associated distinct patterns of homelessness; 

•	 some of the mainstream costs that can be associated with homeless individuals or 

families during the periods before, during, and after their period of homelessness 

•	 characteristics of first-time homeless individuals and families that are related to higher or 

lower homeless or mainstream system costs; and 

•	 the implications of these findings for homeless policy and planning. 

Homeless systems include programs within a community that are designed and dedicated to providing

housing and services to people who are homeless. The homeless programs accounted for in this study

are outreach programs, emergency shelters, transitional housing, and permanent supportive housing 

for homeless people with disabilities. Programs that only provide supportive services to homeless 

people are not included in this study. 

Mainstream service systems are those that are not dedicated exclusively to serving people who are 

homeless, yet provide services that are needed and often used by them. Mainstream system cost data 

examined for this study include: Medicaid primary healthcare, mental healthcare and substance abuse

treatment; other state-funded behavioral health care; law enforcement and criminal justice; and 

income supports. 

In each site, we examined the system of homeless service provision, patterns of homelessness for a 

cohort of homeless families or individuals based on analysis of Homeless Management Information 

System (HMIS) data, and the costs associated with the use of homeless programs by the study cohort 

based on cost data collected directly from homeless programs. We also acquired and analyzed 

utilization data for mainstream systems in order to measure how mainstream systems interact with 

Chapter 1: Introduction 1–1 
1–2 Chapter 1: Introduction

Contents C-3 

 

 

 

 

 

 

 

people who are homeless and to estimate the costs associated with the use of mainstream systems by

homeless people. Finally, we analyzed homeless and mainstream costs together. 

We follow a growing body of literature in identifying groups of people who experience similar 

patterns of homelessness and analyzing homeless and mainstream service utilization and costs based 

on these patterns. However, this study breaks new ground methodologically in homelessness research 

in the following areas: 

•	 rigorously calculating the costs of providing a family or individual with a day of shelter 

in specific residential programs for homeless people; 

•	 incorporating distinctions among program types and their housing models (e.g., facilitybased transitional housing) into our analysis of both patterns and costs of first-time 

homelessness; and 

•	 analyzing both individuals and families, as well as vastly different types of communities 

or geographic areas using the same research design, facilitating direct comparisons. 

The study does not attempt to isolate which of the mainstream costs are attributable to homelessness, 

and it does not compare the benefits of different programs with the costs of their use. Thus, the study

is not a cost-effectiveness study and is most accurately characterized as a study to measure the costs 

associated with homelessness, rather than the costs of homelessness. 

The study does not attempt to measure the broader costs of homelessness to individuals who become

homeless or to society as a whole. For example, we do not attempt to measure the costs of increased 

morbidity or mortality for individuals who become homeless, nor do we measure the costs to

businesses and property owners that may result from concentrations of sheltered or unsheltered

homeless individuals in cities or neighborhoods. And to the extent that the data we used are not

comprehensive of all homeless program utilization or all relevant mainstream systems, the findings 

somewhat underrepresent the costs for some first-time individuals and families. 

Yet even with its limitations, we anticipate that this information will prompt future research and 

policy discussions on whether resources are being used efficiently to provide services to people who 

are homeless and whether better outcomes might be achieved by triaging clients to specific paths or 

by examining current strategies and designing targeted interventions to serve specific subpopulations. 

Chapter 2 of this report continues with an overview of the research questions and methodology used 

to conduct the study. Chapter 3 discusses the range of unit costs (that is, costs per day for each 

individual or family) associated with various types of residential homeless programs within each site. 

Chapter 4 analyzes costs associated with first-time homeless individuals across the three individual 

study sites, and Chapter 5 analyzes costs associated with first time homeless families across the four 

family study sites. Chapters 4 and 5 begin with a discussion of previous research and a discussion of 

the characteristics of the cohort at each site. The chapters continue with an analysis of the patterns 

and costs of homeless system utilization, followed by a discussion of mainstream system costs. Each 

of these chapters concludes with a discussion of policy implications and areas for future research. 

Chapter 6 provides summary conclusions that encompass both families and individuals. 

1–2 Chapter 1: Introduction 
ES-1 Executive Summary Chapter 1: Introduction 1–3

 

 

Appendix A is a standalone case study for Jacksonville, which is the site where we obtained and 

analyzed data covering the most comprehensive set of mainstream programs. Appendix B contains 

data tables for the Jacksonville case study. Appendix C contains detailed data for the individual study 

sites. Appendix D contains detailed data for the family study sites. Appendix C and Appendix D 

both include summary data for each study site and the results of cross-site multivariate regression 

analyses. 

Aside from Jacksonville, complete case studies for each site are not included in this document.

However, stand-alone case studies for the six sites are available, along with comprehensive data 

tables, on www.huduser.org. 

Chapter 1: Introduction 1–3 
1–4 Chapter 1: Introduction 1–4 Chapter 1: Introduction 
Chapter 2: Methodology Chapter 2: Methodology 2–1 2-1

 

 

 

 

 

 

 

 

2. Methodological Framework for Analysis of 

Costs Associated with Homelessness 

This chapter covers the methodological framework for the Costs of Homelessness study. It presents

the research questions for the study, our approach to answering these questions, the key domains of 

costs that were measured in each community, and some of the methodological challenges that we 

encountered.1 

2.1. Research Questions 

The primary research questions for the study are: What are the combined homeless and 

mainstream system costs for people who become homeless for the first-time? How do these 

costs vary across patterns of homeless system use? 

We pursued the following six specific research questions to help us understand the primary research 

questions. 

1. How do people who become homeless use homeless and mainstream systems? 

2. Are there common patterns of homelessness system utilization (homeless paths) that can 

be used to group people who access homeless services? 

3. Do people who use homeless system resources in similar ways share characteristics that 

can be used to describe each group? 

4. What is the cost of the homeless and mainstream system service use associated with firsttime homelessness and the periods immediately before and after it? How do these costs 

vary by path group? 

5. What is the total cost associated with the period of homelessness for the study

population? 

6. How do mainstream system costs change when a person becomes homeless and in the 

period after homelessness? 

Exhibit 2.1 shows the data that we generated to answer each question. 

This methodology applies to this report as well as to each of the six individual case studies. 

Chapter 2: Methodology 2–1 

1 
2–2 Chapter 2: Methodology

 

 

 

Exhibit 2.1: Research Questions and Outputs for the Study 

Research Questions What this study reports. 

How do people who become homeless 

use homeless and mainstream 

systems? 

• Number, type, and sequence of homeless and 

mainstream service encounters and lengths of stay (or 

number of service units) during the study period. Use of 

systems is reported separately for types of programs 

that comprise the residential homeless services system, 

and for each mainstream system studied. 

Are there common patterns of 

homelessness system utilization 

(homeless paths) that can be used to 

group people who access homeless 

services? 

• Description of groups of homeless families or individuals 

following different paths is based on cluster analysis of 

the number of homeless program enrollments, the types 

of programs used, the sequence of program types, the 

durations of program stays, and the overall length of the 

period of homelessness. 

• Percent of clients that fall into each path group. 

• Similar path groups generated at the site level are 

grouped together for overall analysis. 

Do people who use homeless system 

resources in similar ways share 

characteristics that can be used to 

define each group? 

• Analysis of demographic characteristics and special 

needs (defined by service use) of persons in each path. 

What is the cost of the homeless and • Costs incurred by the homeless system for outreach, 

mainstream system service use emergency shelters, transitional programs, and 

associated with first-time permanent supportive housing 

homelessness and the periods • Costs incurred by selected mainstream service systems 

immediately before and after it? How reported separately for time periods before, during, and 

do these costs vary by path group? after homelessness. 

• Analysis of each of these costs for different path groups. 

What is the total cost associated with • Total estimated homeless and mainstream system costs 

the period of homelessness for the for the study population. 

study population? • Analysis of costs by demographic characteristics and 

path groups. 

How do mainstream system costs 

change in relation to homelessness? 

• Comparison of mainstream system costs for the periods 

before, during and after homelessness. 

2.2. Research Domains 

At the start of the study, we convened an expert panel of homelessness researchers and economists to 

advise us on the design of the study. In preparation for the panel meeting, we conducted a literature 

review on previous attempts to analyze costs associated with homelessness and methods that have 

been used to measure costs of homeless and mainstream service systems. We also explored methods 

to measure indirect costs of homelessness, such as costs associated with premature morbidity and 

mortality and indirect costs to businesses that are located near spots inhabited by persons living “on 

the streets.” After discussing extensively the priorities among cost domains, available methods for 

analyzing different domains, and the feasibility of implementing the methods, we decided to focus 

this study on the direct costs associated with the homeless system and the following mainstream

systems: mental health, substance abuse, and primary health care treatment; criminal justice; child 

welfare; and Food Stamps and Temporary Assistance to Needy Families (TANF). 

2–2 Chapter 2: Methodology 
Chapter 2: Methodology 2–3

Chapter 2: Methodology 2-3

 

 

 

 

2.3. Study Sites, Period, and Population 

2.3.1 Site Selection 

We based our data collection strategy on administrative records whenever possible. For the homeless

services system, this meant using local homeless management information system (HMIS) data to 

understand the utilization of homeless assistance programs. However, these administrative data 

sources did not include information on the costs incurred by these programs, so we collected cost data 

directly from a sample of homeless programs to develop unit costs for various types of homeless 

programs. For mainstream systems, we used local or state administrative data systems to analyze 

service utilization and to measure actual tracked costs. When actual tracked costs were not available, 

we consulted with local officials to derive an average unit cost for each service type within each 

system. These research design decisions influenced our site selection, as we had to select sites where 

these sources of data were available. 

The criteria used to select sites were: HMIS data coverage of at least 75 percent of homeless system

beds serving homeless families or 75 percent of beds serving individuals; high quality HMIS data for 

client identifiers, basic demographic characteristics, and program utilization or services received; a 

strong likelihood we could obtain mainstream client data, based on local relationships between the 

homeless services system and mainstream systems or on the existence of a data repository; and the 

site’s willingness to participate in the study. In addition to these criteria, efforts were also made to 

select an equal number of sites where we would study families and sites where we would study

individuals and to achieve a mix of different community types and geographic locations. Site 

selection was based on analysis of HUD’s Housing Inventory Charts for homeless programs, data on 

HMIS participation rates and data quality, and telephone interviews with CoC staff and homeless 

providers in potential study sites. 

Through this process, we selected six communities to participate in this study: Des Moines, Iowa; 

Houston, Texas; Jacksonville, Florida; Kalamazoo, Michigan; Upstate South Carolina; and 

Washington, DC. We also attempted to include Sacramento, California in the study, but were unable 

to secure access to the required client-level HMIS data due to local interpretation of California State

privacy laws. Based on the availability and quality of HMIS data, we chose to study either homeless 

individuals or homeless families in each community. In Houston we studied both individuals and 

families, because the HMIS data met our criteria for both populations. The study population for each 

site is shown in Exhibit 2.2. 

Exhibit 2.2: Case Study Sites and Study Population 

# Case Study Site Case Study Population 

1 Des Moines, Iowa Single Individuals 

2 Jacksonville, Florida Single Individuals 

3 Houston, Texas Single Individuals 

Families 

4 Kalamazoo, Michigan Families 

5 Upstate South Carolina Families 

6 Washington, D.C. Families 

Chapter 2: Methodology 2–3 
2–4 Chapter 2: Methodology

 

 

 

 

 

 

 

 

 

 

 

 

 

We first analyzed each site independently and drafted six distinct case studies. We then analyzed 

overarching patterns as well as distinctions that emerged across each of the six sites. This report 

provides the overall findings across all six sites. In addition, each of the six distinct case studies 

produced as a result of this research is available as a stand-alone report.2 

2.3.2 Study Period and Study Population 

This study examined the costs associated with a cohort of individuals or families (depending on the 

case study) who became homeless for the first time between July 1, 2004 and June 30, 2005.3 For 

purposes of this study, an individual or family was considered homeless if the household stayed in a 

residential homeless program or was served by a street outreach program. The length of time the 

household was homeless was also defined based on use of these programs, as documented in local 

HMIS databases. Individuals and families were considered to be homeless for the first-time if they 

did not appear in the community’s HMIS at any point prior to the study enrollment period. 

Periods in which members of the study cohort were precariously housed, doubled up, or staying in a 

program that did not report to the HMIS are not included in the homeless system costs estimated by

this study. However, if the studied family or individual had more than one stay in a residential 

homeless program during the study period, then the time between stays is also considered “during

homelessness” when we analyze patterns of homelessness or analyze time-adjusted costs to the 

homeless services system. The period of homelessness is considered to begin on the first day of a

program entry and to end on the date of the last program exit. 

As will be discussed in more detail in Section 2.4, we followed each individual or family’s homeless 

service utilization for eighteen months from the household’s point of entry into the homeless system. 

In Washington, D.C, we followed families for thirty months. To the extent that data were available, 

we measured the individual or family’s mainstream service utilization for twelve months prior to and 

for at least eighteen months after the household’s point of entry into the homeless system. 

To identify the study population, a single individual was defined as a homeless adult who was served 

within our study timeframe and was unaccompanied by any other persons at any point during the 

study period. A homeless family was defined as at least one adult and at least one child (under 18 

years at first program entry) who used residential services together at some point during our study

period. If a member of a family also used homeless programs as a single individual, we included 

those stays as part of the family’s homeless utilization patterns and costs. 

Because of federal law related to HMIS data, the study was not able to analyze services provided to 

people who are homeless by providers of services for victims of domestic violence. Since the study

aimed to capture the complete costs associated with individuals or families who become homeless, 

households that included a person who was served by a victim services provider at any point 

preceding or during the study period, as determined by HMIS records, were excluded from the study

population. In addition, unaccompanied youth under age 18 were excluded from the study. 

2 A “Bibliography of Cost of Homelessness Case Studies” appears at the end of this report. 

3 Kalamazoo is the only site for which we used a different study enrollment period. We identified people for 

the Kalamazoo study cohort based on first entry into the homeless system between January 1, 2005 and 

December 31, 2005, because homeless system utilization data for 2004 were incomplete. 

2–4 Chapter 2: Methodology 
Chapter 2: Methodology Chapter 2: Methodology 2–5 2-5

 

 

 

 

 

 

 

 

 

 

 

 

2.4. Data Sources 

The study relies primarily on three types of data: 

1.	 HMIS data maintained by the local Continuum of Care (CoC); 

2. Homeless program cost data collected directly by the study team; and 

3. Mainstream system administrative data maintained by a data warehouse or by local or 

state agency administrators. 

Each data source and the process for obtaining the data are described in the subsections that follow. 

2.4.1 Homeless Management Information Systems Data 

HMIS data are longitudinal, client-level data that record demographic details and program utilization 

for all persons served by agencies participating in the HMIS at each study site. We used HMIS data 

to identify the study population, to identify each individual or family household’s period of 

homelessness, and to follow each household’s homeless system utilization for eighteen months from

the date the household’s homelessness first began. 4 

HMIS data are maintained by a local HMIS Lead Agency, which acts on behalf of the CoC to manage 

community data on homelessness. In 2004, HUD published HMIS Data and Technical Standards that 

outline data collection, privacy and security requirements for HMIS (Housing and Urban 

Development [HUD], 2004). As a result of the 2004 Standards, HMIS databases across the country

store client-level data uniformly, so that we knew the types of data on homeless clients that we would

be able to obtain and were able to use a common data analysis strategy across all of our study sites. 

We purposely selected communities with high levels of residential homeless provider participation in 

HMIS to ensure that we could get a comprehensive picture of who became homeless within each

study site during the study’s enrollment period and could understand the types of programs people 

used and their patterns of use.5 

As part of site selection, we examined the level of HMIS participation (which is an indicator of how 

well HMIS data represent the homeless service system) for each community, indicators of data 

quality, and whether the community had authorized the use and disclosure of client data for research 

purposes in its privacy policies. We chose only sites with high residential program coverage rates,

good quality data, and authority to release their data for research purposes. Thus, we were confident 

that we could obtain access to the client-level HMIS data for each of our selected study sites. Once 

sites were selected, we began negotiating with the HMIS Lead Agency to obtain access to the data. 

We developed data use agreements that were executed between Abt Associates Inc., and each HMIS 

Lead Agency and that specified the terms of our access, protection, use, and further disclosure of the 

data. The process and timeline for negotiating access to HMIS data varied by site, depending 

primarily on the extent to which the process of granting access to data for research purposes already 

4	 The period was thirty months in Washington, D.C. 

5	 We also attempted to include sites with strong participation from homeless programs that provide 

supportive services only. As we analyzed the HMIS data, we determined that most such programs did not

enter service utilization data sufficient to support a cost analysis; therefore, we did not include costs 

associated with use of supportive service programs. 

Chapter 2: Methodology 2–5 
2–6 Chapter 2: Methodology

 

 

 

 

 

 

 

 

 

had been defined by local policies and procedures. In most cases, time delays were associated with 

administrative reviews or approval processes rather than with substantive local concerns. We were 

able to secure direct access to HMIS data for all six study sites. 

2.4.2 Homeless Program Cost Data 

This study includes homeless system costs associated with the use of residential homeless programs 

for all programs that report client utilization data to the HMIS. While HMIS provides information on 

client use of homeless programs, HMIS does not record costs associated with each program. Within 

the industry of providers of homeless services, there are no standardized unit costs based on funding

reimbursements or other estimates. Therefore, we collected program costs directly from a sample of 

programs within each community and used these data to derive estimates of daily costs of residential 

programs (and in some cases costs per outreach encounter) for each program type at each site. The 

daily costs represent all aspects of each residential program’s costs: operating, leasing, services 

provided as part of the residential program, administration, and, in some cases, the capital costs of the

program’s facility. This process is described in detail in Section 2.5.2. Chapter 3 contains a detailed 

discussion of our findings related to homeless program costs 

2.4.3 Mainstream System Administrative Data 

The third primary data source used for this study was administrative data from mainstream service 

systems. Mainstream systems are those that do not exclusively target people who are homeless. The 

primary mainstream systems that we attempted to include in the study were: 

• primary health care; 

• mental health care; 

• substance abuse treatment; 

• law enforcement and criminal justice; 

• child welfare (including financial support, foster care, and protective services); and 

• Food Stamps and TANF entitlements. 

We were able to obtain mainstream cost data from at least one site for each of these systems, except 

child welfare. However, in Washington, D.C., we obtained and used data on whether each family in 

the study cohort had at least one encounter with the child welfare system over a five-year period. 

We used the mainstream administrative data to track mainstream utilization and estimate the costs 

associated with that utilization for the twelve months prior to each household’s homelessness, for 

each household’s period of homelessness, and for the period following homelessness through 

December 31, 2006 (or June 30, 2007 for Kalamazoo). 

In contrast to homeless services, mainstream system administrative data can be used to estimate both 

utilization and costs. Mainstream services, such as those funded by Medicaid or state health

resources, are frequently funded based on standard state reimbursement rates. Mainstream income 

support systems such as Food Stamps or TANF provide assistance that is quantified at the household 

level. Other systems, such as local jails, track actual utilization, and their administrators have 

estimated nightly costs or arrest costs for budgetary or reimbursement purposes, so that the estimated 

costs of these mainstream systems can be estimated. We also determined through discussions with 

the expert panel that obtaining data on mainstream utilization from client case files or self-reports 

2–6 Chapter 2: Methodology 
Chapter 2: Methodology Chapter 2: Methodology 2–7 2-7

 

 

would not be as accurate or comprehensive as administrative data and that using administrative data 

would be much less expensive than primary data collection. 

We found that the largest challenge inherent in using mainstream administrative data systems was

negotiating access to them. First, we had to identify all of the appropriate local or state administering 

agencies that maintained data on primary healthcare, mental healthcare, substance abuse treatment, 

police and/or sheriff arrests, police and/or sheriff jail incarcerations, Food Stamps benefits, TANF 

benefits, and other relevant mainstream assistance provided to the individuals or families studied at 

each site. 

Once we identified the agencies and began discussions with appropriate staff, we had to convince the 

agencies to provide data for the study. We offered numerous analytical methods to ease the burden of 

participation, ranging from the agency sending us their complete identifiable client-level dataset for 

the study period to the agency conducting all of the analysis and sending only aggregate, tabulated 

data in table shells defined by the study team. While a formal commitment to participate in the study

was an important benchmark, we experienced many delays after that point—for example, in securing 

formal legal approval to exchange client-level data. Therefore, agreement to obtain the necessary

data was not considered complete until we had a signed, data use agreement in hand. Once we had 

such an agreement, we worked with the information technology staff at the mainstream agency to link 

records and analyze the utilization data according to our study specifications. This phase of the 

process was the least complicated, but still yielded many opportunities for project delays. 

These steps had to occur for each separate mainstream administering agency within each community. 

We tried to achieve economies of scale by approaching state agencies that consolidated data across

multiple service providers within a community, but in many cases we were not able to penetrate the

appropriate bureaucracy at the state level. To support this process, we prepared a Mainstream Data 

Analysis Guide that we shared with mainstream administrators in advance to explain the process, 

options, and final table shells. At all sites, the success of accessing mainstream data depended on the 

motivation of our CoC and mainstream agency contacts. In communities where the mainstream 

contact was motivated and invested in the study, we had much greater responsiveness. 

For each mainstream domain, Exhibit 2.3 lists the case study sites in which we were able to

successfully access and incorporate cost data. 

Chapter 2: Methodology 2–7 
2–8 Chapter 2: Methodology

 

 

 

 

 

 

Exhibit 2.3: Mainstream Domains included in the Study 

Mainstream Domains 

JacksonvilleSouth CarolinaKalamazooHouston (Individuals and Families)Washington DCDes Moines 

Primary health care 3 3 3 ** 

Mental health care 3 * * 3 ** 

Substance abuse treatment 3 * * ** 

Law enforcement and criminal justice 3 3 3 3

Child welfare ** 

Food Stamps and TANF 3 3 (FS) 

Other mainstream data 3 ** 

*

Included if funded by Medicaid. 

**Data on whether there was any system utilization, but not types of services, extent of utilization, or costs.
 

2.5. Data Analysis Approach for Case Studies 

The data analysis repeated for each distinct case study had five major components: 

1.	 analyzing HMIS data to identify the study population and measure the use of homeless 

services; 

2.	 developing homeless program typologies, calculating homeless unit costs for each 

program type, and deriving homeless system costs for each person; 

3.	 identifying common groups of homeless system users, i.e. those with common “paths”; 

4. extracting mainstream service data to measure mainstream costs associated with the study

population; and 

5. analyzing homeless and mainstream costs by path groups and other variables. 

Each of these components is described below. Each section provides a discussion of the data sources,

filtering and analysis that occurred, and the output that was used as a basis for the case study findings. 

Analyzing HMIS Data to Identify the Study Population and Measure Homeless Service Use 

(HMIS Analysis) 

Measurement of homeless service utilization was based on analysis of HMIS data to determine each

homeless individual or family’s length of stay within each program. In some cases, we were able to 

obtain data on program utilization maintained outside of the HMIS by specific agencies and to merge 

it with the HMIS data. We also attempted to measure costs associated with supportive services that 

were provided outside a residential program. However, these unit costs were difficult to quantify, and 

we determined that most service programs reported only partial information on service utilization to 

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the HMIS. Therefore, the estimates of total homeless program costs do not reflect stand-alone 

homeless supportive service program utilization unless otherwise noted. 

The three steps in the process of analyzing HMIS data to identify the study population and measure 

homeless service use were: 

1. de-duplicate client records and create a Master Household ID; 

2.	 identify the study population; and 

3. calculate the length of each program stay. 

Each step is detailed below. 

Step One: De-duplicate client records and create master household ID 

First, we compiled personal identifiers and basic demographic characteristics, such as HMIS Client 

ID, first, middle, and last names, social security number, date of birth, gender, ethnicity, race, and 

household IDs. We used The-Link-King software6

 to de-duplicate client records within the HMIS 

and merged client records if the same individual was associated with multiple HMIS Client IDs. We

did not rely on the de-duplication procedures of the HMIS itself. 

Most HMIS databases allow persons to be associated with multiple household IDs. This reflects the 

reality that people sometimes enter a program for homeless people alone and sometimes enter a 

program with various combinations of other adults and children. This phenomenon made it very

challenging to count the number of distinct households served within the study sites during the study

period and to follow particular households over time. We defined our study population according to 

household composition: for example, a single adult must never be accompanied by other persons; a 

person in a family is sometimes if not always accompanied by at least one other person and must at 

some point be accompanied by a child. Therefore, we had to be able to determine each household’s 

composition throughout the study period and, once categorized as a single member household or a 

family household, to measure its total utilization of homeless services and patterns of use over time. 

For family households that changed composition during the period of homelessness, this meant that 

we had to identify utilization of homeless programs (and associated costs) by each member of the 

household at any time during the study period. 

To accomplish this goal, we created master household IDs—one Master Household ID for each 

household—that are shared by all persons who were ever in the same household or had a household 

member in common in any program within our study period.7 For example, if a mother and two 

children entered a program together, in the HMIS they may have been referred to as HMIS Household 

ID 1. For purposes of this study, we assigned them Master Household 1. If they later went to another

program and were joined by a third child, they may have been assigned HMIS Household ID 2. By

contrast, for this study, all four persons (the mother and all three children) were then considered part 

of Master Household 1. If two of the children left and joined their father in a different program, the 

children and their father were then also considered part of Master Household 1. The master 

household approach may in some sense undercount the number of households or merge costs of 

6	 The Link King tool is designed for de-duplication and matching of client data for research purposes using

both probabilistic and deterministic record linkage algorithms. 

7	 For single individuals, the Master Household ID is the same as the Client ID. 

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households that purposely separated. However, other options would have over-counted households 

and suggested lower costs per household. Also, our approach allowed us to track change in 

household composition over time, which turned out to be an important variable in the study. 

Step Two: Identify the study population 

The selection criteria for the study population required the member of the study cohort (individual or 

family) to be served by a residential homeless program for the first time during the study

“enrollment” period. After examining household associations to group persons by Master Household 

IDs and select only individuals or groups of people that met our definition of family, we analyzed 

program entry dates to determine whether the individual or any family member had been in the

homeless services system before the enrollment period. Households were excluded if any member of 

the household was ever homeless prior to the enrollment period. 

For family sites, once a Master Household was determined to be part of the study cohort, then all 

members of the family who were housed in a residential homeless program at any time during the 

complete study period, including after the one year-enrollment period, were included as part of the 

family cohort for analyzing use of homeless programs and measuring costs. 

Step Three: Calculate Length of each Program Stay 

A key building block of homeless system costs is homeless program utilization, which can be 

described in terms of the number of days stayed in a residential program. 

We calculated the length of each program stay, chronologically sequenced and tallied program stays 

for each household, cleaned the program stay data to merge concurrent stays and truncate overlapping

stays, and assigned Program Stay IDs. We defined all program stays associated with a master

household and the gaps in time between these stays as that household’s homeless “path.” The first 

program entry date for each household’s first program stay was designated as that household’s 

“Household Start Date,” and the program exit date of the household’s last program stay was 

designated as that household’s “Household Exit Date.” For program stays that did not have valid exit 

dates, we assumed that the household exited a residential program on the day it started another 

residential program. In cases where there was no exit date for the final stay, we imputed exit dates 

using a “hot deck” imputation approach based on the length of stay for other client records within the 

same program type. Finally, if a household was still enrolled in a program as of the end of the 

eighteen-month follow-up period, the length of stay was truncated to the maximum client end date 

based on 548 days (18 months)8 from the household start date. These lengths of stay were used to 

calculate homeless program costs for each household and to group individuals or families into similar 

patterns of homeless system use. 

Developing Homeless Program Typologies and Deriving Homeless Unit Costs for Each 

Program Type 

To determine the unit cost for each program used by a member of the study cohort (usually a cost per 

day), we inventoried all homeless programs within the system at each site (HUD-funded and not 

HUD-funded), interviewed CoC and program staff to learn more about each program, and developed 

homeless program typologies for each site. The typology’s primary purpose was to identify like 

programs for which unit costs derived from a sample of the group would reasonably represent the 

The period was thirty months (913 days) in Washington, D.C. 

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costs of the full group. Thus, the typology was based on key cost drivers, including: whether a 

residential program was operated in a facility or scattered-site environment, the extent of privacy

afforded, the level of supervision, and the nature and intensity of services provided as part of the 

program. In addition to these cost drivers, we also considered the role of the program within the

homeless assistance system and time limits for participants. The resulting typologies were tailored to 

each site. This means that some program types appear in more than one case study, and some appear 

in only one. 

To derive homeless unit costs by program type within each site, we: 

1. selected a sample of programs within each type from which to collect unit costs directly; 

2.	 used on-site interviews, review of financial documentation, and extensive follow-up to

document total costs for each program, calculated separately for housing operations

(including rent, where applicable), supportive services provided as part of the program, 

administration, and the capital costs associated with facilities owned by the program or 

donated to the program rather than rented; 

3.	 calculated unit costs (household nightly costs for family programs and bed night costs for 

single programs) for each program, with and without capital costs included; 

4. calculated average unit costs for each program type, weighted by the number of occupied 

units or beds, and assigned a cost code to each program designating whether its unit costs 

should be represented by its own actual costs, the costs of another program within the 

same type that was substantially similar, or the weighted average unit costs of the 

program type. 

Cost Data Collection Strategy 

During visits to each of the study sites, we attempted to collect all costs for each sampled homeless 

program and, sometimes, all homeless programs of a particular type. Costs were collected using a 

standard data collection instrument that guided probes for information in various cost categories to 

ensure that all aspects of program operations, services provided as part of the residential program, and

program administration were included. We collected information on sources of funding and made 

sure that the sources and costs balanced, as a check on the total costs. As described in more detail in 

the section that follows, we also spent extensive effort collecting costs on capital expenditures for 

program facilities that were paid for or donated to the agency and, therefore, do not appear in the 

program’s operating budget. All homeless costs are based on 2006 program budgets or actual 

expenses; therefore all homeless program costs are expressed in 2006 dollars. 

We collected comprehensive data on costs of programs providing supportive services only while we 

were on site. We intended to divide the total program figures by appropriate units to derive average 

unit costs that could be multiplied by each person’s actual program utilization. This effort was 

confounded by two issues—our ability to accurately define units that represented the various types of 

services offered by each program, and our ability to accurately track individual client-level utilization 

of service units. 

•	 We found that programs that offered a uniform type of service, such as outreach services, 

could generally be valued in terms of a contact or hour of client-staff interaction. But 

multi-service programs, such as drop-in centers, might provide a $2 bus token, utility

assistance, case management, healthcare, medication, employment support, or a shower. 

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Therefore, it was virtually impossible to estimate the value of administering each service 

type without conducting a thorough time-study of the program. 

•	 Even when we could define units of service and measure their costs, we found that most 

programs providing only social services did not accurately record service utilization in 

the community HMIS. 

Ultimately, we included only the costs of outreach contacts and only for two case studies, 

Jacksonville and Houston. Thus, the homeless system costs reported in the case studies should be 

interpreted as residential homeless program costs. Fortunately, the work we did to inventory 

programs and collect their costs at each site suggests that there are very few non-residential service 

programs targeted to homeless people at our study sites and that many of the programs provide 

modest levels of service. In each case study, we provide information about the extent of missing 

costs to the homeless services system that may result from not including stand-alone homeless 

supportive services programs. 

Capital Costs

We consider it important to include capital costs for the buildings in which the homeless programs

operate as part of the total cost of providing residential services to homeless individuals and families.

When facilities are leased in the private market, we can assume that the costs associated with prior or

future capital investments are included as part of the lease rate. If the agencies own or are donated 

the use of the facility, operating costs do not include rent and, therefore, we would capture only part 

of the facility cost if we did not find another sources of capital cost information. 

We collected two types of information on capital costs: 

•	 Costs incurred to construct and rehabilitate buildings, based on administrative records 

and interviews. We found it very difficult to find complete information, as many of the 

facilities did not have the records associated with a mortgage loan (e.g., a pro forma). 

Some were built several decades ago, some were government property, and some were 

gifts from individuals. In addition to the difficulty of determining original development 

costs, we found that records of property rehabilitation not reflected in annual operating 

budgets were difficult for many providers to assemble. 

•	 2006 property values from tax assessment data. We decided that this was a more 

consistent and comprehensive way of determining capital costs than historical data on 

capital expenditures. However, not all communities systematically record the values of 

tax-exempt properties. We converted all costs to 2006 dollars using the Consumer Price 

Index less Shelter for the MSA or appropriate region and amortized the total investment

over a 30-year period with a three percent inflation rate. 

We prorated the resulting capital values to calculate a daily per unit capital cost. However, we found 

some property values and resulting estimates of daily costs that were not easily explained by the 

property’s size, location, and other characteristics. The scope of the study did not accommodate 

further econometric analysis to explain and validate the reasonableness of the capital cost component 

of estimates of daily unit costs. 

In this report, we have included capital costs in the daily unit costs for the three sites for which we are 

most confident about the validity of the cost estimates, either because many of the programs pay 

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market rents for the facilities they use or because of the quality of the tax assessment data. For 

Jacksonville, Upstate South Carolina, and Des Moines, our cost analysis incorporates estimates of all

capital costs in the costs reported for the homeless services system. 

Homeless System Costs for Each Household in the Study 

Homeless system costs were calculated for each household in the study sample based on the 

following formula, where LOS represents that household’s length of stay in the specified program: 

Program Stay 1 LOS x Program 1 Unit Cost 

Homeless System Costs for + 

Program Stay 2 LOS x Program 2 Unit Cost each Household = 

+ 

Program Stay n LOS x Program n Unit Cost 

We calculated utilization statistics and total, mean, and percentile values of homeless system costs for

the study cohort and for selected subgroups within the cohort. Thus, these costs reflect the actual 

costs associated with participation of the study cohort in residential homeless programs. The costs 

are represented in the case studies as homeless system costs “during homelessness,” although it is 

important to note that the costs may be spread across an extended period in which there are days or 

months during which the individual or family was not being served by residential homeless programs, 

which we refer to as “gaps.” Some of these gaps may result from incomplete HMIS data, but, since

we deliberately targeted communities with high rates of HMIS participation, they most probably

represent the intermittent use of homeless residential services by many individuals and families. 

More extensive discussion on the time periods used to present the findings is provided in Section 

2.5.4. 

Identifying Common Groups of Homeless System Users (Path Groups) and Calculating their 

Costs and Characteristics 

Analysis of “path” groups, or groups of users who share similar patterns of homelessness, is an area

in which this study breaks new ground. For each of the case studies, we analyzed the pattern of

program stays for individual households and used cluster analysis to group households with similar 

patterns of homeless system utilization. We refer to this process as the path group analysis. 

We based the path group analysis on four types of information about the person’s homeless system 

use: 

• types and sequence of homeless programs used (sequence categories); 

• number of program stays; 

• duration of Program Stays (cumulative days across all stays); and 

• gaps between programs stays (cumulative days across all gaps). 

To develop the sequence categories we created a sequence analysis file, which reports the program

type sequences used by each client and aggregates like sequences. Three or four members of the 

study team independently grouped the sequences into similar “sequence categories” and then worked

together to develop consensus sequence categories. The sequence categories became one variable 

used in the multivariate cluster analysis. We then applied multivariate cluster analysis to derive the 

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path groups based on the four variables listed above.9 We did not determine in advance the number 

of path groups desired. For each site, we reviewed various analytical outputs, and chose the model 

that resulted in the most coherent clusters with sufficiently sized path groups. Thus, the number of 

clusters varied across sites. Finally, we assigned a Path Group ID to each of the client records in our

research database to make possible the analysis of costs and demographics by path group. 

Extracting Mainstream Service Utilization Data for the Study Population 

We used the mainstream data to estimate the mainstream system costs associated with our study

population that were incurred anytime from 12 months prior to each household’s homelessness 

(Household Start Date) through December 31, 2006. In Kalamazoo, the study period began and 

ended six months later, so mainstream data collection ended on June 30, 2007. We analyzed 

mainstream costs for three time periods: 

•	 Prior to Homelessness: 12 months prior to Household Start Date through Household End 

Date 

•	 During Homelessness: Household Start Date through Household End Date 

•	 Following Homelessness: Household End Date through December 31, 2006 (June 30, 

2007, in Kalamazoo). 

For example, if someone experienced homelessness from July 15, 2004 through November 30, 2004, 

the time periods for the mainstream service utilization were: 

•	 Prior to homelessness: July 15, 2003 – July 14, 2004 

•	 During homelessness: July 15, 2004 – November 30, 2004 

•	 Following homelessness: December 1, 2004 – December 31, 2006 

•	 Full period: July 15, 2003 – December 31, 2006 

Costs following homelessness represent mainstream costs incurred after the household's last exit from

the homeless system during the 18-month period in which we tracked homelessness and any costs 

incurred after the 18-month period. Mainstream costs were calculated for each timeframe for each 

individual and summed into master household totals.10 

The steps used to match HMIS data with mainstream service data and calculate mainstream costs 

were: 

1. Finder File. We produced a finder file for each study site that we provided to each 

agency to use to identify people in our study who used the mainstream system. 

2. Agency Services Information. We worked with the mainstream system administrator or 

mainstream agency contacts to document general agency information, types of agency

services provided, and the unit or costs of client services and allocated client benefits. 

9	 The study team used a cluster analysis algorithm that can handle both continuous and categorical variables 

(Chiu, Fang, Chen, Wang & Jeris, 2001; Zhang, Ramakrishnon & Livny, 1996). 

10	 In Washington, D.C. we only received information on whether households received any services in 

specified domains at any time. The time period for these results was from July 2003 through July 2008. 

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3. Matching Client Records. Either Abt or the mainstream system administrator matched 

client records in the mainstream database(s) to clients in the finder file. Once shared 

records were identified, mainstream records associated with these individuals were 

extracted for the full study period. 

4. Client Service Utilization. Depending on whether client-level data could be released to 

Abt, either Abt or the mainstream system administrator analyzed mainstream service 

utilization data and generated standard mainstream table shells for pre-, during, and posthomelessness and the full study period by path group and by specified demographics and 

household variables. These were used as the basis for the case study reports. 

Analyzing Homeless and Mainstream Costs 

To calculate total costs associated with homelessness in each site, we started by summing homeless 

and mainstream costs for each individual or family for each period and then aggregated the costs 

across time periods and households to convey the costs associated with a particular group of homeless

individuals or families in the study cohort. 

Total Costs incurred by the Homeless System Costs associated with 

+ Homelessness = Total Costs incurred by Mainstream Systems 

Most of the analysis reported in the case studies shows household medians and averages and total 

costs for specific domains during the periods before, during, and following homelessness. However, 

members of the study cohorts spent varying amounts of time homeless and, therefore, had shorter or 

longer periods following homelessness, as well as varying amounts of time homeless, and this can 

make the cost estimates misleading. For example, if Medicaid costs are lower for the study 

population during homelessness than after homelessness, one might assume that people become 

disconnected with mainstream medical care during homelessness. However, if the period of

homelessness averages three months and the period after homelessness averages fifteen months, the 

difference in costs may just reflect that the households had longer time period in which to incur costs 

following homelessness. We addressed this issue by calculating time-adjusted average monthly 

household costs for each period and group to allow for meaningful comparison of costs associated 

with different time periods and across groups that may have varying lengths of homelessness. 

Multivariate Analysis of Determinants of Costs

To examine how demographic characteristics and patterns of homelessness are related to costs, the 

study team used a multivariate analysis technique called multiple regressions. Multivariate analysis is 

useful because it allows us to identify the independent impact or effect of each variable of interest on 

costs, while holding all other variables constant. This analysis helps us to answer questions, such as: 

•	 Which demographic factors are associated with higher costs, after controlling for the 

duration of homelessness and path groups? 

•	 Everything else being equal, what is the relationship between the duration of 

homelessness and total costs incurred? What is the relationship between the duration of 

homelessness and total mainstream costs? 

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•	 Which path group tends to incur the highest costs, holding the demographic variables 

constant? Which path group tends to incur the lowest costs? 

•	 Is there a correlation between mainstream system costs and homeless costs? 

To conduct the multivariate analysis, we developed regression models to explain homeless system 

costs. The explanatory variables used in the models included: 

•	 homeless path group or path group constituent variables (length of stay, number of stays, 

and length of gaps); 

•	 gender (individuals sites only); 

•	 race (individuals sites only); 

•	 age (individuals sites only); 

•	 number of adults (family sites only); 

•	 number of children (family sites only); and 

•	 changes in household composition (family sites only). 

A central research question for this study is the relationship between homeless paths (e.g. groups of 

people who use the system in similar ways) and costs. Thus, homeless path group was used as an 

explanatory variable. However, we were also interested in gaining a more nuanced understanding of 

the impact of cumulative length of homeless stays, number of homeless stays, length of gaps between 

stays, and types of programs used. These two analyses could not be done in the same model, since 

the path group variable was derived from the variables on homeless patterns. Thus we ran two 

families of models related to homeless costs, one set using the path group variable itself, and another 

using the three independent variables related to patterns of homelessness.11 Within each family of 

models, we layered different combinations of the independent variables to understand their relative 

influence. 

For Houston and Jacksonville, the sites in which we had access to client-level mainstream data, 

regression models were also developed to explain the variations in total homeless system and 

mainstream costs per household. Separate models were estimated for the following categories of 

costs:12 

•	 total costs (total homeless costs + total mainstream costs); 

•	 total homeless costs; 

•	 total mainstream costs; 

•	 specific mainstream costs 

11	 A fourth variable used in the cluster analysis, program sequences, was not included. 

12 The study team used the logarithm (log) scale of the costs as the dependent variable. The log specification 

is commonly used in the cost modeling literature. It has a number of appealing characteristics. First, the 

estimated model coefficients can be interpreted as percentage changes in the dependent variable for a 1-unit 

change in the explanatory variable. Second, it implies non-linearity and joint determination of the cost 

level by all the explanatory variables in the model. Third, the specification mitigates a common form of

heteroskedasticity in the model’s error term (Wooldridge, 2001). One exception is that, for regression

models developed for the mainstream domain costs in Jacksonville, we used the cost amounts in their 

original metric. 

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To measure the relationship between these categories of costs and homelessness, three families of 

models were developed to separately test independent variables for 1) homeless path group, 2) the 

four variables related to patterns of homelessness, and 3) homeless system costs as an independent 

variable and excluding path group variable and the four variables related to patterns of homelessness. 

The models also included versions with and without covariates for involvement in mainstream 

domains. For instance, the model for criminal justice measured whether people who had received 

mental health treatment (as well as the other mainstream systems) were associated with higher 

criminal justice costs, when controlling for the other independent variables. 

2.6. Cross-Site Analysis 

The cross-site findings presented in this report are the result of two analytical approaches. First, we 

synthesized the findings from the separate case studies and identified common themes as well as 

salient differences that emerged among the various sites. Second, we integrated data across sites into

a combined cross-site cohort dataset and analyzed the records using multivariate regression analysis, 

adding a dummy site variable to model the influence of site differences. In some cases, we also had 

to standardize the variables that diverged across sites prior to creating the cross-site dataset. The latter 

analytical approach was only possible for analysis of the homeless system patterns and costs, which 

were gathered consistently across all sites. It was not possible to conduct a similar analysis of 

mainstream costs, since we were unable to collect client-level mainstream costs in most sites and 

since the mainstream domains obtained differed from one site to another. 

The steps for the cross-site multivariate analysis are described in more detail below. 

Standardization of Variables 

While an important part of the case studies was to generate both program and path typologies that 

were tailored to the site and household type, for the cross-site analysis, we re-categorized these 

typologies using the generic groupings of emergency shelter, transitional housing, permanent 

supportive housing, and non-residential program types. For example, in Houston, we originally 

categorized individual emergency shelters as either short-term shelter or extended stay shelters. In 

Jacksonville, the distinction between overnight shelters and 24-hour shelters was a more important 

typological distinction. For the cross-site analysis, these programs were all re-categorized as 

“Emergency Shelter.” The “non-residential type included outreach programs as well as programs that 

were involved in direct placement of clients into mainstream housing with a short rental subsidy and 

case management. 

For each individual or family, we then created a program type use variable, based solely on which of

these general program types the household used. The basic groupings created were as follows: 

• cohort members using emergency shelter only; 

• cohort members using transitional housing only; 

• cohort members using emergency shelter and transitional housing only; and 

• cohort members using any other combination of program types. 

The last combination included households that were served by non-residential programs as well as 

those served by permanent supportive housing. Unlike the path groups used in the case studies, these 

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groupings were not based on cluster analysis and did not account for length of stay, number of stays, 

or gaps, or the sequence in which households used the particular programs. However, these other 

factors (except sequence) were re-introduced as variables in the cross-site multivariate regressions. 

Finally, we ensured that the data were comparable across sites. This was particularly necessary for 

Washington D.C., which used a 30-month study period instead of an 18-month study period. In order 

to compare Washington, D.C. data directly to the other sites, we re-analyzed the patterns of the 

Washington, D.C. cohort, and incorporated only the data on costs, length of stay, number of stays, 

and gaps that were incurred during each family’s first 18-months.13 In addition, the Washington D.C.

cohort included 87 families that only used a program that placed families into mainstream housing. 

These families were excluded from the cross-site analysis, since they were never literally homeless, 

and this program did not have equivalents in other sites. 

Cross-site Multivariate Analysis 

We conducted two sets of additional regressions to support the cross-site analysis. One set of 

analyses was conducted for the four family sites, and another set of analyses was conducted for the 

three individual sites. Models were developed to explain two outcome variables: length of

homelessness and homeless system costs. 

These regressions used the same variables that were used to understand site-specific correlations (see 

section 2.5.5), with the exception of homeless path group, which was not comparable across sites. 

Instead, the models included the new program type use variable, as well as the length of stay, number 

of stays, and gap days. Each model in the cross-site regressions also included a variable for the site to 

control for differences in program costs across communities. Also, the family sites incorporated 

demographic data that were not used on the case study level, including gender of adults in 

households, race of head of household, age of head of household, and age of youngest child. 

Follow-up analyses were also conducted to address additional questions that arose: 

•	 For families, we modeled the relative risks of households falling into one or other of our 

program type use categories, based on the explanatory variables. 

•	 For individuals, we modeled the impact of the explanatory variables on number of stays, 

and another model to explain the cumulative length of gaps between homeless stays. 

2.7. Limitations of the Study 

Although this study of the costs associated with homelessness paves new ground and provides 

important findings in many areas, the results of this study also have several limitations. 

Perhaps most importantly, the study does not attempt to isolate which of the mainstream costs are 

caused by homelessness, and it does not compare the benefits of different programs with the costs of 

their use. Thus, the study is not a cost-effectiveness study and is most accurately characterized as a 

study to measure the costs associated with homelessness, rather than the costs of homelessness. 

13	 We did not re-generate information on changes in household composition, which might have occurred after 

the first 18 months. 

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Specific limitations of our methodology include the following: 

1.	 The study does not include homeless or mainstream system costs associated with

individuals or families who may have experienced homelessness but who were not 

entered into the HMIS. 

2. The study explicitly excludes households that were served by residential domestic 

violence providers at any point during their homelessness. 

3. The estimates of costs to the homeless system do not reflect costs associated with the 

programs that do not report data to the HMIS. 

4. Some capital costs are missing, as noted in Section 2.5.2. 

5. Mainstream costs are limited to the domains for each case study listed in Section 2.4.3. 

For all of these reasons, the estimates in this study may underrepresent costs associated with 

homelessness in our study sites. 

Further, real world data is “messy.” The reliance on administrative data rather than direct data 

collection requires both trusting in the validity of the data entered by local system users and

confronting inevitable gaps in data completeness. The actual data includes numerous data fields that 

were left blank and others that were inaccurate. Missing or inaccurate information in identifying 

fields, such as name, social security number and date of birth, inhibited our ability to match records 

within the HMIS itself in order to construct a complete homeless path or even to determine whether a 

client met the basic criteria for inclusion in the cohort. It also hampered our ability to match data 

with mainstream domains. Missing program exit dates was a frequent occurrence and affected our 

ability to precisely calculate length of stay, which is a critical part of determining homeless system

costs as well as establishing the period of homelessness itself. 

While we used state-of-the-art tools and statistical techniques to compensate for data entry

shortcomings, such as using probabilistic record matching to link client records and hot-deck 

imputation to fill in missing exit dates, these techniques are only as accurate as the original input and 

decline in validity as the proportion of available data declines in relation to the missing data. Finally,

not all of the data administrators of mainstream systems were able to use Link-King, which supports 

advance record-matching algorithm. In these cases, a more direct, deterministic record matching 

approach was used, which may have led to an undercount in the number of matches found. 

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3. Homeless Program Costs 

This chapter reports on the costs of residential programs for homeless people across the six study

communities. Little has been documented nationally about the program budgets or daily costs of 

providing different types of homeless programs. Estimates for homeless programs used in other 

studies of the costs of homelessness have been based primarily on levels of reimbursement available

from public agencies. For this study, homeless program costs are based on actual budgets collected 

from examples of different types of residential programs in each of the case study sites.1 Using actual

program costs provides a more detailed understanding of the variation in costs across homeless 

programs. It also provides insight on the main cost components of homeless residential programs: 

operations, services, administration, and in some cases capital investments in facilities owned by 

programs.2 

This chapter discusses daily program costs by program type within our study sites, starting with 

program costs for individuals and followed by a discussion of program costs for families. Within 

each section, the costs per person per day are discussed in two different ways: 

1.	 Community costs: average daily costs for all programs types in the community for which 

we collected cost data, weighted by program size; and 

2.	 Cohort costs: average daily costs for the program types as they were used by the study 

cohort. 

The distinction is subtle but important. The average costs per day weighted by program size represent 

the costs of the sample of programs for which we collected costs at each site weighted by the typical 

number of individuals or families using the program each day.3 These average costs fulfill the 

interest in the field in understanding the cost per day of different types of homeless programs. They

also allow us to compare the variability of costs from one community to another. However, 

community weighted averages do not reflect the way the study cohort used the various programs. 

Averages weighted by program size assume that households use each program in proportion to its 

size.4

 In contrast, the average cost per day for members of the study cohort reflects the actual levels 

of use of each program by the cohort. For example, if the study cohort used more expensive 

1	 Daily unit costs were calculated by taking a program’s 2006 annual budget, divided by 365 days to get the 

average daily cost of the program and then divided by the average number of occupied units per day to

arrive at the average daily cost per unit. See Section 2.5.2 for a detailed discussion of the methodology. 

Homeless program costs are expressed in 2006 dollars. 

2	 To explore the relative value and influence of capital costs for programs that owned their own properties

(and therefore invested real or in-kind resources to build, acquire and/or rehabilitate them), capital daily 

cost estimates were developed for the Des Moines, Jacksonville, and Upstate South Carolina case studies. 

3	 The sample was selected to achieve an understanding of the costs of each homeless program type operated 

in each community; however, the average costs are not statistically representative of all homeless programs 

within each the community. 

4	 For example, assume that a community has one 10-unit and one 90-unit emergency shelter. The weighted

average assumes that if the cohort spends ten days in emergency shelter, one day will be spent in the 10-

unit program and nine days will be spent in the 90-unit program. In practice, members of the study cohorts 

did not use programs according to these proportions. 

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emergency shelter programs extensively, then the cohort’s average costs per day are higher than the 

weighted averages for all programs for which we collected data, and vice-versa.5 

As we discuss throughout this report, the cost findings illustrate the powerful influence of variation in 

costs among particular programs, as well as variations in costs among types of programs. 

3.1. Homeless Program Costs for Individuals 

We identified three primary types of homeless residential programs for individuals in Des Moines, 

Houston, and Jacksonville: emergency shelter, transitional housing, and permanent supportive 

housing. Sometimes we went beyond this three-part classification and created further categorizations 

based on the “housing model”—the type of residential space provided or amount of time an 

individual was expected to spend in the program. 

The average cost per day is shown for each program type within each site in Exhibit 3.1. Overnight

emergency shelter has the lowest cost per day, typically offers the fewest services in the least private 

settings, and is often open only during evening and nighttime hours. Transitional housing is generally

an expensive model and frequently offers individual room or apartment settings and a range of 

supportive services. In Houston, Extended Stay Emergency Shelter, in many respects very similar to 

transitional housing but with shorter intended lengths of stay, has slightly higher costs than 

transitional housing. Permanent supportive housing also generally offers private living space and 

supportive services. Providers who operate it indicate that residents are offered services equivalent in 

intensity to or even greater than services offered in transitional housing; however, in most cases, we 

found that permanent housing programs arrange for residents to receive services directly from

mainstream systems.6

 Services paid for by permanent supportive housing programs directly appear to 

be limited to housing-focused services and basic case management. As a result of this structure, 

permanent supportive housing programs do not have to secure resources to fund these services 

directly, and the costs are on average comparable to the less expensive 24-hour emergency shelter 

programs from the perspective of the homeless system. Scattered Site Permanent Supportive Housing 

has higher costs than transitional housing in Houston primarily due to the costs of leasing private 

apartments.7 

5 If we did not directly collect costs from a program, we used the costs of another program within the same

type that was substantially similar. If there was no substantially similar program, we used the weighted

average costs of the program type. 

6	 Because these clients receive services that they would otherwise be eligible for and could continue to 

receive these services if they moved to alternative housing, we did not include this cost as part of the 

housing program. Although the resident may be enrolled in this service as a direct result of being accepted 

into the housing, anecdotally we heard that clients moving into PSH are already enrolled in mainstream

care and may even be referred to the permanent supportive housing by their mainstream providers. Our

analysis of PSH client enrollment in mainstream services, reported in Chapter 4, is consistent with this 

assertion. Services paid for with the program budget and those dedicated to the project are accounted for in

the program daily costs, when possible. 

7	 The Houston site does not include the daily equivalent value of capital investments. Therefore, the daily

costs of facility-based programs may under-represent the housing operations costs in comparison to 

programs that lease space in the private market. 

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Exhibit 3.1 also presents the proportion of costs spent for housing operations, services, agency 

overhead, and the daily cost equivalent of capital investments for programs that are operated in a 

facility owned by the agency. When facilities or individual housing units are leased, the capital costs 

are reflected in the housing operations budget. 

Exhibit 3.1: Average Cost Per Person Per Day of Homeless Residential Programs Serving 

Individuals by Program Type and Site a

Site – Program Type Housing Model 

Average Cost 

Per Person 

Per Dayb Housing 

Operations 

Supportive 

Services 

Agency 

Overhead 

Capital 

Costsc 

Des Moines 

Emergency Shelter Congregate $19 $8 (42%) $9 (44%) $2 (9%) $1 (5%) 

Transitional Housing Shared Rooms $34 $11 (33%) $14 (43%) $7 (20%) $1 (4%) 

Transitional Housing Individual Rooms $50 $17 (34%) $11 (21%) $7 (13%) $16 (31%) 

Permanent Supportive 

Housing Shelter Plus Care $18 $17 (94%) < $1 (2%) < $1 (4%) $0 (0%) 

Houston 

Emergency Shelter Short Stay $28 $7 (25%) $17 (60%) $4 (15%) 

Emergency Shelter Extended Stay $61 $14 (23%) $27 (44%) $20 (33%) 

Transitional Housing Facility-based $55 $16 (29%) $30 (55%) $9 (16%) 

Permanent Supportive
 

Housing Facility-based $22 $14 (64%) $5 (25%) $3 (12%) 

Permanent Supportive
 

Housing Scattered Site $59 $31 (52%) $18 (31%) $10 (17%) 

Jacksonville 

Emergency Shelter Overnight $14 $7 (54%) $3 (25%) $1 (8%) $2 (13%) 

Emergency Shelter 24-hour Shelter $32 $22 (70%) $5 (16%) $5 (14%) $0 (0%) 

Transitional Housing Facility-based and 

Scattered Site $29 $13 (46%) $11 (37%) $4 (15%) < $1 (2%) 

Permanent Supportive SRO, FacilityHousing based and 

Scattered Site $29 $14 (48%) $9 (30%) $2 (7%) $4 (14%) 

a Costs represent the average across programs within each type, weighted by the typical number of individuals served in each

program each day. Costs only represent homeless system costs and do not include the value of mainstream system costs that 

may be incurred while individuals or families reside in these programs. 

b Total weighted daily unit cost may not equal the sum of the budget component estimates due to rounding c Capital costs were available for Jacksonville and Des Moines, but not for Houston. 

More expensive programs generally have higher costs across all budget categories. Higher costs of 

housing operations may reflect more supervision when comparing an overnight program to a 24-hour 

program, or increased private space and smaller program capacity (i.e., decreased economies of scale) 

when comparing transitional and permanent supportive housing programs to emergency shelters. 

Often more expensive programs provide more services to clients, in the form of either lower case 

loads or a broader range of services. Agency overhead costs frequently are higher in more expensive 

programs, again in part due to smaller program capacity and associated decreases in economies of 

scale. It also appears that many of the more costly programs have higher management and overhead 

expenses and may be operated by agencies that have a professional management structure. As the 

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break-down of costs in Exhibit 3.1 shows, the higher cost of transitional housing is generally driven 

by higher costs across all areas: housing operations, services, overhead, and capital costs. 

Often cost differences reflect idiosyncratic features of particular programs. Nonetheless, there are 

trends in costs by program type that appear to be tied to the programmatic and physical requirements 

of the different program types. As we discuss in Chapter 4, transitional housing that is used by the 

study cohort of homeless individuals is consistently more expensive than emergency shelter used by

the cohort. Multivariate analysis that controls for other cost drivers shows that individuals who use 

transitional housing, or transitional housing in combination with emergency shelter, have costs more 

than double costs of individuals who only use emergency shelters. 

3.1.1 Monthly Program Costs and Local Costs of Housing 

Exhibit 3.2 shows the average costs per month for each program type in each community compared to 

HUD’s Fair Market Rents (FMRs) for a one-bedroom unit in the same community. The FMR is one 

way to quantify the value of a rental subsidy for a month. 

Exhibit 3.2: Average Cost Per Person Per Month for each Homeless Program Type for 

Individuals and FY2006 One-Bedroom Fair Market Rentsa 

Emergency 

Shelter 

Transitional 

Housing 

Permanent 

Supportive 

Housing 

2006 Fair Market 

Rent for Onebedroom Unitb 

Des Moines $581 $1,018 – $1,492 $537 $549 

Houston $853 - $1,817 $1,654 $664 – $1,757 $612 

Jacksonville $408 - $962 $870 $882 $643 

a Costs shown reflect weighted averages by program type. Ranges represent the averages of different housing models 

within a program type, also shown as daily costs in Exhibit 3.1. 

b FMR Source: HUD, 2005. The FMR does not include the monthly fee paid to a public housing agency for administering 

the voucher program, which was approximately $58 per unit per month in these three communities. (HUD, 2007) 

In Chapter 4 we discuss average and median lengths of homeless program stays and report that the

majority of individuals who become homeless in each of the three study sites use homeless programs 

for considerably less than one month. However, for individuals who do use homeless programs for 

longer than one month, the monthly figures provide a way to compare the cost of the assistance that is 

being provided by these programs to a rent subsidy. The FMRs are much more similar across the 

three sites than the average homeless program costs per month, reflecting in part the great variability

from site to site in what is provided within each homeless program type and how it is provided. 

Except for overnight emergency shelters in Jacksonville and permanent supportive housing in Des 

Moines, the FMR is lower than the monthly costs of all types of homeless residential programs in 

these communities. The sections below describe each program type, the costs associated with 

providing it, and the extent to which programs are providing both shelter and supportive services to 

clients—in contrast to the Fair Market Rents, which represent only the cost of housing. 

3.1.2 Emergency Shelters for Individuals 

All three sites provide emergency shelter for individuals, primarily in large facilities with congregate 

sleeping arrangements, communal meals, and short expected lengths of stay. Jacksonville has two 

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models of shelter: overnight shelter and 24-hour shelter. The overnight facilities offer minimal 

assistance (a hot meal, a cot, and chapel services) and often limit the number of consecutive nights 

clients can stay. For example, one overnight shelter allows three free nights per month and then 

charges $5 per night. Although overnight shelters are not very large, they serve more people than 

other program types because they have the highest turnover rates. Jacksonville’s 24-hour emergency

shelter has continual supervision, on-site supportive services, and no explicit limits on length of stay. 

Des Moines’ emergency shelter beds are similar to Jacksonville’s 24-hour shelter model. Houston 

also has two models of shelter, referred to in this study as Short-Stay Emergency Shelter and 

Extended Stay Emergency Shelter. The short-stay programs serve either single men only or single 

women alongside women with children. Short-stay shelters offer beds, food, and assistance in 

moving clients back into housing as quickly as possible. The shelters for men are overnight shelters. 

One of them allows clients to stay for free for up to 8 nights a month and then begins charging a 

nightly fee. The women’s short-stay shelters have 24-hour staffing and allow stays of up to 90 days. 

The category that we refer to as Extended Stay Emergency Shelters offers a rich variety of supportive 

services and accommodates stays of 3 to 6 months. Extended stay shelters provide clients a greater 

level of privacy and have a wider array of services than the shorter-stay model, in many ways

paralleling the environment and programming provided at a transitional housing program but with the 

expectation of shorter stays. Programs in this category are primarily targeted to women with a history

of substance abuse. 

Exhibit 3.3 reports the average cost per person per day, the range of costs per day across programs 

within each program type at each site, and the average cost per day of each program type as it was 

actually used by the study cohort. 

Exhibit 3.3: Average Cost Per Day of Emergency Shelter for Homeless Individuals 

Site Housing Model 

Average Cost Per 

Person Per Day 

Range of Costs Per 

Person Per Daya 

Average Cost Per 

Day As Used By 

The Cohort 

Des Moines Congregate $19 $19 $19 

Houston Short Stay $28 $19 - $73 $36 

Houston Extended Stay $61 $31 - $85 $67 

Jacksonville Overnight $14 $14 $14 

Jacksonville 24-hour $32 $32 $32 

a If only one number is provided, costs were only collected from one program. 

While emergency shelter costs are generally low, they are quite varied. Overnight and short-term 

emergency shelters have relatively low daily costs. In Jacksonville, the overnight emergency shelter 

has a cost of only $14 per day. Des Moines’ congregate shelter program is provided for $19 per day. 

Jacksonville’s 24-hour shelter serves both singles and families and has a daily cost more than double 

the cost of the overnight emergency shelter, $32. Houston’s short-stay programs have a similar 

average daily cost, $28, although costs ranged from $19 per day to $73 per day depending on the 

program. Houston’s extended stay shelter model has a cost almost triple the daily cost of the shortstay shelters, $82. The lower cost emergency shelter programs all have high capacity (more than 100 

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beds) and are able to achieve significant economies of scale that are not achievable with programs 

that have only 20 to 40 beds. 

Single women are frequently served in shelter programs that also serve families and that also have 

much higher daily costs.8 A single agency in Houston operates a short-stay program for single men 

and another program for families and single women. The shelter for men, a large facility with more 

than 300 beds, operates at a daily cost per person of only $19, compared with $73 for the program for 

families and single women. Half (51 percent) of the $54 difference in cost can be attributed to 

services, for which the agency spends $40 per single woman compared with $13 per single man. But 

the program also spends $26 more per night for single women on housing operations and agency

overhead, since the women and families program provides more privacy and individual space and 

there are fewer units in the facility over which to prorate fixed housing operations and agency 

overhead costs. 

Exhibit 3.3 also shows that the average daily cost of emergency shelter in Houston as it was actually

used by members of the study cohort is higher than the cost per person per day weighted by program

capacity. This means that individuals in the study cohort of first-time homeless individuals used the 

expensive programs slightly more than the less expensive programs within each category. 

3.1.3 Transitional Housing Programs for Individuals 

Transitional housing programs serving single adults in our study sites are offered in both facilitybased and scattered site settings. Of the programs we examined, those designed exclusively for single 

adults use a facility-based model, whereas programs that serve families with children or both families 

and single women use both models. In the facility-based model, clients are housed in a single 

building or a campus of buildings owned or leased by the program. In the scattered site model, 

households are placed in independent apartments located in larger complexes where most of the 

buildings’ tenants are not homeless. The difference in privacy and independence associated with 

scattered site transitional housing (which was offered for single women but not for single men in our

study sites) may contribute to longer lengths of stay for single women. And since single women were 

often served in more expensive programs that were designed to accommodate families, their 

associated costs were also higher when compared with single men in the study cohort, as we discuss 

in Chapter 4. 

Most transitional housing programs offer supportive services, including case management, assistance 

in securing benefits, and job training. In Jacksonville, many of the transitional programs screen out 

persons who are actively using drugs or alcohol and cite employment, sobriety, and obtaining

permanent housing as their primary program goals. By contrast, most programs in Houston target 

persons with substance abuse histories. One large program targets tuberculosis patients who are in 

recovery, and another serves persons with HIV/AIDS. Several transitional programs in Houston 

serve only women. 

Des Moines has two models of transitional housing: one with individual rooms or apartments and 

another with shared rooms. The facilities used by the programs with individual rooms are large 

8 This is an important point that is discussed in more depth in Chapter 4, since we find that, even when

patterns of homelessness such as lengths of stay are controlled for, single women are associated with 

substantially higher costs than single men, implying that women use more expensive programs. 

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buildings in downtown Des Moines, some of which are valuable properties. This has implications for

the programs’ daily costs per person, since we included a daily cost equivalent of capital 

infrastructure in the estimates for Des Moines. Programs providing transitional housing with shared 

rooms generally are group homes and have a completely different housing and capital cost structure. 

They target homeless people with particular types of need. Three of the five programs in this 

category serve people who are homeless and have a history of incarceration and, therefore, a need for 

specialized services that help to address barriers imposed by a criminal history and to mitigate 

behavior that may lead to reincarceration. Another is a program for veterans operating within an 

emergency shelter building but with more privacy, longer lengths of stay, and extensive client 

services funded by the Veterans Administration. The final program is targeted to homeless men 

recovering from substance abuse. 

Exhibit 3.4 shows the range of daily program costs for transitional housing within each site and 

compares average program costs per day overall with the costs of the programs as they were used by

the study cohort. 

Transitional housing has the highest program cost per person per day across the three residential 

program types in Des Moines ($46) and Houston ($55). In Jacksonville, the cost of transitional 

housing ($29 per person per day) is comparable to the cost of the 24-hour model of emergency 

shelter. As shown earlier in Exhibit 3.1, approximately half of the costs of transitional housing are 

expended for housing operations and agency overhead, ranging from 45 percent in Houston, to 57 

percent in Des Moines, to 61 percent in Jacksonville. In Houston, where we are unable to include the 

daily cost equivalent of capital investments, services account for 55 percent of costs, whereas services 

represent only 26 percent in Des Moines and 37 percent in Jacksonville. The remaining 2 percent in

Jacksonville and 25 percent in Des Moines represent the daily equivalent capital costs of transitional 

housing facilities owned by the agencies. Since many of the transitional housing programs identified 

in Houston were facility-based, the proportion of costs for both housing and services would be lower 

if capital costs were included. 

In Des Moines, the two types of transitional housing have quite different cost structures due to their 

different models and locations. The combined housing and capital daily equivalent cost of the private 

room model ($32.62) is more than 2.5 times that of the shared model ($12.58), primarily due to the 

high value of the properties in which the private room model operates. The supportive services cost 

for the shared room model, which targets special populations, is 37 percent higher ($14.46 versus 

$10.55), offsetting some of the differences in facility-related costs. The cost of administration (~$7) 

is approximately the same for both models. The net cost of the private room model is 47 percent 

higher than the shared room model, a result that affects the average cost of transitional housing as 

used by the study cohort in Des Moines, since the private room transitional housing model was used 

for 35 percent more total days than the shared room model. (The number of days used is not shown in 

the exhibit.) 

Within each type of transitional housing program in Des Moines, the study cohort used lower cost 

programs somewhat more extensively than higher-cost programs. Since many programs in Des 

Moines were targeted to special needs populations, the actual program use and resulting costs may

reflect the extent to which the study cohort met various eligibility requirements. In Houston and 

Jacksonville, the study cohort used the more expensive transitional housing programs more often than 

the less expensive ones. This could reflect the fact that higher cost units often offer more privacy and 

are more attractive to residents, thereby resulting in longer lengths of stay and higher utilization. 

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Exhibit 3.4: Average Cost Per Day of Transitional Housing for Homeless Individuals 

Site Housing Model 

Average Cost 

Per Person 

Per Day 

Range of 

Costs Per 

Person Per 

Day 

Average Cost 

Per Day As 

Used By The 

Cohort 

Des Moines Shared Room Transitional 

Housing $34 $10 - $80 $28 

Des Moines Individual Room Transitional 

Housing $50 $22 - $204 $43 

Houston Transitional Housing $55 $19 - $144 $65 

Jacksonville Transitional Housing $29 $13 - $46 $31 

3.1.4 Permanent Supportive Housing for Individuals 

Permanent supportive housing provides indefinite housing assistance and supportive services to

residents, directly or guaranteed based on formal relationships with mainstream providers. Permanent 

supportive housing in the three study sites is commonly offered in both facility-based and scattered 

site models. Houston has made a considerable investment in permanent supportive housing. These 

units are almost evenly split between facility-based and scattered-site programs. The biggest provider 

of supportive housing units targets persons with HIV/AIDS. Houston also has large permanent 

supportive housing programs for disabled veterans and individuals with severe mental illness. The 

only permanent supportive housing program serving individuals in Des Moines is a Shelter Plus Care 

(S+C) program providing subsidies for homeless people with disabilities who rent private market 

units. Under agreements with several providers of mental health and substance abuse services, a local 

non-profit sponsor of affordable housing make slots in the S+C program available to clients referred 

by those agencies. 

While permanent supportive housing is generally limited to persons with a chronic disability that 

inhibits independent living, the majority of permanent housing units considered part of the residential 

system for homeless individuals in Jacksonville are Section 8 Moderate Rehabilitation Single Room

Occupancies (SROs). Unlike permanent supportive housing, these programs do not exclusively serve 

persons with disabilities, although local providers said that most residents do have disabilities. Aside 

from meals, these permanent housing SROs do not include on-site supportive services. Services are 

provided through formal relationships with mainstream service providers and by referral. 

Jacksonville also has some permanent supportive housing programs that offer more intensive on-site 

supportive services. 

In all three of the study sites for individuals, the cost per person per day of permanent supportive 

housing is less than or equal to the cost of transitional housing, with the exception of the scattered site 

permanent supportive housing model in Houston, which has slightly higher average costs per day

(Exhibit 3.1). The cost of permanent supportive housing averages $18 per day in Des Moines and 

$29 per day in Jacksonville. In Houston, the cost is $22 per day for facility-based housing and $59 

per day for scattered site housing. Because most services are delivered by mainstream agencies that 

residents are otherwise eligible for (and would be eligible to continue to receive if they moved to 

alternative housing), we did not include the costs of mainstream services as part of the permanent 

supportive housing program cost estimates. Although the resident may be enrolled in this service as a 

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direct result of being accepted into the housing, anecdotally we heard that clients moving into 

permanent supportive housing already are enrolled in mainstream care and may even be referred to 

the housing by their mainstream providers. Our analysis of enrollment of users of permanent 

supportive housing in mainstream services (reported in Chapter 4) is consistent with this premise. 

Services paid for within the program budget or otherwise dedicated to the project are accounted for in 

the program daily costs to the extent possible. 

Martha Burt conducted two self-report surveys (2004 and 2007) of more than 90 permanent 

supportive housing providers that enable us to place these costs in context. The surveys were part of 

a multi-year study of the Taking Health Care Home evaluation for the Corporation of Supportive 

Housing (Corporation for Supportive Housing [CSH], 2005; CSH, 2008).9

 These programs housed 

primarily individuals with chronic patterns of homelessness and used mainly facility-based models. 

From the 2007 survey, Burt reports costs averaging $46 per unit per day, with housing costs of $27 

and services costs from all sources of $19. These costs are higher than the estimates of the average 

cost per person per day presented in Exhibit 3.5 for permanent supportive housing in Des Moines and 

Jacksonville, and for facility-based permanent supportive housing in Houston. These lower overall 

costs in the study sites reflect lower services costs, but also lower housing operations costs, as shown 

in Exhibit 3.1. Perhaps the programs surveyed in the Burt study are more comparable to properties in 

this study with costs at the higher end of the ranges shown in Exhibit 3.5. 

Exhibit 3.5: Average Cost Per Day of Permanent Supportive Housing Programs for Homeless 

Individuals 

Site Housing Model 

Average Cost 

Per Person 

Per Day 

Range of 

Costs Per 

Person Per 

Daya 

Average Cost 

Per Day As 

Used By The 

Cohort 

Des Moines Scattered Site $18 $18 $18 

Houston Facility-based $22 $13 - $69 $54 

Houston Scattered Site $59 $35 - $80 $47 

Jacksonville Scattered Site and Facility-based $29 $21 - $41 $24 

a If only one number is provided, costs were only collected from one program. 

Another analysis, conducted by Abt Associates Inc. (2005) for HUD, reviewed the costs of permanent 

supportive housing projects serving individuals with a history of chronic homelessness. That cost 

review also found lower costs than the Burt survey. The Abt Associates analysis was based on 

program budget data collected on-site and included costs of services unless we concluded that they

were mainstream costs readily available to all people with qualifying conditions regardless of their 

homelessness. That study found average daily costs per person of $21 for older facility-based models

(62 percent for housing, 38 percent for services), $22 for newly developed properties (46 percent for 

This information was self-reported in response to a survey and not based on direct examination of program

budget documents. Some survey respondents reported that they were unable to include costs reimbursed by

certain mainstream systems, such as Medicaid. 

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housing, 54 percent for services), and $40 for scattered site models (57 percent for housing, 43 

percent for services).10 

The comparison of average costs per day with the costs per day actually incurred by the study cohort 

within each site (Exhibit 3.5) again illustrates how client-specific or systemic decisions that determine 

who uses which particular program can make a significant difference in costs incurred by the 

homeless services system. This is most clear for Houston. On average, the scattered-site permanent 

supportive housing model in Houston costs almost three times as much as the facility-based model. 

However, the individuals we studied who used facility-based models generally used the more

expensive programs, whereas those who used scattered site housing used less expensive programs 

than the community average. As a result, the average cost per day for members of the Houston cohort 

using facility-based housing was greater than the average cost per day for those who used scattered 

site housing, exactly opposite what we would have surmised from the overall averages for the 

program types. 

Des Moines has only one permanent supportive housing program, so there is no difference between 

the two average costs. In Jacksonville, the difference between the average cohort cost and the 

community-wide average cost shows that members of the Jacksonville study cohort used less 

expensive programs more heavily than more expensive models. 

Very few individuals in our study cohort used permanent supportive housing at any time during the 

study’s 18-month tracking period. For example in Des Moines, we found only four individuals in the 

Shelter Plus Care program from among the 1,124 who became homeless for the first time between 

July 1, 2004 and June 30, 2005. Across all three sites, this phenomenon may be a result of two 

patterns. First, most people using permanent supportive housing programs were not included in this 

study because they had been housed in a homeless residential program before July 1, 2004. Second, 

some individuals in our study cohorts who used permanent supportive housing were not placed there 

until well into the 18-month observation period, so some permanent supportive housing stays may

have been truncated. Regardless, costs associated with permanent supportive housing are not a major 

part of the costs associated with homelessness for our study cohort. 

3.2. Homeless Program Costs for Families 

As we did for individuals, we identified three primary types of homeless residential programs for 

families in our four family study sites—emergency shelter, transitional housing, and permanent 

supportive housing—and also made further distinctions among “housing models” for some program

types in some communities. The average cost per family per day is shown for each program type in 

Exhibit 3.6 for DC, Houston, Kalamazoo, and Upstate South Carolina. The exhibit also shows the 

proportion of costs spent for housing operations, services, agency overhead, and—only for Upstate 

South Carolina--the daily cost equivalent of capital investments for programs that are operated in a 

facility owned by the agency. (Rental or leasing costs for facilities not owned by the agency are 

factored into housing operations.) These are the average costs per day for the programs for which we 

collected cost data, weighted by program capacity. Costs for the programs as used by the study 

cohorts of first-time homeless families are presented later. 

10 These figures do not include daily equivalent costs for capital investments. 

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Chapter 3: Homeless Program Costs Chapter 3: Homeless Program Costs 3–11 3-11

 

 

 

 

 

 

 

Exhibit 3.6: Average Cost Per Family Per Day of Homeless Residential Programs Serving 

Families by Program Type and Sitea 

Site – Program Type Housing Model 

Average Cost 

Per Family Per 

Dayb Housing 

Operations 

Supportive 

Services 

Agency 

Overhead 

Capital 

Costsc 

Emergency Shelter Congregate $123 $67 (54%) $41 (33%) $16 (13%) 

Emergency Shelter Apartment-style $83 $45 (55%) $30 (36%) $8 (10%) 

Transitional Housing Facility-based $73 $19 (26%) $32 (45%) $21 (29%) 

Transitional Housing Scattered Site $72 $33 (47%) $27 (38%) $11 (16%) 

Permanent Shelter Plus Cared 

$42 $39 (94%) $0 (0%) $3 (6%) Supportive Housing 

Emergency Shelter Congregate and $46 $9 (19%) $31 (66%) $7 (15%) Apartment-Style 

Transitional Housing Facility-based $149 $37 (25%) $82 (55%) $30 (20%) 

Transitional Housing Scattered Site $65 $22 (34%) $30 (46%) $13 (20%) 

Permanent Shelter Plus Care $27 $13 (48%) $7 (27%) $7 (25%) Supportive Housing and Facility-based 

Emergency Shelter Congregate $54 $27 (50%) $25 (46%) $2 (4%) 

Transitional Housing Facility-based and $27 $16 (58%) $8 (31%) $3 (11%) Scattered Site 

Permanent Shelter Plus Care 

District of Columbia 

Houston 

Kalamazoo 

$29 $19 (65%) $0 (0%) $10 (35%) Supportive Housing 

Upstate South Carolina 

Emergency Shelter Congregate and $76 $26 (34%) $32 (43%) $13 (17%) $5 (6%) Single Family 

Emergency Shelter Church Hospitality $297 $68 (23%) $194 (65%) $35 (12%) $0 (0%) 

Transitional Housing Scattered Site $40 $20 (50%) $15 (37%) $5 (12%) < $1 (<1%) 

Permanent Shelter Plus Care $22 $21 (96%) $0 (0%) $1 (4%) $0 (0%) Supportive Housing 

a Costs represent the average across programs within each type, weighted by the typical number of families served in each

program each day.

b Total weighted daily unit cost may not equal the sum of the budget component estimates due to rounding. c Capital costs are included for Upstate South Carolina only. Capital costs are only applicable to programs that own their 

own facilities.
 d The District has both scattered site and facility-based programs, but costs were only collected from the City-funded scattered

site program. 

As we found for programs for individuals, the more expensive family program types tend to have 

higher costs across all budget categories. That is, cost differences among programs are not explained 

by only one budget category. For example, in Houston, facility-based transitional housing costs more

than 3 times as much as emergency shelter ($149.39 vs. $46.37). The housing operations cost is 4.2 

times higher ($37.35 vs. $8.87 per family per day), and the services cost is 2.7 times higher ($82.11

vs. $30.62 per family per day). The higher cost of housing operations probably reflects both 

increased private space and lower program capacity, which decreases economies of scale. The higher 

Chapter 3: Homeless Program Costs 3–11 
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cost of services probably reflects more intensive services, as would be expected for transitional 

housing. 

In DC, apartment-style emergency shelter is more expensive than scattered site transitional housing 

($83 vs. $72). The housing operations cost is one-third higher ($45 vs. $33), and the services cost is 

one-tenth higher ($30 vs. $27). The apartment-style emergency shelter is facility-based, with 24-hour 

staffing, and the higher cost of housing operations may reflect this additional on-site supervision. 

Often more expensive programs provide more services to clients, in the form of either lower case 

loads or a broader range of services. Agency overhead costs frequently are higher in more expensive 

programs, again in part due to smaller program capacity and decreased economies of scale. Cost 

differences also reflect idiosyncratic features of particular programs, such as program, size, amount of 

private space per family, level of volunteer or in-kind services, or the value of the physical location. 

Unlike transitional housing for individuals, transitional housing for families is not consistently more 

expensive than emergency shelter. Emergency shelters are more expensive on average than 

transitional housing programs in DC, Kalamazoo, and Upstate South Carolina. One reason is that 

families often get private rooms or apartments in emergency shelter, in contrast to emergency shelter

programs for individuals. Emergency shelters that serve families also are small and therefore have 

few units over which to prorate fixed costs, such as on-site supervision. Emergency shelter programs 

for families are likely to be open 24 hours a day and often provide fairly intensive supportive 

services. In Upstate South Carolina, the church-based shelter programs have particularly high in-kind 

costs associated with volunteer labor and donated materials. We counted the value of these 

contributions as costs since the program could not be operated without them. Thus, the physical and 

programmatic differences between family shelters and family transitional programs are not as great as 

they are between these program types for individuals. At the same time, there usually are very 

different philosophies, program goals, and intended lengths of stay between family emergency 

shelters and family transitional housing programs. 

The characteristics of specific programs have more influence on costs for each program type within 

the family sites compared with the individual sites, because most communities had only a few family

programs. Thus, the average program costs reflect heavily the costs of specific programs, such as a 

high-cost publicly-operated congregate shelter in the District of Columbia,11 the small church-based 

shelters in South Carolina, a large and service-rich facility-based transitional housing program in 

Houston, and a particularly low-cost transitional housing program in Kalamazoo. 

Despite the lower average cost per day for family transitional housing compared with family

emergency shelter, we found that families in our study cohort who use transitional housing programs 

have higher costs than families who only use emergency shelter, as will be discussed in Chapter 5. 

Families in the study cohort who used only emergency shelter used less expensive shelter programs 

more heavily, while those who used transitional housing only or in combination with shelter used 

transitional housing programs higher-cost shelter programs more heavily. 

11	 This program has subsequently been closed and the DC system has shifted entirely to an apartment-based 

emergency system. 

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-

 

 

As we found for individuals, permanent supportive housing was the least expensive program type 

from the perspective of the homeless system. In most cases, we found that permanent housing 

programs arranged for residents to receive services directly from mainstream systems rather than 

from the permanent supportive housing programs directly, so permanent housing programs did not 

have to secure resources to fund these services directly and the services costs are not accounted for in 

these estimates. However, even setting aside the issue of services, permanent supportive housing for 

families usually has equivalent or lower housing operations costs than the emergency shelter or

transitional housing programs in the same site. Having said that, the cost of permanent supportive 

housing plays only a small role in the cost of homelessness for the study cohort of first-time homeless 

families. Very few families in the study cohort used it, because of a combination of capacity

constraints and lack of families qualifying for permanent supportive housing on the basis of a 

disability. 

3.2.1 Monthly Program Costs and Local Costs of Housing 

Exhibit 3.7 shows the average costs per month for each program type in each community along with 

the average 2006 HUD Fair Market Rents for a two-bedroom unit in the same community. 

Exhibit 3.7: Average Cost Per Family Per Month for Each Homeless Program Type for 

Families and FY2006 Two Bedroom Fair Market Rentsa 

Emergency 

Shelter 

Transitional 

Housing 

Permanent 

Supportive 

Housing 

2006 Fair Market 

Rent for Twobedroom Unitb 

District of Columbia $2,496 - $3,698 $2,146 - $2,188 $1,251 $1,225 

Houston $1,391 $1,940 – $4,482 $799 $743 

Kalamazoo $1,614 $813 $881 $612 

Upstate South $599 $2,269 $1,209 $661 Carolina (Greenville MSA) 

a Costs shown reflect weighted averages by program type. Ranges represent the averages for different programs within a 

program type. 

b FMR Source: HUD, 2005. The FMR does not include the monthly fee paid to a public housing agency for administering 

the voucher program, which ranged from $50 to $90 per unit per month in these four communities. (HUD, 2007)
 

In Chapter 5 we discuss the total homeless system costs incurred for each first-time homeless family

over an 18-month tracking period. Many families remain in homeless programs for a month or more. 

In most cases, a month of assistance provided within the homeless system exceeds the local Fair 

Market Rent—that is, the maximum subsidy cost of providing a housing voucher to the family. The 

sections below describe each program type, the costs associated with providing it, and the extent to 

which programs are providing both housing assistance and supportive services—in contrast to the 

Fair Market Rents, which only represent housing assistance. 

Chapter 3: Homeless Program Costs 3–13 
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3.2.2 Emergency Shelters for Families 

All four study sites provide emergency shelter for families, but shelter for homeless families looks 

quite different from shelter for homeless single adults.12 Two types of shelter are offered in the 

District of Columbia: congregate emergency shelter and apartment-style emergency shelter. 

Congregate Emergency Shelters have communal eating and bathing facilities and little privacy.

Families may share rooms, depending on the size of the family and the space available at the facility. 

During our study period, the largest of the congregate programs, DC Village, was the main point of 

entry into the emergency shelter system for families in DC. DC Village closed in October 2007, just 

before the end of the period during which we tracked families. Policy-makers were aware of the high 

daily cost of DC Village, and advocates for homeless people objected to its remote location and its 

lack of privacy. The factor that precipitated the facility's closing was the DC government's need to 

use the property for another purpose. 13 

The District of Columbia also houses families in Apartment-Style Emergency Shelters in which each 

family has a private apartment. However, there is 24-hour supervision, and access by visitors is 

restricted. During the study period, entry into these facilities usually was by referral from DC 

Village. The programs are funded by the DC government, and they must take any family referred to 

fill a vacancy.14 Emergency shelters for families have fairly high per family costs (Exhibit 3.6). In 

DC congregate shelter is the most expensive homeless program type, averaging $123 per family per 

day. Apartment-style shelter costs two-thirds as much ($83) per day in comparison, with the savings 

relatively evenly distributed across housing, services, and administration. 

In Houston, emergency shelter programs for families provide both dormitory-style shelter units with 

shared kitchen and bath facilities and individual apartments that provide families more privacy and 

autonomy over their daily routines. Services include basic emergency support services such as food, 

immediate crisis intervention and de-escalation, and referral to more intensive services at other 

programs. The length of stay in congregate dormitory programs is intended to be shorter than in 

individual apartment emergency shelters, with an emphasis on referring families into more intensive 

service programs such as apartment-based shelters or transitional housing. Apartment-Style 

Emergency Shelter programs are structured as 90-day shelters with a level of service and linkage that 

is intended to be more intensive than congregate dorm emergency shelters. These programs focus on 

placing families directly into permanent housing. Exhibit 3.8 presents the costs of these two program 

types together. The average cost of emergency shelter for families in Houston is $46 per family per 

day, with the services budget 66 percent of that total. 

In Kalamazoo, families are served primarily by two shelter programs. One is a large house that is 

shared by up to six families. The other is operated for both families and single women in a large 

facility with shared common areas and private sleeping rooms. This facility also has a transitional 

housing program for families on another floor. Across the two programs, the average cost is $54 per 

12	 Except when single women are served alongside families in a women and families program. 

13	 After the closing of DC Village, another congregate program, DC Hypothermia, remained open but with

plans to close. The number of apartment-style shelters was expanded to offset the loss of beds at DC

Village. 

14	 The only exception is that the program can refuse to accept a family that would threaten the safety of other 

residents. 

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family per day, but the program operated in the single-family home is significantly more expensive 

due to lower economies of scale for housing and overhead and substantially more supportive services. 

South Carolina provides three types of emergency shelters: congregate shelters, single family homes, 

and church hospitality networks. Congregate Facilities have open bed space or small sleeping rooms 

with shared living space and bathrooms. Occupancy is often fluid between families and single 

women based on need that day. Length of stay typically is less than six weeks. Single Family

Houses are shared by multiple families, but offer private space for each family and have somewhat 

longer lengths of stay. Church Hospitality Networks provide housing sponsored by various 

congregations around the 13-county area covered by the Upstate South Carolina Continuum of Care. 

The actual shelter space rotates weekly in church rooms, and the programs are heavily staffed by

volunteers. Lengths of stay typically are short but can last several months. The cost per family per 

day for the church-based program type is very high ($297), in part reflecting actual paid costs and in 

part reflecting the estimated value of volunteer hours and donated space and supplies.15 Together the 

congregate and single family shelters cost an average of $76 per family per day, of which 43 percent 

funds services. 

Exhibit 3.8 reports the average cost per family per day, the range of costs per day across programs 

within each program type at each site, and the average cost per day of each program type as it was 

actually used by the study cohort. 

Exhibit 3.8: Average Cost Per Day of Emergency Shelter for Homeless Families 

Site Housing Model 

Average Cost 

Per Family 

Per Day 

Range of Costs 

Per Family 

Per Daya 

Average Cost 

Per Day As Used 

By the Cohort 

District of Columbia Congregate $123 $123b $123 

District of Columbia Apartment-style $83 $67 - $102 $80 

Houston Congregate and $46 $23 - $175 $61 Apartment-style 

Kalamazoo Congregate $54 $32 - $179 $75 

Upstate South Carolina Congregate and $76 $37 - $135 $82 Single Family 

Upstate South Carolina Church $297 $229 - $348 $229 Hospitality 

a If only one number is provided, costs were only collected from one program. 

b Costs were also collected for DC Hypothermia overflow shelter, which has daily costs of $28 per family; however, these 

costs were not included in the program type average, since the Hypothermia shelter serves only a limited purpose.

Members of the study cohort also used shelters for single individuals at times, whose costs are included in the DC case 

study and analysis reported in Chapter 5. They are not reported here, since this section discusses costs associated with 

family programs. 

15	 Many emergency shelter programs rely on substantial volunteer support to operate. Our cost calculation

methodology shows the costs that would be required to replicate the level of effort provided by these 

programs. 

Chapter 3: Homeless Program Costs 3–15 
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Emergency shelter programs for families have huge variations in costs, ranging from $23 per day on 

the low end to $348 on the high end, as shown on Exhibit 3.8. The range of costs reflects differences

in both the housing model and the type and level of services provided. Exhibit 3.8 also illustrates the 

influence of the specific programs used by the study cohort on the costs of homelessness reported in 

this study. The average costs per family per day for members of the cohort are slightly higher than 

the overall average daily costs of emergency shelter in Houston and for congregate and single-family

shelters in Upstate South Carolina, meaning that the cohort spend a greater number of nights in more 

expensive programs than the lower cost ones. No one in the study cohort in Upstate South Carolina 

used the more expensive of the two church hospitality programs, so the cohort’s costs represent only 

the relatively lower cost church program. The Kalamazoo cohort’s daily costs for emergency shelter 

are almost 40 percent higher than the overall program average, since one-third of the cohort’s shelter 

nights were spent at the more expensive shelter program. In DC the cohort used less expensive 

programs slightly more than higher cost programs within the Apartment-Style Emergency Shelter 

program type. 

3.2.3 Transitional Housing Programs for Families 

The four family study sites have transitional housing programs that aim to help the head of household 

become stably employed, maintain sobriety, and move to market-rate housing with or without the 

assistance of a Housing Choice Voucher. Facility-based programs are operated in a building owned 

by or rented exclusively for the program, while scattered site programs are provided in individual 

apartments that are rented on behalf of the program’s clients. In some programs, families must find 

and move into different permanent housing units at the end of the transitional period. Other scatteredsite programs allow families to remain in the same housing unit after graduating from the transitional 

program, assuming the families can assume the lease payments. Some housing units in a scatteredsite program may be in the same larger rental development or may be located in particular 

neighborhood and serve families with ties to that neighborhood. 

The District of Columbia, Houston, and Kalamazoo all offer both facility-based and scattered site 

transitional housing models. In Kalamazoo, one of the transitional programs is operated within the 

same facility as an emergency shelter, and almost all participants have graduated from the shelter 

program. One transitional housing program that was heavily used by the study cohort in Kalamazoo 

is facility-based and has very low housing operations costs. All transitional housing programs for 

families in Upstate South Carolina use a scattered-site housing approach. 

The cost to operate transitional housing programs varies widely from one program to another, within 

and across sites, ranging from a weighted average cost per day of $27 for the transitional housing 

programs in Kalamazoo to a weighted average of $107 per day in Houston (Exhibit 3.9). The 

structure of the housing (e.g., facility-based vs. scattered site) does not seem to drive costs up or down 

consistently. On average, housing operations consumes a greater proportion of the program cost and 

services a lower proportion of the cost in scattered site models than it does in facility-based models. 

However, for the three sites that have both types of transitional housing, we were not able to include 

an estimate of capital costs for transitional housing programs that owned their facilities. Had we done 

this, it would reduce the percentage of total cost represented by services for these programs. The 

absolute dollar value of the average cost per day used to fund services is higher for facility-based 

programs than for scattered site programs in DC and much higher in Houston (Exhibit 3.6). It is 

possible that facility-based programs provide more living-support services, such as child care or 

informal resident mediation, while the case management and self-sufficiency related services on 

3–16 Chapter 3: Homeless Program Costs 
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average are comparable in intensity for facility-based and scattered-site transitional housing. It is also 

possible that scattered site programs provide more of their services through referral to mainstream

employment or treatment programs, and that these services costs do not show up in their direct 

budgets.16 In interviews conducted for the study, program staff described similar levels of services 

across the two housing models. 

Exhibit 3.9 reports the average cost per family per day, the range of costs per day across programs 

within each housing model at each site, and the average cost per day of each program type as it was 

actually used by the study cohort.17 

Exhibit 3.9: Average Cost Per Day of Transitional Housing for Homeless Families 

Site Housing Model 

Average Cost 

Per Family 

Per Day 

Range of Costs 

Per Family 

Per Day 

Average Cost 

Per Day As Used 

By the Cohort 

District of Columbia Facility-based $73 $30 - $109 $77 

District of Columbia Scattered Site $72 $40 - $112 $68 

Houston Facility-based and 

Scattered Site $107 $52 - $177 $134 

Kalamazoo Facility-based and 

Scattered Site $27 $14 - $66 $22 

Upstate South Carolina Scattered Site $40 $26 - $44 $40 

In addition to the considerable range of program costs per day within each site, there is huge variation 

among sites, with the most expensive transitional housing program in Kalamazoo comparable in cost 

to some of the least expensive programs in Houston. These site differences have a substantial impact 

on the overall costs associated with first-time homeless families from one community to another. (See 

further discussion in Chapter 5.) The exhibit also shows that families in the study cohort who use 

transitional housing in Houston and families who use facility-based transitional housing in the 

District of Columbia make relatively heavy use of the more expensive transitional housing programs. 

The difference is most notable in Houston, where the study cohort used a high-cost, service-rich

transitional program more heavily than other programs. This Houston program provides very highlevels of services ($100 per day), including extensive services for the children of families enrolled in 

the program. In contrast, in Kalamazoo, families in the study cohort used the least expensive 

transitional housing program two-thirds of the time, increasing the differences in costs for first-time

homeless families among the four communities. 

16	 For homeless system costs, we recorded costs of all housing and services provided directly by the program.

The homeless system costs do not include costs of services provided by mainstream systems if the services 

were also available to other people who were not enrolled in the homeless program. To the extent that 

families received services from mainstream programs that were included in the mainstream system cost 

analysis for that site, these costs would be reflected in the mainstream system cost analysis for that site. 

Some mainstream services such as employment and training were not included in either the homeless 

system or mainstream system costs, whereas services such as mental health and substance abuse treatment 

services were included more frequently. 

17	 If only one number is provided in the Range column, costs were only collected from one program. 

Chapter 3: Homeless Program Costs 3–17 
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3.2.4 Permanent Supportive Housing Programs for Families 

For families, permanent supportive housing is most commonly provided using a Shelter Plus Care, 

scattered-site model, and services are primarily brokered through mainstream agencies. Most target 

families have severe and persistent mental illness or chronic substance abuse, although some

programs also target families with HIV/AIDS. Kalamazoo and Upstate South Carolina both use only

a scattered-site model and target families with mental illness. The District of Columbia also uses 

mainly Shelter Plus Care, making units available to the clients of agencies serving homeless families 

with various types of qualifying disabilities. The few small facility-based supportive housing 

programs for homeless families in DC are privately funded, not integrated into the homeless services 

system, and not included in this study. 

Houston provides both facility-based and scattered-site permanent supportive housing. Under 

agreements with providers of mental health and substance abuse services, slots in permanent housing 

are made available to homeless clients referred by those agencies. The referring agencies commit to 

providing case management while their clients are living in the housing and provide or link their 

clients to behavioral and physical health care and to other services such as job training and job 

support. 

In all four of the family study sites, the cost of permanent supportive housing per family per day is 

less than the cost of any other program type in the residential system for homeless families (Exhibit 

3.6), with an average cost of $22 in Upstate South Carolina, $27 in Houston, $29 in Kalamazoo, and 

$42 in the District of Columbia. The costs of operating the housing (i.e., for renting the housing 

units) and for managing the program (i.e. for administering the program) constitute all of the costs 

recorded in DC, Kalamazoo and Upstate South Carolina, and represent 73 percent of the cost of 

permanent supportive housing in Houston. Service costs explain the other 27 percent in Houston. 

This does not mean families in Shelter Plus Care or other scattered-site permanent supportive housing 

programs do not receive services. Rather, most services are delivered by mainstream agencies, and 

residents were eligible to receive them before they moved into permanent supportive housing and will 

continue to receive if them if they move to alternative housing. Anecdotally we heard that clients

moving into permanent supportive housing already are enrolled in mainstream care and may even be 

referred to the housing by their mainstream providers. Analysis of Medicaid records in Kalamazoo, 

discussed later in Chapter 5, supports this hypothesis, since 89 percent of families in the group who 

used permanent supportive housing were enrolled in Medicaid in the period prior to homelessness. 

Exhibit 3.10 reports the average cost per family per day, the range of costs per day across programs 

within each housing model at each site, and the average cost per day of each program type as it was 

actually used by the study cohort. 

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Exhibit 3.10: Average Cost Per Day of Permanent Supportive Housing for Homeless Families 

Site Housing Model 

Average Cost 

Per Family 

Per Day 

Range of Costs 

Per Family 

Per Daya 

Average Cost 

Per Day As Used 

By The Cohort 

District of Columbia Scattered Site $42 $42 $42 

Houston Scattered-Site and 

Facility-based $27 $16 - $59 $38 

Kalamazoo Scattered Site $29 $19 - $58 $20 

Upstate South Carolina Scattered Site $22 $22 

a If only one number is provided in the Range column, costs were only collected from one program. 

b None of the families in the Upstate South Carolina cohort used permanent supportive housing. 

$0b 

Only a small percentage of permanent supportive housing units in most communities are dedicated to 

families, and an even smaller percentage of families in our study cohorts used permanent supportive 

housing during our study period. None of the families in the South Carolina cohort used permanent 

housing, so while the average cost per day of permanent supportive housing is $22, the cost for the 

cohort shown on Exhibit 3.10 is $0. Low utilization occurred across all of the family sites. In 

Houston, the cohort spent only two percent of its total days in residential homeless programs in 

permanent supportive housing. In DC, five percent of the cohort’s days were spent in permanent 

supportive housing programs. The higher percentage for DC is affected by the 30-month observation 

period, which is one year longer than in the other sites. While the Kalamazoo study cohort spent 8 

percent of its days in homeless programs in permanent supportive housing; these stays represent only 

11 families or 3 percent of the cohort. These 11 families were in permanent supportive housing for 

most of the observation period. 

The relatively low use of permanent supportive housing by first-time homeless families is related to a 

number of factors. Most families do not have a disability sufficient to qualify them for the program. 

Furthermore, many communities do not have many permanent supportive housing units for families, 

and the low turnover among those housed within them limits opportunities for families who are 

eligible to be housed in permanent supportive housing. Finally, other families in our study cohort 

may eventually have been housed in permanent supportive housing, but the 18-month observation 

period for three of the four communities in this study may not have been long enough to include these 

stays. 

3.3. Policy Implications of Program Costs 

This chapter summarized the wide-ranging costs of providing residential homeless programs to

individuals and families. Several key policy considerations emerged related to the costs of different 

types of homeless programs, as well as individual programs within a community. 

Emergency shelters for families are generally similar in cost and sometimes even more expensive 

than transitional housing programs, whereas transitional housing for individuals is generally more

expensive than shelter. This broad finding has several policy and planning implications. First, given 

the low daily cost of emergency shelter for individuals, it would be very difficult to fund a prevention 

response that would yield cost savings. However, the higher costs of emergency shelter for families 

Chapter 3: Homeless Program Costs 3–19 
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may make homelessness prevention programs more cost-effective than emergency shelter for some 

families. Communities could also look at the cost structure of current emergency shelter programs

for families to determine if the environment and services offered are appropriate to the needs of those 

who are using them. If shelter is intended to house families only briefly, it may not be necessary or 

cost-effective to provide non-crisis-related services within shelter. Therefore, it may be possible to 

reduce daily costs of shelter programs for families by scaling back on the therapeutic resources 

offered to families on-site. For those with greater needs who need longer stays or more intensive 

services, it may be more cost effective to quickly move them into transitional housing (facility-based 

or scattered site), permanent supportive housing, or permanent housing with mainstream supportive 

services. 

Given, the high costs of transitional housing for both individuals and families, communities may want 

to consider whether alternative interventions or combinations of rent subsidies and standalone 

supportive services could achieve similar outcomes at lower costs. Permanent supportive housing is 

generally less expensive from the perspective of the homeless system than other types of residential 

homeless programs for families, often similar in cost to a deep rental subsidy. To the extent that 

individuals or families have disabilities that qualify them for permanent supportive housing, 

communities should expedite their placement into these units. The low cost of permanent supportive 

housing is largely attributable to lower homeless system service costs made possible by formally 

linking clients to mainstream services. Communities could also explore creating transitional housing 

modeled like permanent supportive housing with housing and limited housing-focused services 

provided by the homeless system and non-housing services intentionally provided by mainstream 

systems. 

In general, communities may want to examine program costs to determine if there are less expensive 

ways of delivering comparable interventions. The huge range of costs within program types—for 

example among transitional housing programs for families—may or may not reflect differences in the 

quality of services delivered or in the outcomes for families. 

Individual program features can also have substantial impacts on the costs of delivering homeless 

assistance. For instance, we discussed the substantially higher costs of an extended stay emergency

shelter program in Houston for single women compared with an extended stay shelter program

serving single men. The women’s shelter provided more services and more privacy and also had

higher per-person administrative costs due to its smaller size. The study did not explore whether 

programs with higher costs also have better outcomes. Nonetheless, the agency operating both of 

these may want to consider whether it would be more cost-effective to develop a program for single 

women with housing costs and administrative overhead more similar to those of the program for 

single men. Compounding the variability of daily costs from one program to another, homeless 

families and individuals do not use homeless programs evenly. Communities will be able to reduce 

homeless system costs the most by reducing costs of programs used most heavily by homeless 

individuals and families. The converse is also true: adding a program feature that raises the cost of a 

heavily used program will have a disproportionate effect on the costs associated with homelessness in 

that community. 

The differences between community average costs for each program type and the costs associated 

with each study cohort discussed in this chapter illustrate the point that costs are driven by actual 

program utilization. Further, utilization varies for people with different demographic characteristics 

and needs. For instance, first-time homeless individuals may use a different set of programs than 

3–20 Chapter 3: Homeless Program Costs 
Chapter 3: Homeless Program Costs Chapter 3: Homeless Program Costs 3–21 3-21

 

individuals with chronic medical needs. Local efforts to shift costs to create a more effective 

response to homelessness must be conducted within the context of the programs serving the group of 

greatest interest to the community. 

None of this is to suggest that communities should always seek to lower program costs. Strong

outcomes may require a sizable investment; however, policymakers should understand what drives 

costs in their communities, so they can consider cost implications as part of the decision-making. 

Cost per day is only one dimension of the costs of homelessness to the homeless services system. 

Lengths of stay, or the number of days an individual or a family uses residential programs for 

homeless people, also have a powerful influence on costs. The next two chapters combine 

information on costs per day and on patterns of utilization of the homeless services system, first for 

individuals (Chapter 4) and then for families (Chapter 5). 

Chapter 3: Homeless Program Costs 3–21 
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4. First-time Homelessness for Individuals and its 

Associated Costs 

This study confirms the findings of some prior research on homelessness for individuals and presents 

new findings about first-time homelessness for individuals and its associated costs. The most 

important themes about costs of first-time homelessness for individuals that emerged from the study

are that: 

•	 The overall experience of homelessness, program utilization, and associated costs vary

widely from one subpopulation of first-time homeless individuals to another, with only a 

small subgroup incurring substantial costs. The half of the cohort with the lowest 

homeless system costs—individuals who only briefly use emergency shelter—incurred 

only 2 to 3 percent of the total homeless system costs. The highest-cost 10 percent of the 

cohort incurred 62 percent of the homeless system costs in Jacksonville, 70 percent in 

Des Moines, and 83 percent in Houston. 

•	 The type of program used by individuals who are homeless appears to have the greatest 

influence on costs and certain program types and specific programs within those types are 

more expensive than others. The cost to the homeless services system of the most 

expensive 10 percent of individuals in the study cohort at each site generally reflects

continuous use of expensive transitional housing programs for much or all of the 18-

month observation period. 

•	 For some subgroups, total homeless system costs incurred per person exceed the cost of 

an annual direct housing subsidy. Communities may want to consider whether housing 

assistance (without supportive services) would be a lower cost and potentially equally 

effective intervention for some of these groups. 

•	 Single women are associated with statistically significant higher homeless system costs, 

even when controlling for their longer stays and the types of programs they use. 

Combining all of these factors, single women over 40 years old frequently have high 

system costs in the current system structure and may benefit from alternative 

interventions designed specifically to meet their needs. Other demographic groups, such 

as African-Americans and older adults are also associated with statistically significant 

higher costs. 

•	 Cost savings may be achievable within the homeless system for first-time long-stayers 

based on providing housing assistance in different ways. However, the relationship

between intensive use of the homeless system and high-cost mainstream use is not strong 

enough to expect significant cost savings within mainstream systems by ending

homelessness for long-stayers as a whole. 

•	 Higher mainstream costs in some domains were associated with individuals who had 

multiple episodes of homelessness. Communities could target individuals who return to 

shelter for a second (or third) non-consecutive program stay. This group may particularly

benefit from intentional prevention-oriented discharge planning strategies. 

•	 Mainstream system utilization and associated costs spike during homelessness, but costs

also increase substantially immediately before first-time homelessness. Thus, costs peak 

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in the period just after the individual enters the residential homeless system. This finding

suggests a need for discharge planning to ensure that individuals leave mainstream

programs, such as inpatient treatment or jails, with adequate housing. 

This chapter begins with a discussion of existing research, presents the findings of this study and then

discusses the findings within the context of existing research. 

4.1. Existing Research 

4.1.1 Patterns of Homelessness among Individuals 

Analysis of longitudinal shelter administrative data conducted a decade ago by Kuhn and Culhane 

(1998) in New York and Philadelphia provided a new typology of patterns of homelessness: 

transitional homelessness, episodic homelessness, and chronic homelessness. Although there had

been prior research and discussion of typologies of homelessness, Kuhn and Culhane’s framework 

was popularized by the National Alliance to End Homelessness (NAEH, 2000) and by the federal 

government when it adopted a ten-year goal to end chronic homelessness as part of its FY2003 

budget (OMB, 2002). Transitional homelessness was characterized by short, single episodes of 

homelessness and described the pattern experienced by 80 percent of homeless individuals. Episodic

homelessness described repeated short episodes of homelessness experienced over the course of 

years, often by younger individuals with chronic addictions. Chronic homelessness described a 

pattern of continuous stay in shelters extending over a year or more, generally by older individuals 

with mental illness. Ten percent of the individuals in Kuhn and Culhane’s dataset experienced 

episodic homelessness, and the remaining ten percent were chronically homeless. The ten percent

who experienced chronic homelessness consumed close to half of the emergency shelter bed nights, 

since they were present almost every night of the year, whereas other homeless individuals moved in 

and out of the system relatively quickly. While their study did not quantify the costs associated with 

each of these patterns of homelessness, the findings gave rise to a view among policymakers that 

communities could free shelter space and homeless system resources by identifying and addressing 

homelessness for the 10 to 20 percent of individuals who experienced episodic and chronic 

homelessness. 

4.1.2 Mainstream Service Use by Homeless Individuals 

Culhane, Metraux & Hadley (2002) also contributed to the literature on homelessness with a study of 

formerly homeless individuals with severe mental illness housed in permanent supportive housing in 

New York City, (“the NY/NY Cost Study”). Almost three-quarters of these individuals had used 

city-funded shelters within the two-year period prior to placement in permanent supportive housing, 

with an average shelter use of 137 days.1

 The study also found that these individuals experienced 

very high use of mainstream service systems (such as emergency rooms, inpatient psychiatric 

hospitals, and jails) in the two-year period prior to placement in permanent housing. The NY/NY 

study cohort incurred an average cost of $40,500 per year (Exhibit 4.1). In the absence of other 

research covering multiple mainstream programs used by homeless individuals, the costs associated 

1 A history of homelessness was an eligibility requirement for the study, so the other quarter of the study

sample presumably had some type of homeless episode in non city-funded shelters prior to placement or 

spent time on the “streets”. 

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with the two-years prior to placement in permanent supportive housing have become for many a 

proxy of the costs of chronic homelessness. 

Exhibit 4.1: NY/NY Cost Study Service Use during Two Year Period prior to Placement in 

Permanent Supportive Housing 

Average days 

during 2 yr 

period prior to 

placement Per Diem 

Cost for 2 

Year Period 

prior to 

placement 

Annualized 

Cost 

City Homeless Services 137 $68 $9,316 $4,658 

State Inpatient 57.3 $437 $25,040 $12,520 

Psychiatric Hospitals 

City Inpatient Public 16.5 $755 $12,458 $6,229 

Hospitals 

Medicaid (inpatient) 35.3 $657 $23,192 $11,596 

Medicaid (outpatient) 62.2 $84 $5,225 $2,613 

Veterans Affairs 7.8 $467 $3,643 $1,822 

State Corrections 9.3 $79 $735 $368 

City Corrections 10.0 $129 $1,290 $645 

TOTAL $80,899 $40,451 

Source: Culhane et al., 2002 

Other studies have shown that homeless people use emergency rooms at a much higher rate than the

general population, attributing this greater use to many different factors, including a higher rate of 

assault-related and unintentional injuries, general poor health status, barriers to accessing routine 

healthcare, and a high rate of substance abuse and mental illness among homeless people (D’Amore,

Hung, Chiang, & Goldfrank, 2001; Kushel, Vittinghoff & Haas, 2001; Mandelberg, Kuhn & Kohn, 

2000; Padgett, Struening, Andrews, & Pittman, 1995). Kushel, Perry, Bangsberg, Clark and Moss 

(2002) analyzed a sample of 2,500 homeless and marginally housed adults in San Francisco and 

found that the 40 percent who went to the emergency room were more likely to be homeless rather 

than marginally housed, after controlling for other characteristics of study sample members. Kushel 

et al. (2002) also found that 8 percent of the study cohort visited emergency rooms four or more times 

within a year, accounting for 54.5 percent of all emergency room visits by the study sample. These 

high users also were more likely to be homeless than marginally housed. A 1998 study by Salit, 

Kuhn, Hartz, Vu and Mosso found that, after controlling for co-occurring substance abuse disorder or 

psychiatric disability and other patient characteristics, homeless patients had hospital stays 4.1 days

(36 percent) longer than non-homeless patients. Folsom et al. (2005) found similar patterns of 

inpatient and crisis service use within the public mental health system. All of these findings suggest

that homelessness is likely to be associated with high mainstream health costs. 

Other studies have found a correlation between homelessness and involvement with the criminal 

justice system. Caton, Wilkins and Anderson (2007) cite findings of high rates of criminal history 

among individuals who experience long-term homelessness and suggest that the criminal justice

system may be a safety net of sorts for individuals with severe mental illness who lack sufficient 

housing and treatment. 

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4.1.3 Opportunities for Cost Savings 

With a growing body of research correlating costly mainstream system utilization with the chronic 

homelessness of people with significant levels of disability, policymakers and advocates became 

interested in understanding which interventions reduce the costs of mainstream system use associated

with homelessness. 

The NY/NY Cost Study concluded that placement in permanent supportive housing significantly

reduced homeless and mainstream expenditures for formerly homeless, severely mentally ill

individuals. This finding suggests that permanent supportive housing is an effective strategy to

address chronic homelessness for persons with severe mental illness at little additional cost.2 An 

experimental study of the cost-effectiveness of HUD-VA sponsored permanent supportive housing 

(VASH) for homeless veterans with severe mental illness (Rosenheck, Kasprow, Frisman, & LiuMares, 2003) found that the costs of permanent supportive housing were approximately 18 percent 

higher ($2,067 annually) than the costs of standard care. Higher costs were largely attributable to the

additional intensive case management costs and increased outpatient treatment costs incurred by this 

group. Rosenheck et al. did not observe differences between the intervention groups (VASH 

intervention, case management only, and standard care) in VA or other system costs significant 

enough to achieve cost offsets; however, the housing outcomes were greater for supported housing 

study participants so the study concludes that the intervention was most likely cost-effective.3 

Different methodologies between the Rosenheck et al. and Culhane et al. studies limit the ability to 

compare results. 

In a paper synthesizing findings on cost effectiveness—Rosenheck (2000) observes that while 

mainstream service use is frequently positively associated with homelessness, not all persons who are 

homeless and mentally ill have high service use. Interventions that target directly those individuals 

with high service use can more easily show cost-effectiveness than those that serve a broad group of 

homeless mentally ill persons. Rosenheck points out that in the evaluation of two programs targeting 

persons who were homeless and mentally ill but not necessarily high service users, only 10 percent of 

participants had annual inpatient costs sufficient to offset the costs of the intervention.4 He concludes 

that, while cost offsets are achievable, resource-intensive interventions must be narrowly targeted to 

high service users to realize the savings. 

These studies are just a few among a growing body of research on costs associated with individuals 

who are homeless with severe mental illness. In addition, many localities have conducted, with

varying degrees of rigor, their own cost studies of individuals who are chronically homeless or 

2	 The NY/NY Cost Study found that the cost reductions in mainstream and homeless systems resulting from

placement in permanent supportive housing were almost equal to the costs of providing the permanent 

supportive housing itself. This finding has fueled substantial investment in developing permanent 

supportive housing for chronically disabled homeless individuals around the country. 

3	 Cost-effectiveness is defined relative to societal value. In the absence of an established societal value for 

housing, Rosenheck reports cost-effectiveness for various monetary values. 

4	 The study evaluated the VA’s Chronically Mentally Ill Veterans Program and the Access to Community 

Care and Effective Supportive Services Program evaluations. Rosenheck et al. measured fewer mainstream 

domains than Culhane et al. (2002) in the NY/NY Cost Study. With more comprehensive data, it is possible 

that more than 10 percent of participants would have realized cost savings equal or greater than the costs of 

the intervention. 

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individuals who are identified as frequent high-cost users. (See Culhane, Metraux, Park, Schretzman 

& Valente, 2007 for examples.) In many cases, this research has been used to build support and 

secure funding for interventions to assist individuals who may benefit from permanent supportive

housing. The research has also left policymakers and advocates eager for parallel research on other 

populations. 

Our study is intended to expand the base of knowledge on costs associated with other populations 

who experience homelessness, besides those with chronic patterns of homelessness or severe mental 

illness. Kuhn and Culhane (1998) noted that most other populations have relatively short episodes of

homelessness and therefore can be expected to have much lower costs than those measured for 

homeless individuals with severe mental illness, but there has been little work to quantify the level 

and nature of those costs. This study examines first-time homelessness for individuals and the level 

of resources associated with their use of the homeless and mainstream systems in Jacksonville, 

Florida; Houston, Texas; and Des Moines, Iowa.5 While these results are not representative of the 

nation as a whole, they can help build our understanding of costs associated with homelessness to 

inform national and local policymaking. 

4.2. Characteristics of First-time Homeless Individuals 

We studied first-time homelessness among single adults in three study communities: Jacksonville,

Florida; Houston, Texas; and Des Moines, Iowa.6 Across the three sites, we identified 7,502 

individuals who became homeless for the first time between July 1, 2004 and June 30, 2005. More 

than half the study population was homeless in Houston, Texas. The characteristics of the study 

cohort in each site are shown in Exhibit 4.2. 

Individuals who experienced first-time homelessness in the study communities were predominantly 

male, 73 to 81 percent across the three sites. On average, first-time homeless individuals were 

between 39 and 41 years of age at first program entry; only 15 to 18 percent were older than 50. In 

comparison to the national estimates in HUD’s 2007 Annual Homeless Assessment Report (AHAR) 

(HUD, 2008), first-time homeless individuals in our three study sites were more likely to be male and

somewhat younger. The AHAR estimates that the single adult homeless population who used 

emergency shelter or transitional housing is 69 percent male and that 24 percent are older than 50. 

The proportion of the study cohort that was African-American varied across the three communities,

from 21 percent in Des Moines to 48 percent in Jacksonville to 57 percent in Houston.7 

5	 Past research has also found wide regional variations in costs of both homeless and mainstream services 

(Culhane et al., 2007). 

6	 Any adult who was served as part of a family at any time during the study period was not considered a 

single adult and was excluded from the study cohort. In Houston, these persons were studied as part of the 

family study cohort. 

7	 Information on ethnicity was missing from a high percentage of the HMIS records at our study sites. 

Therefore, ethnicity is not included in our demographic analysis. People who identified themselves as white 

and Hispanic were simply categorized as white. 

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Exhibit 4.2: Characteristics of the Study Cohort of Individuals Who Became Homeless between 

July 1, 2004 and June 30, 2005 as compared with National Estimatesa 

Size of Study 

Cohort Women 

AfricanAmerican Average 

Age 

Age over 50 

years 

Jacksonville 1,972 persons 19% 48% 41 yrs 18% 

Houston 4,406 persons 26% 57% 41 yrs 16% 

Des Moines	 1,124 persons 27% 21% 39 yrs 15% 

National estimateb 31% 33% N/A 24% a Percentages are based on sample members for whom we have data for the characteristic. 

b

AHAR estimate for individuals who used emergency shelter or transitional housing between October 2006 and September 

2007 (HUD, 2008). 

Some of the differences between our study population and national estimates of the characteristics of 

homeless individuals may reflect differences among the three study sites and other communities or 

the fact that our study includes some individuals who used only outreach and some who used only

permanent supportive housing programs, neither of which are included in the AHAR. However, the 

comparison with the AHAR estimates may also suggest differences between first-time homeless 

individuals (our study) and all homeless individuals (AHAR). In addition to describing the study

cohort and placing it in a national context, demographic data about the study cohorts also were used

to understand relationships between demographic characteristics and costs. Findings from

multivariate regression analysis presented later in Section 4.3.2 show that higher homeless system

costs are associated with being female, African-American, or older, even when controlling for 

homeless utilization patterns such as lengths of stay. 

Section 4.3 focuses on utilization and costs of the homeless system itself; costs of mainstream

services are discussed in Section 4.4. 

4.3. Patterns of First-Time Homelessness and Associated 

Homeless System Costs 

4.3.1 Homeless System Utilization 

As shown in Exhibit 4.3, we found that more than half of the study cohort experiencing homelessness 

stayed “in the system” for substantially less than one month. The median length of time spent in 

homeless residential programs was 2 days in Houston, 10 days in Jacksonville, and just over 3 weeks 

in Des Moines. Average lengths of stay are longer than these medians: almost 6 weeks in Houston, 8 

weeks in Jacksonville, and just over 10 weeks in Des Moines. The differences between the median 

and average lengths of stay reflect the skewed distribution of the homeless experience for individuals. 

While half of the first-time homeless population in Houston spends only a couple of days in homeless 

programs over an 18-month period, a sizable population has very long lengths of stay that 

substantially increase the average. As we show in the next section, costs for individuals in our study

communities are similarly skewed. This finding on patterns of homelessness confirms the research by 

Kuhn and Culhane (1998) on patterns of homeless service utilization, extends those conclusions to 

communities other than New York and Philadelphia, and provides an important context for 

understanding the costs associated with homeless individuals. Local communities, such as Columbus 

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Ohio, have analyzed their own HMIS data and found similarly skewed patterns of use of the homeless 

services system. 

Exhibit 4.3: Use of the Homeless System by the Study Cohorts of First-Time Homeless 

Individuals During an 18 Month Period 

Average Days 

in Homeless 

Programs 

Median Days 

in Homeless 

Programs 

% of Cohort 

with One 

Program Stay 

Average 

Number of 

Program 

Stays 

Average 

“Gap 

Days” 

Between 

Stays 

Jacksonville 57 days 10 days 50% 3 Stays 75 days 

Houston 39 days 2 days 65% 3 Stays 44 days 

Des Moines 73 days 24 days 53% 3 Stays 63 days 

In addition to lengths of stay, other patterns also show a dramatically skewed distribution of the 

homeless experience. The average number of program stays (continuous days in a particular

program) across the sites was three, as shown by Exhibit 4.3, but at least 50 percent of the cohort had 

only one stay, and the remainder of the cohort in each site averaged five or more stays.8 The “gap

days” shown in the exhibit (days during the entire period of homelessness when an individual was not 

in a residential homeless program) are, by definition, associated with individuals with more than one 

stay and show that those with more than one stay were not just bouncing among residential homeless 

programs from one day to the next. In many cases, months elapsed between when an individual 

exited one program and when he entered another program. We cannot tell whether any particular 

individual was homeless on the streets during “gap,” living in his own housing unit, unstably housed 

with friends or family, or in an inpatient or institutional program.9 

Multivariate regression analysis with covariates for demographic characteristics, program type, and 

sites was used to understand the factors that drive longer cumulative lengths of stay in homeless 

residential programs for the 7,502 individuals in the study cohort. The model’s results are presented 

in Exhibit 4.4.10 When multiplied by 100, the coefficients for the covariates can be interpreted as

percentage differences in the number of days spent in homeless programs from the reference category

because the outcome variable is in logarithm scale. 

8	 For purposes of this study, a stay is defined by continuous residence in a specific program. A new stay is 

counted each time the person enrolls in a new program. A “stay” is not to be confused with an “episode” as 

defined by Kuhn and Culhane (1998) as residence in homeless programs with gaps no longer than 30 days. 

9	 Some of these “gaps” may also represent incomplete data, since not every homeless program enters data 

about their clients in the HMIS. 

10	 See Appendix C.2.1, Model 2, for more detailed multivariate regression analysis results, including a model 

without the program type variable. 

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Individuals using both emergency shelter 

and transitional housing stayed more than 

3 times longer than people who used only 

emergency shelter, the omitted category.11 

Individuals using only transitional 

housing stayed about 3 times longer. 

People served by outreach12 or permanent

supportive housing programs alone or in 

combination with emergency shelter or 

transitional housing stayed more than 

twice as long as those who used only

emergency shelter. The shorter lengths of 

stays for people who use only emergency 

shelters likely reflect both the shorter-term

nature of their need for residential 

assistance and the environment and design 

of most emergency programs, which 

encourage shorter stays or have explicit 

limits on days that can be spent in shelter. 

Shorter stays result in lower costs, as will

be detailed in the next section. 

The model results also highlight the 

influence of the nature and composition of 

the homeless services system at each site. 

After controlling for the program type 

used and demographics, individuals in

Des Moines stayed 23 percent longer in

homeless programs than individuals in 

Jacksonville (the reference category). 

Many members of the study cohort in Des 

Moines used a form of transitional 

housing in which residents have private 

living space and lengths of stay that 

suggest that outplacements to mainstream

permanent housing are not a high priority

for the programs. Everything else being 

equal, individuals in Houston stayed 47 

percent fewer days in homeless programs 

Exhibit 4.4. Regression Analysis of Lengths of Stay 

for First-Time Homeless Individuals in Des Moines, 

Houston, and Jacksonville 

Explanatory Variables 

Total Days Spent in 

Homeless Programs 

(log scale) 

Types of Homeless Programs Used+ 

2.029*** Only Used TH Programs (0.063) 

2.294*** Used both ES and TH Programs (0.088) 

Used Other Program Types or 1.261***

Combinationsa (0.067) 

Site Variables+ 

0.227*** Iowa 

(0.061) 

-0.465*** Houston 

(0.046) 

Demographics+ 

-0.232*** Age 18 – 24 (0.075) 

-0.043 Age 25 – 30 (0.070) 

0.190*** Age 41 – 50 (0.051) 

0.261*** Age 51 and over (0.062) 

0.735*** Female 

(0.047) 

0.300*** African-American 

(0.040) 

0.100 Other Races (0.080) 

1.685*** Constant 

(0.054) 

Observations 7502 

R-squared 0.36 

+ Reference categories are: Used ES Only, Jacksonville, Age 31 –

40, Male, White. 

Standard errors in parentheses. * significant at 10%; ** significant

at 5%; *** significant at 1% 

Definitions: ES is emergency shelter, TH is transitional housing,

and PSH is permanent supportive housing. a

Used Outreach Alone, Used PSH Alone, Used Outreach or PSH in 

Combination with ES or TH
 

11	 The coefficient of 2.294 indicates that these individuals spend 2.3 additional days for each reference day, or 

3.3 times the reference category. 

12	 In an attempt to capture the period of time that people experienced homelessness on the streets as part of 

length of homelessness calculations, each contact with a street outreach team was counted as one-day of 

homelessness—equivalent to a one-day program stay in a residential program—unless the contact was 

made on a day that the individual stayed in a residential homeless program, in which case the outreach 

contact was disregarded for length of stay calculations. 

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than individuals in Jacksonville. This probably reflects the time limits imposed on individuals in 

some of the emergency shelters and the fact that many individuals who were identified on the street 

did not use residential programs. Thus, individual program environments and rules may substantially 

influence lengths of stay. It is important to recall that this study does not measure the benefits of

stays in the homeless services system, so we cannot say whether shorter or longer lengths of stay are 

positive or negative or whether the costs associated with these stays are worth the investment. 

Ways in which the utilization of homeless programs varies by gender and race also are shown in 

Exhibit 4.4 and discussed below, along with cost variations by gender and race, in Section 4.3.3. 

4.3.2 Costs to Homeless System of First-time Homelessness 

The cost to the homeless services system for serving each first-time homeless individual is the sum of 

the costs of each program stay. The cost of each stay is the daily cost of the particular program used 

by the individual times the number of days in the stay. Daily costs varied tremendously from one 

program to the next. Differences in daily costs of programs used by members of the cohort generally

explain differences in homeless costs from one person to another for individuals with otherwise 

similar patterns of homeless system use. (See Chapter 3 for a discussion of variations in the costs of 

homeless programs by site and program type.) 

On average, individuals incurred $2,101 in homeless system costs across the three study sites. The 

average homeless system cost incurred for each individual homeless person in the study cohort is 

similar in Houston and Des Moines ($2,257 and $2,308) and somewhat lower in Jacksonville 

($1,634). 

Exhibit 4.5: Average Homeless System Cost per Individual 

Jacksonville Houston Des Moines 

Average Cost per $1,634 $2,257 $2,308 Individual 

Houston and Des Moines have similar average costs per first-time homeless individuals, despite 

having very different lengths of stay. Houston’s shorter lengths of stay than Des Moines are offset by

the higher daily program costs of the program types used by the Houston study cohort. Though 

average lengths of stay in Jacksonville were only slightly lower than the average for Des Moines, the

Jacksonville cohort spent over half of its days in emergency shelter at an average cost of $29 per day;

whereas the Des Moines cohort spent over half of its days in transitional housing with individual 

rooms at an average daily cost of $43 per day. 

Average costs offer a general picture of the costs associated with homelessness, but they obscure 

important information about the wide variation in costs associated with first-time homelessness. Only

a small group of homeless individuals incurred high costs at each site, while the majority had minimal 

costs. The half of the cohort with the lowest homeless system costs incurred only 2 to 3 percent of 

the total homeless system costs; whereas the highest-cost 10 percent of the cohort incurred 62 percent 

of the homeless system costs in Jacksonville, 70 percent in Des Moines, and 83 percent in Houston. 

As was discussed extensively in Chapter 3, transitional housing for individuals is more expensive on 

average than other program types, and programmatic factors also encourage longer lengths of stay, 

also driving up the costs for individuals who use transitional housing. Thus, it is not surprising that 

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the cost to the homeless services system of the most expensive 10 percent of individuals in the study

cohort at each site generally reflects continuous use of expensive transitional housing programs for 

much or all of the 18-month observation period. 

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A multivariate regression model was also 

used to identify the relationship of different 

factors, including length of stay, to total 

homeless system costs per person (Exhibit 

4.6) to better understand what is underlying 

the wide distribution of costs. The model 

R-squared statistics of 0.68, meaning that 

the set of explanatory variables used in the 

model was able to account for 68 percent 

of the variation in costs. 

The model results suggest that, for these 

study cohorts of first-time homeless 

individuals, the influence on total cost per 

individual of the program type used is 

much greater than the influence of staying 

in the program for an additional month. 

Each additional month adds only 35 

percent to the cost per individual, whereas 

using transitional housing (alone or in 

combination with emergency shelter) more 

than doubles an individual’s total cost. 

Once both length of stay and program type 

are taken into account, the community in

which the individual becomes homeless 

has no significant effect on the total cost 

per individual. 

In addition to the length of stay and the 

type of program used, additional stays and 

the greater lengths of time between stays 

were both also associated with increased 

costs, but only with small increases. 

4.3.3 Variations in Homeless System 

Utilization and Costs by Gender, 

Race, and Age 

The multivariate analysis that predicts 

lengths of stay (Exhibit 4.4) shows that 

women stay in homeless programs 74 

percent longer than single men. An 

alternative model specification excluding 

the program type covariate shows that 

women have 38 percent fewer distinct 

Exhibit 4.6. Regression Analysis of Total 

Homeless System Costs for First-Time Homeless 

Individuals in Des Moines, Houston, and 

Jacksonville 

Explanatory Variables 

Total Homeless Costs 

(log scale) 

Type of Homeless Program Used+ 

Only Used TH 1.299*** 

(0.049) 

Only Used ES and TH Programs 1.114*** 

(0.067) 

Used Other Program Types or 

Combinationsa 

0.793*** 

(0.051) 

Site Variables+ 

Iowa 0.068 

(0.045) 

Houston 0.012 

(0.033) 

Homeless System Utilization 

Number of Homeless Program 0.037*** 

Stays (0.003) 

Length of Stay (in months) 0.351*** 

(0.005) 

Homeless Gap Days (in months) 0.073*** 

(0.004) 

Demographics+ 

Age 18 – 24 0.074 

(0.055) 

Age 25 – 30 0.105*** 

(0.051) 

Age 41 – 50 0.098*** 

(0.037) 

Age 51 and over 0.098** 

(0.046) 

Female 0.974*** 

(0.035) 

African-American 0.192*** 

(0.030) 

Other Races 0.051 

(0.059) 

Constant 3.953*** 

(0.041) 

Observations 7,502 

R-squared 0.68 

+ Reference categories are: Used ES Only, Jacksonville, Age 31 –

40, Male, White. 

Standard errors in parentheses. *significant at 10%; **significant

at 5%; ***significant at 1% a

Used Outreach Alone, Used PSH Alone, Used Outreach or PSH 

in Combination with ES or TH 

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stays.13 This may reflect the different causes of homelessness for men and women. Men may be 

more likely to be asked to leave housing shared with family or friends due to disputes than women, 

resulting in short-term but repeated shelter stays. Or, alternatively, men may be more willing to leave 

unappealing shelter conditions for the streets. With longer lengths of stay, it is not surprising that 

women are also associated with higher homeless system costs. However even controlling for length 

of stay, being female is associated with 97 percent greater homeless system costs than being male, as

shown in the model in Exhibit 4.6. Both the longer lengths of stay and higher costs are most likely a 

reflection of the specific homeless programs used by females. 

As was discussed in Chapter 3, emergency shelters that serve women are more likely to be 24-hour, 

full-service shelters rather than overnight shelters, which have much lower daily costs. In addition, 

some women stay in service-intensive programs that also serve families. These programs have higher 

costs per day on average than those that exclusively serve single adult populations. Like single 

women, families tend to have fewer distinct stays, but their cumulative lengths of stay are longer on 

average than those of men. These similarities may be a reflection of the program influences, if single 

women and families are frequently served within the same setting, or they may reflect that the needs 

and decisions of single women are more similar to women with children than they are to single men. 

Less dramatic, although still statistically significant, the models presented in Exhibits 4.4 and 4.6 also 

show that African-Americans have 30 percent longer stays than whites and 19 percent greater costs

than whites after controlling for lengths of stay and program types. Again, the higher costs after 

controlling for lengths of stay probably reflect the fact that African-Americans used programs with

more expensive daily costs than those used by whites within each program type. Nothing from our 

review of homeless programs suggests that certain programs encourage those who are AfricanAmerican to stay in programs longer or that the homeless services system encourages AfricanAmericans to use more expensive programs. However, African-Americans also have 14 percent more 

stays than Whites, which may also contribute to the greater cumulative number of days in homeless 

programs. Reasons related to the circumstances that led to homelessness, reduced housing stability

after exit from a residential program for homeless people, more limited access to informal or formal 

supports, and greater involvement with criminal justice or other mainstream systems may help to 

explain the longer lengths of stay and more frequent stays for African American individuals. 

Finally, the length-of-stay model (Exhibit 4.4) shows that relatively older individuals have longer 

stays than younger persons.14 For example, relative to the 31 to 40 year olds in the study population, 

individuals between the ages of 18 and 24 have stays 23 percent shorter, 41 to 50 years olds stay 19 

percent longer, and individuals 51 and older stay 26 percent longer. Although this study examined 

only individuals who experienced homelessness for the first-time, the finding that longer lengths of 

stay are associated with older individuals is consistent with Kuhn and Culhane’s (1998) research, 

which found that individuals who were chronically homeless were older than other homeless groups. 

The longer lengths of stay for older adults may be a function of age-related disabilities and associated 

barriers to housing stability, barriers to employment, or more fractured family relationships. 

Conversely, younger adults may have shorter lengths of stay related to the circumstances that led to 

their homelessness (e.g., if they became homeless due to family conflict or temporary income loss), 

13	 For details of the models that predict numbers of stays and gap days, see Appendix C.2.2. 

14	 In this study cohort, as in the homeless population in general (HUD, 2008), few people are elderly, that is, 

62 or older. 

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have fewer employment barriers, have fewer long-term disabilities, or have greater access to family

and other support networks that may be able to help resolve their homelessness. Older adults also 

have 10 percent greater costs than the 31 to 40 year old group after controlling for length of stay and 

program type, potentially attributable to residence in relatively more expensive programs within the 

transitional or permanent supportive housing program types. Somewhat counter-intuitively, the 

slightly younger group of 25 to 30 year olds was also associated with 11 percent higher costs. Again, 

this is likely a reflection of the specific programs used by this group. For instance, in Des Moines 

individuals who used only the more expensive form of transitional housing were younger than those 

who used other program types. 

4.3.4 Costs for “Path” Groups: Individuals Who Use the Homeless System in Similar Ways 

To better understand the heterogeneity of the homeless experience and its associated costs, we used 

multivariate cluster analysis to categorize individuals into “path groups” based on their lengths of 

stay, number of stays, length of gaps between stays, and the types and sequences of programs used. 

Cluster analysis was conducted independently for each site. 

The following path groups emerged that described similar patterns of use across all three sites, 

representing 79 to 94 percent of the study cohort in each site: 

•	 Emergency Shelter Short Stayers 

•	 Emergency Shelter Long Gappers 

•	 Sequential Program Users 

•	 Circling Program Users 

Exhibit 4.7 briefly describes each of these four common patterns of use of the homeless services 

system by first-time homeless individuals and shows the relative size of each group within each site.15 

Each of the path groups making up these common patterns is discussed in more depth in the text that

follows, followed by discussion of path groups unique to particular sites. Data on all path groups for 

each of the three sites are provided in Appendix 4.7. 

15	 For purposes of this section, the universe of individuals in the Houston study cohort is 3,535 adults. The 

full Houston study cohort of 4,406 individuals included 871 adults who were only found on the streets; who

have been excluded from the discussion of path groups. The HMIS lacked identifiers for a large percentage 

of these individuals, and, therefore, it was not possible to determine if any of these people also used other 

programs. 

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Exhibit 4.7: Path Groups Common to All Three Sites and their Relative Sizes 

Common Path 

Groups Brief Description 

Emergency Shelter 

Short Stayers 

Emergency Shelter 

Long Gappers 

Sequential Program 

Users 

Circling Program 

Users 

Used only emergency shelter, 1 

or 2 brief stays totaling 1 to 3 

weeks. 

Used emergency shelter only, 7 

to 40 times over 13 months, 

though only 1 to 5 months 

actually spent in shelter. 

Used at least 2 program types (in 

this sequence): emergency 

shelter, transitional housing, 

and/or permanent housing. 

Used transitional housing or 

permanent supportive housing 

and later returned to emergency 

shelter. 

Jacksonville 

(% of Study 

Cohort) 

66% 

10% 

12% 

7% 

Houston Des Moines 

(% of Study (% of Study 

Cohort)a Cohort) 

65% 57% 

10% 14% 

3% 4% 

2% 4% 

Total % of Study Cohort represented by these Common 95% 80% 79% Path Groups in each Site 

a

Percentages exclude the portion of the Houston Study Cohort that was only found on the streets. 

The Emergency Shelter (ES) Short Stayers path group represents the majority of the study cohort of

first-time homeless individuals in each site. The Sequential Program Users and Circling Program

Users are the only two path groups that involve use of multiple program types, including those not 

combined into these common path groups. This means that 81 percent of individuals in Jacksonville, 

92 percent of individuals in Des Moines, and 95 percent of individuals in Houston used only one type 

of homeless program over an 18-month period. 

Very few individuals in our study cohort ever used permanent supportive housing. This may be 

because most people using permanent supportive housing programs were excluded from this study

since they were homeless prior to the start of the study. Also, capacity of permanent supportive

housing may be limited enough that turnover may not be sufficient to accommodate continued 

demand from individuals with chronic disabilities who become newly homeless. 

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The common path groups are shown graphically in Exhibit 4.8.16 

Exhibit 4.8: Proportion of Study Cohort Represented by Common Path Groups 

ES Short 

Stayers 

(57 - 66%) 

Other Path 

Groups 

(5 - 21%) 

Circlers 

(2 - 7%) 

ES Long 

Gappers 

(10 - 14%) 

Sequential 

Program Users 

(3 - 12%) 

The groups are characterized by differences in their patterns of use of the homeless services system, 

but analysis of their demographic characteristics and mainstream program involvement17 help to 

describe further the differences among these common path groups. (Exhibit 4.9) 

16	 The pie chart is intended only to illustrate the relative size of each path group and should not be interpreted 

literally. The size of pie chart represents the size of the path group averaged across the three sites. 

17	 Based on mainstream domains collected in Jacksonville (Medicaid, mental health, substance abuse, 

entitlements, and jail) and Houston (mental health, City and County jail). 

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Exhibit 4.9: Characteristics of Individuals in Common Path Groups 

Common 

Path Groups Jacksonville Houston Des Moines 

ES Short 

Stayers 

Relatively fewer women 

Slightly fewer African 

Americans 

Relatively younger 

Average healthcare use 

Less substance abuse 

and criminal justice 

involvement
 

Very few women 

Fewer African-Americans
 

Relatively younger adults
 

Lowest rates of mental 

health care 

Lowest rates of criminal 

justice involvement 

Not demographically 

distinct from other common 

path groups 

ES Long 

Gappers 

Sequential 

Program 

Users 

Almost no women 

More likely to be AfricanAmerican
 

Lowest rates of Medicaid
 

managed care 

Highest criminal justice 

involvement
 

Relatively more women 

Fewer African-Americans
 

Slightly older 

High use of Food Stamps
 

Highest rates of mental 

health and substance 

abuse treatment prior to 

homelessness 

Low criminal justice 

involvement
 

Very few women 

Slightly more AfricanAmericans 

Slightly older (Frequent 

ES Longer Gappers much 

older)
 

Fairly high mental health 

use
 

High rates of criminal 

justice involvement 

Relatively more women 

Slightly more AfricanAmericans 

Slightly older 

Moderate rates of mental 

health care 

Moderate criminal justice 

involvement
 

Not distinct from other path 

groups in percent women 

and African American 

Younger than other 

common path groups 

Relatively fewer women 

Oldest path group 

Circlers More likely to be AfricanAmerican 

Slightly older 

Moderate use of mental 

Predominately women 

Slightly more AfricanAmericans 

Slightly younger 

Very few women 

Older adults 

health care, lower use of 

other healthcare 

Highest rates of mental 

health care and State 

High criminal justice 

involvement 

mental health Inpatient 

hospitalization 

Highest rates of criminal 

justice involvement 

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Path Groups Using Only Emergency Shelter 

Two of the common path groups describe individuals who only use emergency shelter: Short Stayers 

and Long Gappers. These two groups represent roughly three-quarters of each homeless individual 

study cohort. 

Emergency Shelter Short Stayers are by far the largest path group in each of the three sites,

representing 57 to 68 percent of each study cohort (Exhibit 4.7). Emergency Shelter Short Stayers 

use only emergency shelter and have one or two brief stays, totaling one to three weeks. In Des 

Moines, the demographic characteristics of this group do not appear substantially different from those 

of the other path groups, but in Jacksonville and Houston this group is younger (20 to 23 percent of 

the group are 30 years or younger), has fewer women, and has a slightly higher proportion of whites 

than other groups. In Jacksonville, this group had the lowest rates of substance abuse; in Houston,

this group had the lowest rate of mental health system involvement and criminal justice involvement. 

Not surprisingly, this group incurs minimal homeless system costs, averaging only $321 to $686 total 

per person over the 18-month period (Exhibit 4.10). Despite the large size of this path group, the total 

homeless system costs associated with Emergency Shelter Short Stayers is disproportionately small, 

representing only 8 percent of the total homeless costs for the cohort in Des Moines and in Houston 

and 28 percent in Jacksonville. 

All three sites had a sizable group, 10 to 14 percent, that stayed in emergency shelter an average of 7

to 11 times over the course of a year, but spent an average of only 23 to 124 cumulative nights in 

shelter (Exhibit 4.7).18 These are referred to as Emergency Shelter Long Gappers because of the 

long gaps between shelter stays. A small number of individuals within this group in Houston had a 

huge number of stays (more than 40 brief stays with gaps averaging less than a week between stays),

and this group is much older than the study cohort as a whole or the other Houston Long Gapper 

Groups (Appendix C.1.2). Emergency Shelter Long Gappers are almost entirely male (95 percent in 

Jacksonville, 90 percent in Houston, and 72 percent in Des Moines), and slightly more likely than

members of other path groups to be African-American. In Houston, more than a third of this group

had mental health involvement, and more than a quarter had criminal justice involvement. In 

Jacksonville, this group had very high criminal justice involvement (62 percent). These individuals 

also had involvement in substance abuse and mental health treatment (26 and 21 percent), although

other path groups had similar treatment rates. Even though individuals in this group experienced 

homelessness on and off for a full year, their total homeless system costs averaged only $910 to 

$2,494 per person since most of that time was not spent in shelter (Exhibit 4.10). 

The cost variations for these two groups, all of whom used emergency shelter exclusively, relate 

primarily to the sheer differences in lengths of stay. However, another key cost driver is the cost per 

day of the programs used by each group. The total homeless system costs for Emergency Shelter 

Long Gappers represent 5 to 10 percent of the each study cohort’s costs, slightly lower than the 

proportion of the study cohort they represent. 

18	 Although this study examined first-time homeless individuals, a number of individuals we studied such as

members of this path group experienced patterns of chronic homelessness over time. 

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Path Groups Using Multiple Program Types

The other two common path groups describe individuals who used multiple types of programs either 

sequentially or in a circling fashion, using transitional or permanent housing and later circling back to 

emergency shelter. 

Sequential Users, 3 to 12 percent of the study cohort at each site, used a combination of emergency

shelter, transitional housing, and permanent supportive housing programs. Not all individuals used 

all three program types, but those they used were accessed in the emergency-transitional-permanent 

sequence. Jacksonville had two groups of Sequential Users: short stayers with an average of two 

stays totaling two months, and long stayers with an average of six stays totaling more than a year. In 

Houston and Des Moines, Sequential Users stayed an average of six and nine months over three and 

four stays respectively. Individuals generally had cumulative gaps of more than one month between 

stays (Appendix C.1 tables). In all three sites, more than half of this group’s days in homeless 

programs were spent in transitional housing. 

In Jacksonville, the combined Sequential Users groups were almost one-third female. The Sequential

Long Stayers group had an average age of 47 years—the oldest of all of the path groups, although 

similar to Permanent Housing Long Stayers. More than 30 percent of Jacksonville’s Sequential Users 

were shown by the match with mainstream data to have received substance abuse treatment,

compared with an average of 22 percent for the Jacksonville cohort as a whole. 

In Houston, almost half of Sequential Users were female, and almost 20 percent were over 50 years of 

age, compared with a cohort average of 12 percent. The Houston transitional housing system offers 

many possibilities for single women, including access to much of the scattered site transitional stock 

offered in conjunction with family programs. This helps explain the high percentage of women in 

Houston path groups that used programs other than emergency shelter. 

The average homeless system cost in Jacksonville for Sequential Users was $1,585 for Sequential 

User Short Stayers and $10,416 for Sequential User Long Stayers. The figure for Long Stayers can 

be compared with the average total cost per person of $8,539 for Sequential Users in Des Moines and 

$14,418 in Houston. The costs for Sequential User Long Stayers were the highest of all path groups 

in Jacksonville and Houston, and in Des Moines the costs for Sequential Users were outpaced only by 

a path group that used only transitional housing (Exhibit 4.10). The total costs for Sequential Users 

represents 13 to 22 percent of the cohort’s total homeless costs, two to four times higher than the 

proportion of the cohort they represent. 

The high costs for the Sequential Users were driven both by the long lengths of stay and by the high 

percentage of nights (59 percent to 84 percent) that this group spends in transitional housing 

programs. Transitional housing for individuals has high costs in all sites compared with other 

program types (see Chapter 3 for further discussion), although particular programs of other types used 

by this path group are also expensive: for example, extended stay emergency shelter and permanent 

supportive housing with intensive services. 

Circlers, 2 to 7 percent of the study cohort in each site, are individuals who used transitional housing 

or permanent supportive housing and later returned to emergency shelter. By definition, individuals 

in this group used more than one program type and, therefore had multiple stays. On average, each

person had three stays in Houston, seven in Des Moines, and eight in Jacksonville. The cumulative 

length of gaps between stays is similar to the length of time actually spent in programs (Appendix 

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5.x). Circlers do not appear have distinguishing demographic characteristics that might help to 

identify them when they first enter the homeless services system. In Houston they were 

predominately women and slightly younger, while in Des Moines very few were women and they

were relatively older than other path groups. In Jacksonville, Circlers had low rates of access to 

medical care (15 percent), high mental health involvement (30 percent), and high criminal justice 

involvement (44 percent). For Houston, Circlers had the highest rates of mental health (48 percent) 

and criminal justice (27 percent) involvement of all path groups. We do not have enough information 

to draw conclusions about why these individuals returned to shelter. For instance, the individuals 

may have been terminated from a transitional or permanent housing program without finding

sustainable long-term housing or may have experienced barriers accessing appropriate permanent 

housing related to their mental health or criminal history. Alternatively, they may have had 

involvement with inpatient treatment or jail that disrupted housing and resulted in repeat 

homelessness. 

The group had average homeless system costs of $3,987 in Jacksonville, $6,374 in Des Moines, and 

$10,705 in Houston (Exhibit 4.10). In Jacksonville, the Circlers represented 18 percent of total cohort 

costs though the path group only comprised 7 percent of the cohort’s population. The Des Moines 

Circlers represent only 4 percent of the cohort but incurred 12 percent of the cohort’s total costs, and 

the Houston Circlers represent only 2 percent of the cohort but incurred 9 percent of the total costs. 

Length of stay is a key factor driving this group’s costs, but it does not explain the difference in costs 

across the sites. Houston’s costs were significantly higher than Jacksonville’s, in large part because 

the daily costs of the specific programs used by the individuals in this path group were higher and 

partly because the Houston group spent 89 percent of nights in extended emergency shelter, 

transitional housing and higher cost permanent supportive housing programs, whereas Jacksonville’s

cohort spent only 59 percent of nights in more expensive transitional or permanent programs. Des 

Moines Circlers’ costs were higher than Jacksonville’s in part because this path group spent 76 

percent of its sheltered homeless days in transitional programs and more than half of its transitional 

housing days in the more expensive of the two transitional housing program models. (More detail

about the costs of these models can be found in Chapter 3.) 

Other Path Groups

The remaining portion of each site’s study cohort was represented by path groups with other patterns. 

These groups all represent individuals who used a single program type for extended periods, and as a 

result, most are fairly high cost groups. However, the types of programs each group used differed, so 

they are described individually for each site. Very few individuals in this study used permanent 

supportive housing, either immediately upon entering the homeless services system or after a stay in

emergency shelter or transitional housing. 

Jacksonville Emergency Shelter Long Stayers. This group represents only 2 percent of the 

Jacksonville cohort, but they had almost year-long continuous stays in emergency shelter. The 

Emergency Shelter Long Stayers are the only path group across all three sites with patterns of 

homelessness consistent with Kuhn and Culhane’s original chronically homeless group (Kuhn & 

Culhane, 1998), though not all members of this group would meet HUD’s current definition of 

chronically homeless which has a disability component.19 While the size of this group is smaller than 

19	 HUD’s definition of chronic homelessness also incorporates Kuhn and Culhane’s episodically homeless, 

which is more parallel to the Emergency Shelter Long Gappers. 

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the percent identified by Kuhn and Culhane, the Jacksonville cohort only includes first-time homeless 

individuals; thus, one would not expect to find a sizable chronically homeless population. Rather, the 

small size of this path group may provide an indication of the proportion of first-time homeless 

individuals who may continuously use emergency shelters without an appropriate re-housing 

intervention. 

In contrast to the study cohort as a whole, 54 percent of emergency shelter long stayers were female, 

and the group had the highest percentage of African Americans, 73 percent, compared with 47 

percent for the Jacksonville study cohort as a whole. Compared with other first-time homeless

individuals in Jacksonville, members of this group were more likely to receive income support from

the Food Stamps program prior to homelessness (48 percent) or during their long stays in shelter (77 

percent), but this does not appear to have helped them avoid homelessness or leave it quickly. Their 

use of mainstream systems suggests that medical illness may have contributed to their extended 

homelessness. Their rate of involvement with the criminal justice system was low (Appendix C.1.1). 

The cost to the homeless system to house these individuals was very high, $9,756 per person (Exhibit 

4.10). Yet, due to the small size of the group, their total cost to the homeless services system was

modest, representing 13 percent of the cohort’s total costs. The average cost per Emergency Shelter 

Long Stayer is equivalent to 15 months of maximum rent subsidy at the FY2006 Fair Market Rent of 

$643 per month for a one-bedroom unit (HUD, 2005) (Exhibit 4.11). Given the pattern of long-term

homelessness that emerged over the 18-month observation period and the high costs associated with 

individuals in this group, an alternative permanent housing intervention may be a more appropriate 

intervention for this group than shelter. 

Jacksonville Permanent Supportive Housing Long Stayers spent an average of one year in 

residential homeless programs, primarily in permanent supportive housing. This group was about 

one-third female, compared to 20 percent for the study cohort as a whole, and a similar percentage 

was more than 50 years old, much higher than in any other path group in Jacksonville. Not 

surprisingly, for a group that used mainly programs available only to persons with disabilities, their 

rates of use of mental health and substance abuse treatment were high (Appendix C.1.1). The 

homeless services system incurred approximately $8,500 per person for this group (Exhibit 4.10), 

slightly greater than a maximum annual rent subsidy based on the Fair Market Rent. Permanent 

Supportive Housing Long Stayers represent 15 percent of the total Jacksonville cohort’s homeless 

system costs, though these individuals represent only 3 percent of the overall cohort. Most of these 

expenses were incurred for project-based SRO housing or Shelter Plus Care vouchers, so 

conceptually these costs to the residential system for homeless people are essentially equivalent to 

paying rent in the private market and therefore are quite different from the residential homeless 

system costs incurred on behalf of other path groups. Most of the services associated with these units 

were provided through relationships with mainstream providers and may be reflected in the 

mainstream service system costs incurred for this path group or may not be fully captured. 

Houston Users of Extended Stay Emergency Shelter. In Houston, 3 percent of the study cohort 

used extended stay emergency shelter programs for an average of 158 days, slightly more than 5 

months. This subset had average per person homeless system costs of $10,540. Extended stay 

programs are a hybrid model that provide clients a greater level of privacy and have a wider array of

services than the shorter-stay model, in many ways paralleling the environment and programming 

provided at a transitional housing program. They are more expensive than less service-rich 

emergency shelters. The Extended Stay programs are primarily targeted to women with a history of 

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substance abuse. Fifty-five percent of the people in this group were women, and 69 percent were 

African American. 

Houston Users of Transitional or Permanent Supportive Housing Only. In Houston, 16 percent 

of the study cohort went directly to transitional housing or to permanent supportive housing. These 

individuals were mainly women (77 percent), in sharp contrast to the users of transitional or 

permanent supportive housing programs who arrived there sequentially or who used them and then 

“circled” back to emergency shelter. This group is somewhat less likely to be African American than 

the study cohort as a whole. Their use of mental health care and encounters with the criminal justice 

system were not different from the study cohort as a whole. Their lengths of stay in the residential 

system for homeless people were slightly lower than Sequential Users or Circlers in Houston, and 

their costs to the homeless services system were slightly lower, $8,799 on average (Exhibit 4.10).

Nonetheless the average costs per person are still very high compared with the average cost per

person of $2,257 for the cohort overall. This path group represented the majority (52 percent) of 

homeless costs within Houston, substantially larger than the proportion of the cohort (16 percent) they 

represent. 

Des Moines Transitional Housing Only, Shared Rooms. In Des Moines, 13 percent of the study

cohort used transitional housing provided in shared rooms and, therefore, with relatively little

privacy. This group was 42 percent female (compared with 27 percent for the study cohort as a 

whole) and less likely to be African American (12 vs. 21 percent). They were somewhat younger 

than the study cohort as a whole and stayed an average of just over 4 months (133 days), substantially

less than Sequential Users, Circlers, or those who used only Transitional Housing provided in 

independent rooms, described below. We have no mainstream data for Des Moines from which to 

speculate further on the possible causes of their homelessness or the way in which they were served 

by transitional housing. However, one of the shared room transitional housing programs in Des 

Moines serves women who have recently been incarcerated. The average total cost to the homeless 

services system for members of this group is only $3,103 (Exhibit 4.10), reflecting their use of a 

relatively low cost model for transitional housing for a relatively short period of time. Because of the 

relatively low costs per person, this group was associated with only 18 percent of the homeless 

system costs incurred by the cohort, a proportion only slightly higher than the size of the path group. 

Des Moines Transitional Housing Only, Independent Rooms. Eight (8) percent of the study

cohort in Des Moines used only a form of transitional housing that provides private rooms to clients. 

This group had lengths of stay averaging almost 8 months (237 days), perhaps due to the higher levels 

of privacy and relative independence provided to this group. Members of this path group were 

predominately male (85 percent compared to 73 percent of the study cohort as a whole), but similar to 

the rest of the study cohort in other respects. Given the long lengths of stay for this group and their 

use of an expensive type of transitional housing (see Chapter 3), they had the highest cost per person

of any path group in Des Moines, $11,731 (Exhibit 4.10). Cumulatively, they incurred 42 percent of 

the total homeless costs for the Des Moines cohort even though the group comprised only 8 percent of 

the cohort. 

The average per person costs for individuals in each path group are shown in Exhibit 4.10. 

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Exhibit 4.10 Average Homeless System Costs Per Person By Path Group 

ES Short 

Stayers 

ES Long 

Gappers 

Sequential 

Users 

Circling 

Users Other Path Groups 

Average 

for Overall 

Cohort 

Jacksonville $686 $910 $1,585 

Short Stayers 

$3,987 $8,493 

PSH Long Stayers 

$1,634 

Houston $353 $880 ES 

Long 

Gappers 

$10,416 

Long Stayers 

$14,418 $10,705 

$9,756 ES 

Long Stayers 

$8,799 

TH or PSH Only 

$2,257 

Des Moines $321 

$2,494 

Frequent 

ES Long 

Gappers 

$1,224 $8,539 $6,374 $3,103 

TH – Shared Rm 

$2,308 

$11,731 

TH – Indiv Rm 

Exhibit 4.10 clearly illustrates the range of average homeless system costs per person for each of the 

path groups, as discussed in the previous section. The highest cost path groups (long stayers in 

expensive programs) in each of the three sites had average costs per person 15 to 41 times the average 

costs per person of the lowest cost path group, Emergency Shelter Short Stayers. Since path groups 

correspond strongly with costs, policymakers could use information like this to determine how much 

they could invest in alternative interventions for different path groups while staying cost-neutral. 

This could be a simple as assessing whether there are less expensive ways of delivering similar

services to single women, who are frequently served in a higher-cost family program environment. 

For higher cost path groups, the CoC could also assess the level of housing and service assistance

currently provided to long stayers relative to alternative interventions. Fair Market Rents (Exhibit

4.11) represent the equivalent of funding a deep rental subsidy for an individual for a month. For 

example, Jacksonville could fund a rental subsidy for 16 months with the resources currently spent on

average to house a Sequential Long Stayer in homeless programs for one year. To determine the 

relative cost-effectiveness of the current strategy to alternative interventions, policymakers can

compare the costs and long-term outcomes of the housing assistance and services provided to

Sequential Long Stayers in these programs with the costs and outcomes that might be achieved by

using these funds to support alternative interventions, such as a rental subsidy. 

Chapter 4: First-time Homelessness for Individuals and its Associated Costs 4–23 
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Exhibit 4.11: 2006 Fair Market Rent for One-bedroom Unit in Individual Study 

Sites 

Jacksonville Houston Des Moines 

MSA MSA MSA 

2006 Fair Market Rents: monthly $643 $612 $549 rent for one-bedrooma

a FMR Source: HUD, 2005. The FMR does not include the monthly fee paid to a public housing agency 

for administering the voucher program, which was about $58 per unit per month in these three 

communities. (HUD, 2007) 

Thus, an important policy question is whether there is alternative prevention, housing, or other 

homeless interventions that could be offered at similar or lower costs that would achieve improved 

outcomes or be preferable for other moral, programmatic, or policy reasons? If the response is

affirmative, then in addition to developing the alternative interventions, the CoC would also need to 

identify the individuals that need to be assisted differently. The path group analysis provided in this 

section provides some clues about what to look for in an assessment process, though more research in 

this area is needed. 

A related finding is that all program types and all programs within each type do not have equal costs; 

thus, long-stayers do not have universally high-costs. For example, Jacksonville’s Emergency Shelter

Long Stayers (the group with homeless system use most comparable to Kuhn and Culhane’s 

chronically homeless cluster) have lower average per person costs than the Sequential Long Stayers 

in Jacksonville who used transitional housing extensively. Setting aside ethical or programmatic

reasons, Jacksonville may benefit more financially by seeking an alternative intervention for the

Sequential Program Users than for other path groups. Similarly, if stakeholders in Houston undertake 

efforts to reduce lengths of stays in Houston’s standard emergency shelters, they will not achieve 

cost-savings remotely approaching those that could be realized from efforts to reduce lengths of stays

in the higher-cost extended stay emergency shelters. Again, that is not to say the extra investments in 

more expensive programs are not warranted based on additional benefits or outcomes for program

clients. This cost analysis may help to identify programs about which cost-effectiveness analysis 

would be helpful. 

4.4. Costs Associated with Mainstream System Use 

In contrast to homeless residential system costs, mainstream system costs can occur before or after an 

individual’s period of homelessness and there may or may not be a relationship between 

homelessness and increased or decreased involvement in mainstream systems. As described in 

section 4.1, prior research suggested that periods of homelessness are related to increased costs across 

most mainstream domains and that certain interventions may reduce acute care costs and other 

mainstream costs associated with crises that lead to homelessness. This research also assumes that 

reduced costs over time reflect positive client outcomes brought about by the intervention. At least 

theoretically, the cost reductions can be used to fund the homelessness interventions. This study was 

not designed to understand the client outcomes or cost-effectiveness of specified homelessness

interventions. However, the study attempts to measure the study cohort’s mainstream system

involvement and associated costs incurred to serve these individuals before, during, and following 

4–24 Chapter 4: First-time Homelessness for Individuals and its Associated Costs 
Chapter 4: First-time Homelessness for Individuals and its Associated Costs Chapter 4. First-time Homelessness for Individuals and its Associated Costs 4-25 4–25

first-time homelessness. This information may help policy makers assess the extent of potential 

mainstream cost savings possible or recognize the limited opportunities for them. 

For Jacksonville, we were able to obtain mainstream utilization and cost data for the Medicaid 

primary health care, Medicaid and State-funded mental health and substance abuse treatment, food 

stamps, and Temporary Assistance for Needy Families (TANF) systems aggregated by path group for

the periods before, during and following homelessness. We also received client-level total 

mainstream costs for each domain and each study period. We were not able to obtain access to 

individual client encounter data, so we do not know the exact dates of the mainstream involvement or 

costs of individual services within these domains. The limitations of data aggregated by time period 

will be discussed later in this section. We were able to obtain client-level data documenting each 

arrest and jail stay throughout the full study period. In Houston, we were able to obtain client-level 

service utilization and cost data for City and County jails, mental health treatment, and inpatient stays 

in the state psychiatric hospital. For Des Moines, we were not able to obtain any data on any

mainstream systems; therefore, this section discusses costs only for Jacksonville and Houston. 

This section presents estimates of mainstream costs for the study cohorts in Jacksonville and Houston 

and also compares them with the results of previous research. Like past cost studies, these results

may understate mainstream costs since we have not accounted for all mainstream domains. 

4.4.1 Rates of Mainstream System Involvement 

As it is for homeless system costs, utilization of mainstream systems is an essential building block for 

estimating costs. Examining rates of interaction with mainstream systems also yields a better

understanding of the characteristics of the individuals in the study cohorts—at least the minimum 

percentage of the cohort with certain needs or experiences, since it is likely some members of the

cohort have needs for services but did not access them during the study timeframe. Some individuals 

also may have used non-publicly funded services that were not captured in the datasets we analyzed. 

Exhibit 4.12 shows rates of cohort involvement with mainstream systems in Jacksonville and Houston 

across the study period. Use during the 12 months prior to homelessness can help show needs that 

were present during that period. It can also be compared to the patterns of use after the start of 

homelessness to suggest how homelessness or involvement with homeless programs may have 

affected mainstream use. 

Exhibit 4.12 Rates of Involvement with Mainstream System Domains Prior to Homelessness, 

During Homelessness and Overall During the Study Period 

Jacksonville Houston 

Prior During After Overall Prior During After Overall 

Average days in period 

Medicaid Primary Health 

Mental Health 

Substance Abuse 

Criminal Justice 

Income Support 

365 132 599 1096 

13% 9% 16% 20% 

13% 8% 18% 25% 

9% 7% 15% 22% 

19% 13% 22% 38% 

29% 22% 43% 52% 

365 83 689 1137 

11% 9% 12% 18% 

6% 2% 9% 13% 

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In Jacksonville, almost one-third of individuals were receiving income support (mainly food stamps) 

in the 12-months prior to homelessness, and 13, 13 and 9 percent respectively had accessed publicly

funded medical, mental health and substance abuse treatment. Almost one-fifth had been in arrested 

or in jail. 

A relatively smaller percentage of individuals interacted with these systems during homelessness, 

providing a fairly small group of individuals for policymakers to target for potential cost offsets. The 

smaller percentage with service encounters primarily reflects the shorter period of time homeless for 

most of the study cohort, compared with the periods of time before and after homelessness. The 

average length of each period is shown in the first row of Exhibit 4.12. Food stamps eligibility may

have dropped during homelessness for people in programs supplying meals. Nonetheless, as later 

sections on mainstream costs will show, these small percentages of individuals can incur substantial 

costs per person. 

Use of mainstream systems rises following the end of homelessness. This may be primarily due to 

the longer period of time in which we tracked people following homelessness. In some cases— 

income support, Medicaid primary health care, and perhaps mental health and substance abuse 

services—the increased rates may also reflect the success of the homeless services system in linking 

homeless individuals to needed mainstream services. In other cases—criminal justice, and again 

perhaps mental health and substance abuse services—the higher rates of use following homelessness 

could indicate that spending time in the residential services system for homeless people does not 

change—and may even exacerbate—the negative behavior of individual homeless people. There 

clearly are cost implications associated with increased use of mainstream systems following 

homelessness. 

The next section details the costs incurred by certain mainstream systems and sets the stage for the 

next step of analysis that a community can take: exploring whether the costs are positive or negative, 

and whether there are opportunities to reduce costs for the percentage of clients who interact with 

these systems through homeless interventions. 

4.4.2 Costs to Mainstream Systems During Homelessness 

First we present costs incurred during the study cohort’s period of homelessness (Exhibit 4.13),20 the 

primary costs that we assume to be influenced by homelessness. The costs shown in the exhibit 

reflect only the domains for which we were able to obtain data, so they are minimum costs associated 

with our cohort of first-time homeless individuals. 

20	 “During” homelessness is used to describe the period from the first day of the first stay in a residential 

program to the last day in the last stay within the 18-month study period. For individuals with more than 

one homeless program stay, during homelessness also includes gaps or periods of time between homeless 

stays when the individual may be housed. 

4–26 Chapter 4: First-time Homelessness for Individuals and its Associated Costs 
Chapter 4: First-time Homelessness for Individuals and its Associated Costs 4–27

Chapter 4. First-time Homelessness for Individuals and its Associated Costs 4-27 

 

 

 

 

 

 

Exhibit 4.13: Average Mainstream System Costs per Person Incurred “During” 

Homelessness 

Jacksonville Houston 

Average Costs Average Costs 

During Average Costs During Average Costs 

Homelessness During Homelessness During 

Per Person Homelessness Per Person Homelessness 

Involved in Per Person in Involved in this Per Person in 

this Domain Cohort Domain Cohort 

Medicaid Primary Health $2,436 $219 

Mental Health $1,318 $106 $4,157 $391 

Substance Abuse $2,265 $158 

Criminal Justice $3,057 $397 $6,520 $157 

Income Supports 

Average Total Per 

$627 $138 

Person Costs for these 

Domains 

$1,018 $547 

Total Incurred During 

Homelessness by the 

Cohort for these 

Domains 

$2,006,539 $2,412,227 

For each mainstream domain, Exhibit 4.13 shows the average costs per person for those who were 

served or interacted with that mainstream system and average per person costs when considering all 

individuals in the cohort. Per person costs for those who actually interacted with each system were

relatively high, ranging from $627 for food stamps and TANF to $3,057 for those arrested or jailed 

during homelessness. The criminal justice expenses are high in part due to the large number of 

people who were involved with criminal justice (13 percent of the cohort, Exhibit 4.12). And those 

who were jailed, stayed in jail a long time—an average of 40 days each. When spread across the

entire Jacksonville cohort, the costs are diluted.21 

Therefore when considering the average mainstream cost per person in the overall cohort, costs 

during homelessness were relatively low, because most people spent only a brief time homeless and 

because only a portion of the cohort actually incurred costs in each of the domains. In Houston, 

average criminal justice costs are much lower than average mental health costs (Exhibit 4.13) for each 

cohort member, in part because only 2 percent of the study cohort had criminal justice costs during 

homelessness, compared with 9 percent who received mental health services (Exhibit 4.12). In fact, 

average costs per person for those who interacted with each system were higher for those involved 

with criminal justice than for those who received mental health care. As with Jacksonville, the 

average per person costs for both domains is diluted by the large percentage of individuals (more than

90 percent) who were not involved with either the mental health or the criminal justice system. Thus 

this further illustrates the point that an intervention can most easily achieve cost savings if it is 

targeted to those with high use (or any use). Conversely, interventions targeted to subgroups of 

21 The Jacksonville case study Appendix provides greater detail on these mainstream costs. 

Chapter 4: First-time Homelessness for Individuals and its Associated Costs 4–27 
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homeless individuals that are not heavily involved in mainstream systems, and probably interventions 

targeting all first-time homeless individuals, are unlikely to achieve cost savings sufficient to fund 

them. 

4.4.3 Mainstream Costs Before, During, and After Homelessness 

Although utilization rates for the study cohort go down during homelessness, as shown on Exhibit 

4.12, this is largely a reflection of shorter time periods. Costs, expressed as one-month costs to 

control for the different lengths of the time periods before, during and following homelessness, go up

during homelessness for most domains, as shown on Exhibit 4.14. In Jacksonville, the total monthly 

mainstream costs incurred by the study cohort increased from an average of $161 per month per 

person to $231 per month (43 percent increase) during homelessness and went back down to an

average of $166 per month per person following homelessness. (See the Jacksonville case study in 

Appendix A for more detail.) In Houston, mainstream costs increased from an average of $67 per 

month per person to $197 per month during homelessness (194 percent increase) and then reduced 

back to an average of $65 per month per person following homelessness. 22 

A smaller portion of the cohort interacts 

with each system during homelessness, 

so the increase in average monthly costs 

reflects concentrated usage of services 

by these users within a relatively brief 

period of time. In the periods before and 

after homelessness, more people 

interacted with the systems but the 

interactions were spread over longer

periods and therefore the adjusted 

monthly cost is lower. More on the 

relationship of these costs before 

homelessness is provided in the next 

section. The lower rates of involvement 

with mainstream service systems may

also reflect that some individuals may

have received alternative services from 

homeless programs alleviating their need 

for mainstream care, and that those who 

did not have their needs met by the 

program internally may have needed 

higher cost clinical or acute care.

However, not all of the change is 

explained by concentrated service use. 

In some cases, individuals used, on 

average, more expensive services during 

homelessness. For instance, in 

Jacksonville, the average cost per unit of physical health care covered by the Medicaid fee-for service 

22 See the Houston case study (Sokol, Leopold, Spellman, & Khadduri, 2009) for more detail. 

Exhibit 4.14: Monthly Mainstream Costs by Domain 

and Period, Jacksonville and Houston 

Exhibit 3.8: Average Monthly Mainstream Costs 

Jacksonville 

$0 

$100,000 

$200,000 

$300,000 

$400,000 

$500,000 

Pre During Post 

Mental Health 

Criminal Justice 

Substance Abuse 

Physical Health 

Entitlements 

Jacksonville 

Exhibit 3.9: Average Monthly Mainstream Costs -

Houston 

$0 

$200,000 

$400,000 

$600,000 

$800,000 

$1,000,000 

Pre During Post 

State Hospital 

Mental Health 

Criminal Justice 

Houston 

4–28 Chapter 4: First-time Homelessness for Individuals and its Associated Costs 
Chapter 4: First-time Homelessness for Individuals and its Associated Costs Chapter 4. First-time Homelessness for Individuals and its Associated Costs 4-29 4–29

 

 

 

 

 

 

 

 

 

 

 

 

plan was $100 per unit during the period prior to homelessness, $117 during homelessness, 

decreasing slightly to $110 following homelessness. More dramatic is the change in the Jacksonville 

cohort’s Medicaid-funded mental health average cost per unit: $87 prior, $129 during, and $98 

following homelessness. However, for Medicaid substance abuse treatment, the average cost per unit 

during homelessness was lowest ($426) compared with $471 per unit before and $508 per unit

following homelessness. In Houston, the mental health treatment cost per unit was highest ($218) in 

the period preceding homelessness, dropping to an average cost per unit of $154 during homelessness 

and $141 per unit following homelessness. While bearing in mind that the average costs could reflect 

high-cost use by a handful of individuals and limited use by others, the higher cost per unit during 

homelessness for some domains is consistent with the theory raised in prior research that some people

may receive more expensive acute care during periods of homelessness, but this pattern is not 

universal. 

4.4.4 Mainstream Costs Immediately before Homelessness 

While total mainstream costs increased during homelessness compared to the period prior to

homelessness, suggesting more intensive mainstream use by particular individuals during 

homelessness, we come to a slightly different conclusion about the pattern by graphing mainstream

utilization month by month, as shown in Exhibit 4.15 for jail stays in Jacksonville. The number of 

jail stays increases substantially immediately before first-time homelessness and peaks in the period 

immediately following first entry into a homeless program.23 We see similar patterns for criminal 

justice involvement and mental health treatment costs in Houston, shown in Exhibits 4.16 and 4.17.

The patterns graphed in these exhibits are very similar to those found in analysis of inpatient 

hospitalizations by homeless individuals in Philadelphia conducted by Culhane, Averyt and Hadley

(1997). This pattern is not apparent when the cost analysis relies on average total monthly costs for

the time periods before, during, and after homelessness shown in Exhibits 4.14.24 This examination 

of data by month requires client-level service utilization data with actual dates of service, which we

were not able to obtain from any of the Jacksonville mainstream systems except criminal justice.25 

23	 Other research analyzing rates of homelessness among ex-offenders found that individuals released from

state prisons or jails have a greater risk of homelessness than individuals with similar characteristics who 

have not been recently incarcerated. In the communities studied, risk of homelessness among ex-offenders 

was higher for individuals with certain demographic characteristics. The same research also found that 

longer periods of incarceration were associated with greater risks of homelessness after release. (Graham, 

D., Locke, G., Bass Rubenstein, D. & Carlson, K., unpublished) 

24	 These findings also corroborate those of Scully and Shank (2007), presented at the Summer 2007 National 

Alliance to End Homelessness conference. Scully’s presentation prompted us to analyze data in this way to

better understand patterns of use relative to homelessness 

25	 The three period analysis was specified in the original data request to mainstream agencies who were not 

authorized to disclose client-level data. Now that this spike has emerged consistently for multiple domains, 

in the future we would explore alternate data specifications to capture this phenomenon more 

comprehensively. 

Chapter 4: First-time Homelessness for Individuals and its Associated Costs 4–29 
4–30 4-30 Chapter 4. First-time Chapter 4: First-time Homelessness for Individuals and its Associated Costs Homelessness for Individuals and its Associated Costs Abt Associates Inc. Total Jail Stays for Study Cohort

Time Relative to First Day in Homeless System 

Exhibit 4.16: Houston (Individuals) Jail Stays Relative to Homelessness 

Time Relative to First Day in Homeless System 

4–30 Chapter 4: First-time Homelessness for Individuals and its Associated Costs 

60
 

50
 

40
 

30
 

20
 

10
 

0
 

12 Months Prior

1st Day in Homeless 

System 

Exhibit 4.15: Jacksonville Jail Stays Relative to Homelessness 

0 

20 

40 

60 

80 

100 

120 

Total Jail Stays for Study Cohort

1st Day in Homeless 

System 

12 Months Prior

11 Months Prior 11 Months Prior10 Months Prior 10 Months Prior

9 Months Prior 9 Months Prior8 Months Prior 8 Months Prior7 Months Prior 7 Months Prior6 Months Prior 6 Months Prior5 Months Prior 5 Months Prior4 Months Prior 4 Months Prior3 Months Prior 3 Months Prior2 Months Prior 2 Months Prior

1 Month Prior 1 Month Prior

1 Month Post 1 Month Post

2 Months Post 2 Months Post3 Months Post 3 Months Post4 Months Post 4 Months Post5 Months Post 5 Months Post6 Months Post 6 Months Post7 Months Post 7 Months Post8 Months Post 8 Months Post9 Months Post 9 Months Post

10 Months Post 10 Months Post11 Months Post12 Months Post13 Months Post14 Months Post15 Months Post16 Months Post17 Months Post18 Months Post 

11 Months Post12 Months Post13 Months Post14 Months Post15 Months Post16 Months Post17 Months Post18 Months Post 
Chapter 4: First-time Homelessness for Individuals and its Associated Costs Chapter 4. First-time Homelessness for Individuals and its Associated Costs 4-31 4–31

 

 

 

 

 

 

 

 

Adding another layer of detail to the analysis, Exhibit 4.17 graphs mental health system costs 

separately for crisis services, inpatient treatment and outpatient treatment in Houston. The exhibit 

shows a dramatic increase in costs for inpatient and crisis treatment and a slight increase in outpatient 

treatment immediately before homelessness. Particularly interesting is the fact that inpatient 

treatment costs peak in the month prior to homelessness and then decline sharply in the month 

following the start of homelessness, whereas crisis and outpatient service costs peak in the month 

following the start of homelessness and then drop to levels slightly higher than the period before 

homelessness. It is logical that inpatient costs would decline once someone enters a residential

homeless program, since a person cannot be staying in an inpatient facility at the same time he is in a 

homeless facility. However, the dramatic increase in use immediately prior to homelessness suggests 

that individuals may be exiting inpatient programs with inadequate housing placement services or that 

the mental health crisis that necessitated inpatient care is related to housing instability and

homelessness in some other way. 

The images are compelling and suggest a strong relationship between mainstream involvement and 

the start of homelessness. However, the current analysis has several important limitations. These 

exhibits depict total numbers of jail stays and total mental health costs for the cohort. We would need 

much more analysis to determine whether the individuals experiencing the crises before homelessness 

are the same people who later are shifting to outpatient mental health use. Furthermore, the analysis 

is built up from each individual’s service utilization relative to his or her actual first day in the

homeless system. The first month in the homeless system is roughly equivalent for all persons in the 

cohort and exactly the same for the 12 months prior to entry into the homeless system, so the pattern 

of progressively increasing mainstream costs is defensible for those timeframes. However, following 

the first day some people in the cohort quickly exit homeless programs, while others stay homeless 

Exhibit 4.17: Houston (Individuals) Mental Health Costs by Month Relative to Homelessness 

$0 

$50,000 

$100,000 

$150,000 

$200,000 

$250,000 

$300,000 

Total Monthly Costs 

1st Day in Homeless 

System 

9 Months Pre8 Months Pre7 Months Pre6 Months Pre5 Months Pre4 Months Pre3 Months Pre2 Months Pre

1 Month Pre

1 Month Post

2 Months Post3 Months Post4 Months Post5 Months Post6 Months Post7 Months Post8 Months Post9 Months Post 

Time Relative to First Day in Homeless System 

Crisis Services InPatient OutPatient 

for long time periods or later return to homeless programs. Subsequent episodes of homelessness 

may also be related to increased mainstream involvement, but later increases are muted in these 

Chapter 4: First-time Homelessness for Individuals and its Associated Costs 4–31 
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graphs, since the costs of those who have subsequent episodes in month 6, for example, are summed 

with those in the cohort who are no longer homeless. 

We did not collect and structure data in ways that facilitate conducting time-series analysis of 

mainstream system use relative to the end of homeless residential stays or subsequent episodes of 

homelessness. However, we believe that these interesting exploratory findings suggest opportunities 

for further research. 

4.4.5 Characteristics Associated with Mainstream System Costs 

A regression model was used to explain mainstream costs for different systems using covariates for 

demographic characteristics and homeless system utilization (Exhibit 4.18). Unlike the previous 

models presented in this chapter, we did not use a logarithm specification for the outcome variable for 

this analysis. These regression coefficients thus represent the differences in dollar costs between

individuals with and without a particular characteristic. 

Findings on the relationship between homeless utilization patterns and mainstream system costs over 

the total study period (before, during, and after homelessness) were somewhat inconsistent between 

the two sites.26 In Jacksonville, multivariate analysis controlling for demographics and homeless 

experience showed a statistically significant relationship between length of stay in homeless 

residential programs and most mainstream costs (Exhibit 4.18). For each additional 30 days spent in 

homeless programs, physical healthcare costs increase by about $199, costs for food stamps and 

TANF increased by $80, and costs for substance abuse treatment increased by $61. In contrast, 

criminal justice costs dropped slightly for individuals in the Jacksonville study cohort who spent more 

time in homeless residential programs. Criminal justice costs increased by $150 for every 30 “gap”

days spent between homeless program stays, which suggests a possible link between engagement 

with the criminal justice system and homeless recidivism. 

The multivariate analysis for Jacksonville did not show a statistically significant relationship between

mental health costs and lengths of stay in homeless programs. This may mean that homeless 

programs, especially those that encourage longer lengths of stay, link mentally ill clients with routine 

outpatient treatment or otherwise stabilize clients sufficiently to reduce their need for more expensive 

crisis or in-patient psychiatric treatment. Alternatively, it is possible that more expensive service-rich

programs provide mental health services themselves, offsetting the need for mainstream mental health 

services. Or perhaps persons who successfully stay in transitional housing or permanent supportive 

housing are not the individuals with the greatest or most severe mental health needs, therefore 

suggesting that those with higher needs and associated treatment costs leave earlier or never enroll in

the first place.27 Many other explanations are possible, but the relationship between homeless system

and mental health costs is notable. 

26	 We were not able to analyze changes in mainstream costs from one period to another using regression

analysis, since we did not have access to client-level data by domain and period in Jacksonville. 

27	 A 2006 HUD study of leavers and stayers in permanent supportive housing indicates that higher use of

mainstream mental health systems such as inpatient mental hospital admissions and emergency services 

during residence in permanent supportive housing is a strong predictor of leaving permanent supportive 

housing rather than staying long-term. (HUD, 2006) This finding supports the idea that people with greater 

mental health needs or less stable routine mental health treatment may have shorter lengths of stay in some

homeless program types. 

4–32 Chapter 4: First-time Homelessness for Individuals and its Associated Costs 
Chapter 4: First-time Homelessness for Individuals and its Associated Costs 4–33

Chapter 4. First-time Homelessness for Individuals and its Associated Costs 4-33 

 

 

 

 

 

 

Exhibit 4.18. Regression Analysis of Mainstream System Costs for First-Time Homeless 

Individuals in Jacksonville 

Outcome Variable: 

Costs of Mainstream Domains 

Physical 

Health 

Costs 

Mental 

Health Tx 

Costs 

Substance 

Abuse Tx 

Costs 

Income 

Supports 

Costs 

Criminal 

Justice Costs 

Homeless System Utilization 

Number of Homeless Program 

Stays 

-74.742** 

(36.628) 

-15.781 

(37.545) 

-15.465 

(14.559) 

-5.599 

(10.013) 

-34.855 

(21.201) 

Homeless Length of Stay (in 

months) 

198.681*** 

(47.651) 

-47.273 

(48.844) 

60.639*** 

(18.941) 

80.128*** 

(13.027) 

11.861 

(27.582) 

Homeless Gap Days (in months) 

13.062 

(43.528) 

-18.746 

(44.618) 

40.846** 

(17.302) 

0.982 

(11.900) 

149.972*** 

(25.196) 

Demographics+ 

Female 2,170.849*** 

(430.825) 

1,663.730*** 

(441.617) 

257.364 

(171.251) 

1,770.719*** 

(117.779) 

-992.334*** 

(249.377) 

Black 560.360* 

(337.435) 

-907.569*** 

(345.888) 

-378.032*** 

(134.129) 

280.946*** 

(92.248) 

380.364* 

(195.320) 

Other race 209.352 

(925.260) 

575.892 

(948.438) 

-745.892** 

(367.788) 

-174.340 

(252.948) 

814.333 

(535.575) 

Age: 18-24 646.639 

(656.886) 

1,237.724* 

(673.342) 

-192.726 

(261.110) 

416.656** 

(179.580) 

91.847 

(380.230) 

Age: 25-30 128.096 

(589.908) 

636.365 

(604.686) 

-196.469 

(234.486) 

248.953 

(161.269) 

-59.916 

(341.461) 

Age: 41-50 47.339 

(416.223) 

237.133 

(426.649) 

15.568 

(165.447) 

-152.958 

(113.787) 

-639.606*** 

(240.925) 

Age: 51 or above 912.642* 

(503.089) 

1,065.059** 

(515.691) 

-43.218 

(199.976) 

-104.207 

(137.534) 

-1,094.955*** 

(291.206) 

Constant 477.218 

(380.681) 

1,183.239*** 

(390.217) 

727.681*** 

(151.319) 

394.947*** 

(104.071) 

1,820.685*** 

(220.352) 

Observations 1972 1972 1972 1972 1972 

R-squared 0.04 0.02 0.02 0.16 0.04 

+ Reference categories are Males, Whites, and Ages 31 – 40. 

Covariates for missing gender, race, and age were included in the full models (Appendix B). 

Standard errors in parentheses. *significant at 10%; **significant at 5%; ***significant at 1%
 

In Houston, unlike Jacksonville, a positive and statistically significant relationship was found 

between homeless program lengths of stay and mental health costs (Exhibit 4.19), as well as between

homeless system costs and mental health costs (Appendix C.3). Among persons who received mental 

health treatment, on average each additional month spent in homeless programs was associated with 

an increase of $136 in mental health costs. The Mental Health and Mental Retardation Authority of 

Harris County offers numerous mental health programs targeting people who are homeless, including 

mental health programs that work in conjunction with local law enforcement officials and hospitals to

divert individuals who are homeless from jail and inpatient hospitals. The higher mental health costs 

associated with long periods of sheltered homelessness likely reflect this local system of care.

Alternatively, higher costs could reflect that individuals with mental illness are more likely to stay

longer in the homeless system because their mental illness affects their ability to secure and maintain 

permanent housing outside the homeless services system. 

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Exhibit 4.19. Regression Analysis of Mainstream Costs for First-Time Homeless 

Individuals in Houston 

Outcome Variable 

Mental Health 

Costs 

Criminal Justice 

Costs 

Homeless System Utilization 

2.035 -23.043* Number of Homeless Program Stays (15.330) (12.658) 

135.568*** -33.204 Homeless Length of Stay (in months) (31.638) (26.123) 

207.498*** 136.029*** Homeless Gap Days (in months) (28.694) (23.693) 

Demographics+ 

Females 408.504* -174.216 

(233.006) (192.393) 

African-Americans -281.174 62.298 

(216.820) (179.028) 

Other Races -671.700** -813.770*** 

(308.407) (254.652) 

Ages 18 – 24 -625.156 -388.749 

(414.834) (342.528) 

Ages 25 – 30 -28.563 -321.642 

(369.645) (305.216) 

Ages 41 – 50 -797.297*** -1,250.060*** 

(268.755) (221.911) 

Age 51 and Above -1,498.154*** -1,635.552*** 

(334.779) (276.428) 

Another covariate was also included for mainstream system involvement. 

Constant 1,990.985*** 2,520.263*** 

(262.855) (217.039) 

Observations 4,404 4,404 

R-squared 0.04 0.04 

+ Reference categories are Males, Whites, and Ages 31 – 40. 

Standard errors in parentheses *significant at 10%; **significant at 5%; ***significant at 1%
 

In addition, individuals in Houston who have gaps between homeless program stays have even higher 

mental health costs. For each additional 30 days of time spent between homeless stays, mental health 

costs increase by $207. This correlation suggests that in addition to facing challenges remaining in 

permanent housing, individuals with mental illness may also have a difficult time staying in

homelessness programs. 

Like the Jacksonville results, criminal justice costs in Houston are associated with gaps between 

homelessness. For each additional 30 days spent between various homeless program stays, criminal 

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justice costs for individuals in Houston increase by $136. 28 Data were not available for Medicaid, 

substance abuse services, or entitlement programs in Houston. 

The regression models also included covariates for gender, age, and race (Exhibits 4.18 and 4.19). 

Controlling for homeless system use, single women are associated with much higher mainstream

costs in most domains than men. In Jacksonville, first-time homeless women are associated with 

$2,171 more in physical health costs, $1,664 in mental health costs, and $1,771 in food stamps and 

TANF than first-time homeless men in Jacksonville. Women are also associated with $992 less in 

criminal justice costs. Similarly, first-time homeless women in Houston have higher mental health 

costs of $409. The cost differences for criminal justice expenses are not statistically significant. 

Older age is also associated with statistically significant cost differences. Individuals in Jacksonville 

and Houston over 40 are associated with lower criminal justice costs, $640 to $1,250 less for 

individuals between 41 and 50 years of age and $1,095 to $1,635 less for individuals over 50. In 

Jacksonville, individuals over 50 have $913 higher physical health costs and $1,065 higher mental 

health system costs. In Houston, older adults are associated with lower mental health costs, $800 for 

individuals between 41 and 50 years of age and $1,498 for individuals over 50. 

Race is also associated with statistically significant cost differences (Exhibits 4.18 and 4.19). In 

Jacksonville, African-Americans are associated with $560 more in physical health costs, $281 more

in food stamps and TANF, and $380 more in criminal justice costs, but $907 less in mental health 

treatment costs and $378 less in substance abuse treatment costs. These results provide a mixed 

picture, since they suggest that African-Americans are better connected to income support programs

and may have fewer behavioral health needs, but have greater involvement with criminal justice. 

From this analysis, we cannot tell when the costs occurred in relation to homelessness. In Houston, 

individuals of “other” races had significantly lower mental health and criminal justice costs, but the 

results for African-Americans are not statistically significant. 

The results for cost differences associated with gender, age, and race are very interesting considering 

that women, African-Americans, and relatively older individuals are all associated with higher 

homeless system costs. 

4.4.6 Mainstream Costs Associated with Different Path Groups of First-Time Homeless 

Individuals 

The average per person mainstream system costs for each of Jacksonville’s path groups in the periods 

before, during, and following homelessness are shown in Exhibit 4.20. This exhibit illustrates the 

wide-range of mainstream costs for different subgroups of the study cohort defined by ways in which 

they use the homeless services system. Permanent Supportive Housing Long-Stayers incur the most 

mainstream costs when compared with other path groups. For this group, the period during 

homelessness refers almost entirely to the time individuals spent in permanent supportive housing 

programs that were part of the homeless system. Since eligibility for permanent supportive housing is 

contingent upon having a chronic disability, it is not surprising that this group has high mainstream

costs across all three periods. 

28 The multivariate regression analysis for criminal justice may be affected by missing identifiers for the street 

only path group. The matching algorithm and process used for mental health records was more 

comprehensive. 

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Exhibit 4.20: Jacksonville Cohort’s Average Per Person Monthly Mainstream Costs By Path 

Group and Period 

$0 

$200 

$400 

$600 

$800 

$1,000 

$1,200 

$1,400 

Single ES Short

Stayers

Street/ ES Short

Stayers

Single ES Long

Stayers

Multiple ES Long

Gappers

Sequential Short

Stayers

Sequential Long

Stayers

Circling/Relapsers

PSH Long

Stayers

All Paths 

Mainstream Costs Following 

Homelessness 

Mainstream Costs During 

Homelessness 

Mainstream Costs Prior to 

Homelessness 

Average Per Person Monthly 

Mainstream Costs 

Path Groups 

We conducted multivariate analysis to show the extent to which mainstream costs for the total study

period are greater for certain subgroups defined by the paths they take through the homeless services 

system. An extract of the regression models for each mainstream domain in Jacksonville is shown in 

Exhibit 4.21, and the complete model is provided in the Jacksonville case study Appendix B.

Descriptions of the path groups were presented in Section 4.3.4. 

Exhibit 4.21: Modeling Mainstream Costs for First-Time Homeless Individuals in Jacksonville by 

Path Groups 

Mainstream System 

Costs 

Medicaid 

Costs 

Mental Health 

Tx Costs 

Substance 

Abuse Tx Costs 

Entitlement 

Costs 

Criminal 

Justice Costs 

Emergency Shelter 

Short Stayers Omitted: reference category 

Emergency Shelter 

Long Stayers 

1,629.965 

(1,118.827) 

-1,238.011 

(1,158.049) 

-12.359 

(448.596) 

2,326.988*** 

(306.924) 

47.142 

(656.299) 

Emergency Shelter 

Long Gappers 

-540.835 

(576.914) 

-163.468 

(597.138) 

349.426 

(231.315) 

-93.135 

(158.263) 

1,677.589*** 

(338.415) 

Street/ES Short 

Stayers 

-134.925 

(400.498) 

-2.881 

(414.539) 

312.461* 

(160.581) 

-4.741 

(109.867) 

541.743** 

(234.931) 

PSH Long Stayers 7,562.911*** 

(1,005.047) 

-177.606 

(1,040.280) 

1,174.122*** 

(402.976) 

439.888 

(275.711) 

839.736 

(589.556) 

Sequential Program 

Users (Short Stayers) 

910.630 

(577.251) 

1,306.901** 

(597.487) 

883.603*** 

(231.450) 

-247.596 

(158.355) 

43.786 

(338.613) 

Sequential Program 

Users (Long Stayers) 

-634.893 

(1,233.235) 

-716.680 

(1,276.468) 

1,345.077*** 

(494.468) 

43.305 

(338.309) 

42.512 

(723.410) 

Circling Program Users 

-342.969 

(658.072) 

-501.256 

(681.141) 

491.023* 

(263.855) 

325.064* 

(180.526) 

1,099.228*** 

(386.022) 

Model also included covariates for Gender, Race, and Age 

Constant 476.466 

(410.918) 

978.383** 

(425.323) 

587.542*** 

(164.758) 

467.889*** 

(112.726) 

1,682.568*** 

(241.042) 

Observations 1972 1972 1972 1972 1972 

R-squared 0.06 0.02 0.02 0.18 0.04 

Standard errors in parentheses. *significant at 10%; **significant at 5%; ***significant at 1% 

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The model shows that those who go directly to permanent supportive housing and stay there for 

relatively long periods have on average Medicaid costs $7,563 higher and substance abuse costs 

$1,174 higher than short-stayers in emergency shelter, the reference category. Surprisingly, long 

stayers in permanent supportive housing do not have higher mental health costs than short stayers in 

emergency shelter. This may be because some of the permanent supportive housing programs target 

individuals with chronic addictions who may have fewer mental health treatment needs. Another 

possible explanation is that permanent supportive housing programs may be serving as caretakers for

individuals with less severe mental health needs rather than a therapeutic model for those with acute 

needs. However, the model that predicts mental health costs has R-squared statistics of only .02, so 

patterns of homelessness and demographic characteristics may not be most relevant covariates for 

explaining results. 

The two path groups who move in sequence from emergency shelter to transitional housing or 

permanent supportive housing and do not come back to emergency shelter have high substance abuse

costs and (for one of the path groups) high mental health costs. Sequential Users (Short Stayers) were

associated with over $1,300 in additional mental health costs, and an additional $884 in additional 

substance abuse costs on average, compared with Emergency Shelter Short Stayers. Sequential Users 

(Long Stayers) were associated with an additional $1,345 in substance abuse costs, but did not have 

higher mental health costs. As we discussed earlier in this chapter, the Sequential Users spend a long 

time in transitional housing, in which program staff may play a role in facilitating access to intensive 

substance abuse treatment. It is not clear whether the higher costs for this path group reflect greater 

service needs of these individuals or whether they merely had greater access to services. 

Three path groups had high criminal justice costs: those who had long gaps between emergency

shelter stays; those who spent time on the streets; and those who circled back and forth between 

program types. This finding clearly links the criminal justice system to those individuals whose 

needs are not fully met by the homeless residential system. Individuals whose criminal justice costs 

are rooted in jail time served prior to homelessness may be more likely to follow one of these three 

paths. At the same time, those who have long gaps between stays are often incarcerated during these 

gaps. 

A similar model, shown in Appendix C.3, predicts which of the path groups in Houston have

particularly intensive use of mental health services and the criminal justice system. Four path groups 

area associated with higher mental health costs. Individuals with long gaps between stays had on 

average $2,300 to $3,000 more in mental health costs than individuals with brief stays in emergency

shelter. These higher mental health costs may reflect recurring stays in in-patient treatment programs 

prior to and during homelessness. The Sequential Users with long stay in homeless programs,

primarily in transitional housing, also have mental health treatment costs $2,085 higher than brief 

users of emergency shelter. These costs may be related to inpatient treatment prior to homelessness 

or during, but may also be a reflection of service linkages with mental health programs established as 

a results of staying in certain types of homeless programs. Two of the groups with multiple homeless 

stays and long gaps between stays were associated with higher criminal justice costs than emergency

shelter short-stayers. Emergency Shelter Long Gappers had $1,179 in higher jail and arrest costs, and 

Circlers had $1,943 more in criminal justice costs. Individuals who used transitional or permanent 

supportive housing only were also associated with $791 more in criminal justice costs. 

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4.5. Homeless System and Mainstream Costs for First-Time 

Homeless Individuals During the Period of Homelessness 

Exhibit 4.22 compares the costs per person for the homeless services system and selected mainstream

systems in Jacksonville and Houston and shows that the homeless system costs were much higher. It 

is important to note that this study was not able to collect utilization and cost information for some 

high-cost mainstream domains, such as locally funded emergency room care or emergency medical 

transport. The ratio of homeless to mainstream costs to some degree reflects the relatively low levels 

of involvement with mainstream systems during homelessness for most in the cohort and the fact that

the majority of costs are concentrated among a smaller percentage of the study cohort. This suggests 

that while there may be limited opportunities for cost offsets in mainstream systems for most of the 

first-time homeless cohort, there may be opportunities within the homeless system to allocate

resources to support better outcomes for homeless individuals. There continue to be opportunities to 

identify cost-effective interventions targeting individuals with intensive or high-cost use of 

mainstream systems. 

In Section 4.1, we discussed past research on patterns of homelessness and the growing body of 

research that has been completed on costs associated with homeless individuals who are severely

mentally ill or individuals who are identified as frequent users of inpatient or high-cost mainstream

systems. Past research on homeless individuals has recognized that costs can be assumed to be quite 

low for the majority of homeless individuals, but has not quantified them. This study shows that the 

Exhibit 4.22: Homeless and Selected Mainstream System Costs per Person Incurred 

during Homelessness 

Jacksonville Houston 

Costs 

% of 

Total Costs % of Totala 

Homeless System $1,634 62% $2,257 80%
 

Selected Mainstream Systems $1,018 38% $547 20%
 

a

This percentage is not very meaningful, since the Houston case study includes such limited mainstream domains. 

overall Jacksonville study cohort incurred an average total cost of just over $2,600 per person during 

homelessness (totaling homeless and mainstream systems costs shown on Exhibit 4.22), substantially

lower than the annual estimates of $40,500 per person from the NY/NY Cost Study (Culhane et al., 

2002).29 However, examining the average costs of the full cohort is not nearly as meaningful for

policy purposes as focusing on costs associated with more specific subgroups that could be targeted 

with alternative interventions. 

Exhibit 4.23 presents the costs of five of the eight path groups from the Jacksonville case study (our 

most comprehensive findings) to illustrate the range of costs that have been identified for different 

29 Note that these figures are provided for discussion purposes only. The two studies are not directly

comparable because of the differences in the research objectives and designs, study populations, geographic 

locations, and timeframes for analysis. 

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homeless single adult populations in comparison with the NY/NY Cost Study.30 This discussion 

assumes that local stakeholders have a mechanism to predict future patterns of homelessness as the 

basis for targeting various interventions—presumably the subject of future research. 

Emergency Shelter Short Stayers represent more than half of the first-time homeless study cohort 

in Jacksonville. Individuals in this group have average stays of less than one month and could

theoretically be targeted for prevention strategies. Thus, a major policy question is whether resources 

currently used to house these individuals in shelter could be allocated differently to fund a prevention 

approach. The exhibit shows that, because of their short stays in shelter, the group is associated with 

only $686 per person in homeless system costs and incurs only $452 in mainstream system costs per 

person while homeless. While prevention strategies might hope to decrease some of the mainstream

costs such as criminal justice involvement ($138), other mainstream use is desirable, such as receipt 

of food stamps/TANF ($69) and Medicaid Managed Care ($19). Therefore, to be cost-neutral, 

stakeholders in Jacksonville would need to limit a prevention intervention to an average per person 

cost of $1,000 if cost offsets from both mainstream and homeless systems were used. Given the 

difficulty of reprogramming mainstream resources, only the $686 under the control of the homeless 

system might be available. 

Exhibit 4.23: Comparison of Costs During Homelessness Among Select Jacksonville Path Groups 

and Costs from the NY/NY Study Cohort Prior to Placement in Permanent Supportive Housing 

Jacksonville ES 

Short Stayers 

Jacksonville ES 

Long Stayers 

Jacksonville 

Circlers 

Jacksonville PSH 

Long Stayers 

NY/NY Cost 

Study SMI Cohort 

Path Group Description Less than one Continuous stay in Average 5 months Average one year in 41⁄2 months in 

month spent in ES; ES averaging 10 (8 distinct stays) in homeless programs shelter over 2 yr 

43% also had months homeless across 3 stays, period 

contact with street programs, primarily in PSH. 

outreach teams returning to ES All psychiatrically 

after TH or PSH; Evidence of disabled with 

spread over 10 disability criteria for severe mental 

months PSH. illness 

Homeless System $686 $9,756 $3,987 $8,493 $4,658 

Medicaid (Primary $126 $829 $282 $3,716 $14,208 

Health, Mental Health, 

Substance Abuse) 

Local Hospitals $6,229 

State Mental Health $57 $126 $40 $467 $12,520 

Treatment 

State Substance Abuse $62 $164 $92 $786 -

Treatment 

Criminal Justice $138 $57 $1,400 $561 $1,012 

Income Supports $69 $1,777 $243 $667 

Veterans Affairs $1,822 

Total Per Person $1,138 $12,709 $6,044 $14,691 $40,451 

Total may not reflect the sum of the domains due to rounding. 

30	 Emergency Shelter Short Stayers combines Jacksonville’s ES Short Stayers and Street/ES Short Stayers; 

therefore, five of the eight Jacksonville path groups are represented by the four groups discussed in this 

section. 

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Emergency Shelter Long Stayers represent a small percentage of the Jacksonville cohort, but they

had almost year-long continuous stays in emergency shelter and were associated with substantial 

costs. More than one-third of these individuals received Medicaid-funded primary health care 

(average $829 per person), so it is possible that medical conditions contributed to their long lengths of 

stay. If a locality wanted to target these individuals, they could flag individuals with stays longer than 

a specified length. Three-quarters of the costs associated with this group were incurred within the 

homeless system itself, an average of $9,756 per person. These costs were equivalent to 15 months of 

rent subsidy at the FY2006 Fair Market Rent of $643 per month (HUD, 2005). Mainstream costs 

were substantial, but mainly because 77 percent of the group received food stamps during 

homelessness with an average total benefit of $1,551 per person. Future research would be required 

to know if an alternate housing intervention could achieve cost offsets through reductions of primary

or behavioral healthcare expenses. 

Circlers, 7 percent of the Jacksonville study cohort, spent almost 5 months in residential homeless 

programs spread over the course of more than 10 months. Individuals in this path group were 

characterized by a pattern of returning to emergency shelter at some point after an earlier stay in 

transitional or permanent housing. Because this group had frequent gaps when individuals were not 

staying in homeless programs, the homeless costs (almost $4,000 per person) were not as high as 

some other groups. About one-third of this group received mental health care at some time during the

study period, but a smaller portion accessed primary health care than in other groups. More than 40 

percent were involved with criminal justice at an average cost of $1,400 per person, more than twothirds of all mainstream costs incurred by this group during homelessness. Arrests and jail sentences 

may have occurred between homeless stays, or may have caused the disruption in program usage 

resulting in the return to shelter. Criminal justice agencies may be interested in partnering to design 

an intervention to target this group. 

Permanent Supportive Housing Long Stayers were associated with the highest costs per person, an 

average of almost $15,000 per person for homeless and mainstream services. The individuals in this 

group spent an average of one year staying in residential homeless programs, primarily in permanent

supportive housing. Thus, rather than identifying costs associated with homelessness, data for this

path group essentially illustrates the homeless and mainstream costs that were incurred when the 

homeless system stably housed disabled individuals who experienced first-time homelessness. Most 

of the $8,500 in homeless system costs per person in this group was incurred for permanent housing, 

so conceptually these costs are quite different from costs for the other path groups. These individuals 

each received an average of $6,200 in mainstream services while in homeless programs, most for

primary health care ($3,452) and substance abuse treatment ($950). This group also had a fairly highlevel of criminal involvement ($561 per person) during this period. It is somewhat surprising that the 

individuals in permanent supportive housing did not receive higher levels of mental health treatment, 

though several of these projects targeted individuals with chronic addictions, rather than persons with 

severe mental illness. These data would need to be parsed further to understand how homeless and 

mainstream costs varied when the individuals were in shelters or transitional housing as compared 

with permanent housing, but most of the mainstream costs were incurred while in permanent housing. 

The final column of the Exhibit displays the costs incurred by the NY/NY Cost Study cohort in the 

two years prior to placement in supported housing. This group averaged close to five months in 

shelter during this period and incurred high levels of mainstream services during this timeframe. The 

differences in costs between the NY/NY cohort and the Jacksonville path groups reflect several 

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factors. The most significant is that all members of the NY/NY cohort were severely mentally ill and 

presumably had greater treatment needs and service utilization than any of the Jacksonville path 

groups. The figures also reflect significant differences in costs in different parts of the country, as 

well as state-to-state and city-to-city differences in service levels and access to services.31 Therefore, 

communities have varying opportunities to achieve cost offsets when employing alternative

interventions. This comparison clearly illustrates the point made by Rosenheck (2000) that high-cost 

interventions must be targeted to individuals with high-cost service utilization in order to be costneutral. That is not to suggest that other populations should not be targeted with high-cost 

interventions for ethical, social and other reasons. 

4.6. Policy Implications and Recommendations for Further 

Research 

This chapter documents the patterns and costs associated with first-time homelessness for individuals, 

and perhaps most importantly, the wide range of costs incurred by individuals with different patterns 

of using homeless residential programs. For the majority, stays in homeless programs are a single 

brief occurrence, and costs are minimal. For a small percentage, stays are long, and costs are 

significant. High homeless system costs frequently reflect extended use of higher cost transitional 

housing. Average homeless system costs per person appear to overshadow average mainstream costs 

per person for most during homelessness, since a relatively small percentage of individuals interact 

with mainstream systems during homelessness. And those with extended periods of homelessness are 

not consistently associated with intensive or high-cost mainstream use. Further, while average

monthly mainstream costs peak during homelessness, when graphed based on the month-by-month 

utilization, mainstream system costs actually increase dramatically immediately before homelessness 

and peak immediately after the individual enters the homeless residential system. Thus, while cost 

savings may be achievable within the homeless system for long-stayers, the data from these three sites 

do not suggest significant cost savings within mainstream systems can be achieved by ending 

homelessness for first-time long-stayers as a whole. 

4.6.1 Opportunities for Cost Savings 

From a policy perspective, this study affirms past research and emphasizes that communities should

be cautious when extending per person averages to a broad group of homeless individuals. The 

greatest costs and the greatest potential for cost savings are found among the very small percentage of 

individuals who stay the longest in the homeless system or who have intensive involvement in high 

cost mainstream systems. Policymakers seeking cost-effective interventions for homelessness will 

need to appropriately target strategies to each group. 

Communities can use this type of cost analysis to explore in much more detail how individuals use 

homeless residential programs, the associated costs, and the potential for cost offsets. But 

communities must recognize that cost offsets may not be possible for some of the largest groups of 

individuals who become homeless, and saving money is not the only reason to deliver housing and 

services differently. The majority of individuals who experienced first-time homelessness in this 

31 For instance, in 2006, New York was ranked first with $2,316 in per-capita Medicaid spending for 2006, 

whereas Florida was ranked 46th with $706 per-capita spending (Public Policy Institute of New York State, 

n.d.). 

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study had very short stays with low associated homeless system costs. Nonetheless, communities 

could consider whether the average shelter cost per person for this subgroup could be reprogrammed 

(and potentially augmented) to support prevention and shelter diversion strategies. 

Other policy considerations and cost saving possibilities are raised or affirmed by this research. 

•	 Emergency shelter has low costs for short stayers, but is expensive and presumably an 

inappropriate intervention for longer stayers. Although the idea of prevention is appealing, 

the emergency shelters seem to provide an immediate, low-cost response to homelessness for 

the majority of individuals. It would be very difficult to fund a prevention response at such 

low cost, particularly since it may be challenging to identify up front which of the 

individuals’ homelessness could be prevented with minimal assistance. Perhaps the 

emergency shelter system is an “adequate” response to an immediate housing crisis for most 

individuals, and a place in which individuals who are not able to quickly resolve their 

housing crisis can be more deliberately assisted or referred to more intensive interventions. 

For instance, emergency shelters could target case management or specialized assistance to

individuals who have been in shelter for 30 days or more. 

•	 Higher mainstream costs in some domains were associated with individuals with multiple 

episodes of homelessness (Long Gappers). Communities could target individuals who return 

to shelter for a second (or third) non-consecutive program stay. This group (and others) may

also particularly benefit from intentional prevention-oriented discharge planning strategies 

and other strategies implemented in conjunction with criminal justice systems to reduce 

repeat incarceration. 

•	 For some subgroups, total homeless system costs incurred per person exceed the cost of an 

annual direct housing subsidy. Communities may want to consider whether housing 

assistance would be a lower cost and potentially equally effective intervention for some of 

these groups. 

•	 Transitional housing is generally one of the most expensive homeless program models. 

While this study does not look at long-term efficacy of this program model or its overall costeffectiveness, communities may want to consider whether it is possible, and still consistent 

with program objectives, to shorten lengths of stay in transitional housing through more rapid 

out-placement, to target transitional housing more specifically to those who are less stable or 

more likely to interact inappropriately with mainstream systems and therefore need longer 

term housing support with intensive services, or to reduce the costs of the most expensive 

transitional housing programs. 

•	 We surmise that one reason individual women cost more than individual men is that they may 

be more likely to be housed in programs that also serve families and therefore have a higher 

cost structure. Communities that are advancing a transitional housing solution may want to 

develop transitional housing for single women that can take advantage of a lower cost

structure for individuals. 

•	 Very few individuals in this study used permanent supportive housing, either immediately

upon entering the homeless services system or after a stay in emergency shelter or transitional

housing. We did not examine whether a larger percentage were eligible or appropriate for 

this model, but communities may want to assess whether capacity constraints in permanent 

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supportive housing may be contributing to episodic homeless behavior or longer stays in 

shelter or transitional housing for others. 

•	 Any local system that attempts to change how individuals experience homelessness must 

presume that there are valid strategies to identify and triage people based on their predicted 

use of system resources. This study suggests that certain groups, such as single women over 

40 years old, have higher costs than others; lower cost strategies may be able to be developed 

to house these subgroups more effectively. In this case, age and gender could be coupled 

with other basic screening criteria to triage potential high cost users to alternative 

interventions. More work is needed to understand both predictors and interventions that may

be more effective for various subgroups. 

•	 Some individual homeless programs used by first-time homeless individuals were extremely

expensive, as shown in this chapter by the high costs of the homeless services system for 

particular groups of individuals even when lengths of stay are controlled for. (See Chapter 3 

for more detail on program costs.) Communities should examine homeless program cost 

outliers for possible efficiency gains. 

In identifying these ideas, we hope to increase understanding of how diverse the patterns of first-time

homelessness are, as are presumably the needs of those who experience it, and the strategies and 

resources that are deployed to address it. These possibilities for cost-savings are offered to spark

discussion about ways to identify opportunities to use existing resources to improve local homeless 

systems. However, to reiterate, this study did not examine cost-effectiveness and therefore, we do not

mean to imply that lower cost assistance is better. This study measured only costs associated with 

homelessness. Although the methods we use may be useful in other circumstances to measure costs 

of alternative interventions, any effort to alter current programs or to create new interventions should

be conducted with a comparable understanding of their relative effectiveness for different groups. 

4.6.2 Methodological Lessons 

An important methodological finding of the study is that analysts should be cautious using averages 

to calculate costs for a group of homeless individuals. Not all people incur the same level of costs, 

nor do they present an opportunity to achieve the same level of cost savings. If a community intends

to target all people who are homeless, then applying an average to understand costs or cost savings is 

less of a concern, but a community planning a targeted intervention should recognize that most of the 

cost savings will be achieved for a small minority of homeless individuals and that they must use 

appropriate subgroup data to estimate the savings for the individuals they are targeting. For instance, 

if Jacksonville were to develop a prevention initiative for individuals who would otherwise spend less 

than a week in shelter, analysts in Jacksonville must assume that the homeless system cost offset is 

approximately $600, not the average homeless cost of $1,600 incurred by the complete Jacksonville 

study cohort. 

Client-level data allowed us to: understand and graph the distribution of costs to the homeless system

and some select mainstream systems; conduct multivariate analysis to understand whether costs were 

associated with certain demographic characteristics or homeless patterns that may be able to be used 

by communities to predict costs or target interventions; and avoid misusing averages for service 

utilization, costs, and misleading average costs calculated for broad time periods. Future studies 

should attempt to collect and analyze client-level data whenever possible. 

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4–44 4-44 Chapter 4. First-time Chapter 4: First-time Homelessness for Individuals and its Associated Costs Homelessness for Individuals and its Associated Costs Abt Associates Inc. 

 

 

 

 

4.6.3 Recommendations for Future Research 

In numerous places throughout this chapter, we have cited limitations of our findings. Future 

research could examine several areas to further our understanding of costs of homelessness for firsttime homeless individuals. One of the most important findings on mainstream data was the pattern of 

costs peaking around the first day of homelessness. These patterns need more analysis to understand

how costs taper off after homelessness, teasing out the associations with subsequent episodes of 

homelessness. This study also defined the period during homelessness broadly as the period between 

the first day in a homeless program and the last, inclusive of gaps between stays. More analysis could 

be conducted on mainstream system costs to understand the frequency and types of service use 

relative to the times when individuals were staying in homeless programs and gaps between stays, 

and whether use varied by the type of homeless program used. 

Additional data could also be gathered on other mainstream domains (or all of the mainstream 

domains for the Des Moines case study) to build a more comprehensive understanding of costs. To 

address methodological limitations, client-level service utilization data should be collected, if at all

possible, for all (new and existing) mainstream domains to enable communities to more closely

examine trends relative to periods before and immediately following the start of homelessness. With 

more complete client-level data, additional multivariate regression analysis could also be conducted 

to further understand the factors that are associated with higher costs for various path groups. 

Finally, these methodologies could be employed as part of broader research examining the costeffectiveness of various interventions for different subgroups—arguably, one of the most important 

policy question facing communities today. 

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5. First-time Homelessness for Families and its 

Associated Costs 

This chapter examines the patterns of sheltered homelessness for families and associated costs to the 

homeless services and mainstream systems. The most important themes about costs associated with 

first-time homelessness for families that emerged are that the study: 

•	 Confirms earlier research that long stays in the homeless services system are very 

expensive and makes explicit that most families with long periods of sheltered 

homelessness use transitional housing, either exclusively or in combination with 

emergency shelter. 

•	 Shows that housing vouchers are less expensive than transitional housing per day or per 

month. Whether the cost of transitional housing is ultimately lower than the cost of a 

permanent voucher--because transitional housing is temporary—is an open question. 

•	 Identifies a group of highly troubled families that cycle in and out of the homeless

services system and have very unstable household composition, often including men for 

part of the total period of homelessness. Unlike heavy users of transitional housing, the 

outcomes of the use of the homeless services system by these highly unstable families are 

unambiguously negative in that they are never stably housed. An alternative treatment 

model for these families that focuses on their family instability rather than their housing

instability may be needed. 

•	 Shows that African-American families, shown by other research to be homeless at higher 

rates than other poor families, are associated with lower average costs per family in

comparison to white families. 

•	 Shows that, among the domains for which we were able to collect data, the highest rates 

of utilization and costs for homeless families are the medical costs reimbursed by 

Medicaid. 

•	 Concludes that short-term costs to the criminal justice system, while troubling, do not 

appear high enough to suggest opportunities for offsets. We were not able to collect cost 

data for the use of the child welfare and foster care systems by homeless families in any

of the study communities. This is an area in which additional research might find 

opportunities for cost offsets. 

•	 Suggests—on the basis of the limited information collected for this study—that local 

policies designed to prevent families from becoming homeless and divert those on the 

brink of homelessness can succeed. 

5.1. Existing Research 

The 2007 Annual Homeless Assessment Report (AHAR) describes some salient characteristics of 

sheltered homeless families across the nation (HUD, 2008). Most adults who become homeless with 

their children are women (82 percent), a higher percentage than the two-thirds of adults in all poor 

families who are women. More than half of sheltered homeless families are African American. 

Homeless families are particularly likely to include children younger than age six. 

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Like the AHAR estimates based on HMIS data from a nationally representative sample of 

communities, most previous research on homeless families describes their characteristics. The 

literature has focused on trying to predict which poor families are at greatest risk of becoming 

homeless, given that few families become homeless even among the very poor. Rog, Holupka and 

Patton (2007) found that only 8.7 percent of a study sample of “fragile families”—recent mothers 

with incomes below 50 percent of the poverty level—became homeless during a three-year follow up

period. Various studies have shown that mental health, substance abuse, and domestic violence are 

factors that put parents at risk of becoming homeless, but researchers have not been able to predict 

which families with these risk factors will become homeless (Rog and Buckner, 2007; Shinn, Rog, 

and Culhane, 2005). 

5.1.1 Patterns and Costs of Family Homelessness 

Based on a literature review, an expert panel, and some reanalysis of data, Rog, Holupka and Patton 

(2007) developed a framework for a typology of homeless families, but not a typology itself. They

concluded that two typologies of homeless families are needed: a “prevention” typology that would 

help communities focus their resources on families at highest risk of becoming homeless, and a 

“resource allocation” typology that would help communities assist families who become homeless in 

cost-effective ways. 

Culhane, Metraux, Min Park, Schretzman and Valente (2007) began to develop a resource allocation 

typology, based on cluster analysis of administrative data, conducted separately for New York City, 

Philadelphia, Columbus OH, and Massachusetts. Generalizing across the results of cluster analysis

based on number of shelter stays and cumulative days of shelter use over a three year period in New 

York and Philadelphia and a two-year period in Columbus and Massachusetts, they identify three 

groups of first-time homeless families: 

•	 Temporary: Families who use shelters or transitional housing for a single, relatively 

short, period of time and do not return to the residential system for homeless people after 

leaving it; 

•	 Episodic: Families who cycle in and out of programs for homeless people, with

relatively short stays for each homeless episode; and 

•	 Long-Stayer: Families who stay for long periods of time in shelters, transitional housing, 

or both. 

Culhane and his co-authors (2007) find that “Long-Stayer” families are by far the most expensive for

the homeless services system. The average lengths of stay for this group ranged from six months 

(187 days) in Columbus to more than a year (444 days) in New York City, costing $21, 692 per 

family in Columbus, $30,812 in Philadelphia, $48,440 in Massachusetts, and $55,200 in New York 

(Exhibit 5.1). They question whether this is a cost-effective use of resources, given that these “Long 

Stayers,” who make up about a fifth of all sheltered homeless families, are not more intensive users of 

targeted social services than other groups of homeless families. They base this assessment on the 

rates at which families use such social services as mental health and substance abuse treatment and 

the foster care system. 

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Exhibit 5.1: Average Cost per Family to the Homeless Services System, based on Lengths of 

Stay and Shelter Reimbursement Rates for Each Community 

Columbus, OH Philadelphia Massachusetts New York City 

Temporary $3,828 $4,900 $11,550 $13,900 

Episodic $17,168 $19,043 $21,450 $38,500 

Long Stayer $21,692 $30,812 $48,440 $55,200 

Source: Culhane, Metraux, Park, Schretzman, and Valente, 2007. 

Culhane et al. (2007) match families in their study sample to selected mainstream systems for which 

they were able to obtain data. However, they do not report the costs of mainstream system use or

suggest whether these costs could be reduced by preventing or ending homelessness for particular 

families. Such analysis of cost offsets has been confined to the individual homeless population and is 

discussed in Chapter 4. 

As far as we know, this is the only previous analysis of the costs of homelessness for families. Other 

studies have been program evaluations that have reported on the outcomes of interventions for

homeless families, but not systematically on their costs.1 

5.1.2 This Study and Previous Research on Costs of Family Homelessness 

This study of family homelessness in four additional communities—Kalamazoo, MI, Houston, TX, 

Upstate South Carolina, and Washington, D.C.—builds on and differs from Culhane et al. (2007) in 

the following ways: 

•	 Like Culhane et al., we use cluster analysis, conducted separately for each of our four 

communities, to identify groups of first-time homeless families who follow different 

patterns or “paths” of use of the homeless services system. However, we use additional 

dimensions—type of program used, sequences of program use, and the lengths of “gaps” 

during which families are not in a residential program for homeless people—to create 

these clusters. 

•	 Like Culhane et al., we use data from selected mainstream systems to which we were 

able to gain access to interpret the relative neediness of families and also to infer what 

caused them to become homeless. 

•	 Instead of standard reimbursement rates for public funding of residential programs for 

homeless people, we use actual costs of programs collected from program budgets. This 

enables us to explore the influence of different types of programs on homeless costs. 

•	 For three of the four communities, we are able to report data on the costs of the use of 

mainstream systems by homeless families and to make some inferences about potential 

cost savings and offsets. 

For a summary of this literature, see Locke, Khadduri, and O’Hara, 2007. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–3 

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5.2. Characteristics of First-Time Homeless Families 

We studied first-time homelessness among families in Houston, Washington DC, Kalamazoo, and 

Upstate South Carolina.2 Across the four sites, we identified 1,374 families as first-time homeless 

between July 1, 2004 and June 30, 2005.3

 Although Houston is by far the largest community in the 

study in terms of general population, only 35 percent of the study population is in Houston and 

Washington DC had almost as many first-time homeless families as Houston (Exhibit 5.2). 

The characteristics of the families in the study cohort in each site are shown in Exhibit 5.2. At all 

sites, most were single-parent families, and most adults were female. However, all sites included 

some adult men. The percentages of family members identified as black or African American reflect 

differences among the four communities. At the same time, as is the case for the AHAR national 

estimate, homeless families at these sites were disproportionately African American, compared with 

the African American percentage of the poverty population in the same communities. Nevertheless, 

all sites except for DC have many white families. Because of limitations of the HMIS data for these 

four communities, we were not able to determine the percentage of families who identified 

themselves as Hispanic or Latino. The AHAR estimate is that, nationally, 22 percent of homeless 

families identify themselves as Hispanic (all races), considerably lower than the percentage of all

poor families who are Hispanic (HUD 2008). In each of the communities and especially Houston, the 

percentage of first-time homeless families who are minorities, including families identifying 

themselves as Hispanic, doubtless is somewhat higher than the percentage who are African American. 

Exhibit 5.2: Characteristics of the Study Cohort of Families Who Became Homeless 

between July 1, 2004 and June 30, 2005 

Number of 

families 

Adults who 

are male 

African 

American 

Average Age 

of Adults 

Average 

Family Size 

Houston 477 13% 61% 32 3.2 

DC 410 17% 93% 32 3.5 

Kalamazoo 342 15% 61% 30 3.2 

Upstate SC 145 11% 53% 31 3.0 

The age of adults and average family size for the study cohorts in the four communities are very

similar to those characteristics for homeless families nationally, as estimated by the AHAR (HUD 

2008). Nationally, adult men are somewhat more common among adults in homeless families (18 

percent), compared to the first-time homeless study cohorts in the study communities except for 

Washington, DC. 

2	 A family was defined as a group of people who were served together at any time during the study period

and who, at any time during the study period, included at least one adult (18 or older) and one child (17 or

younger) when served by a program for homeless people. As a result, members of homeless families 

sometimes were found in programs serving homeless individuals at the study sites. “Stays” in individual 

programs were considered part of the overall period of homelessness, and their costs were included in the 

costs of serving homeless families. 

3	 In Kalamazoo, we identified families for the study cohort based on first entry into the homeless system

between January 1, 2005 and December 31, 2005. 

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We followed all members of each family in the study cohort for 18 months after the family (or one of 

its members) first appeared in the homeless services system. For DC, we were able to follow the 

study cohort for 30 months following the beginning of homelessness, and we decided to take 

advantage of this longer observation period because we found few families in the study cohort in 

transitional housing or permanent supportive housing when we followed them just for the first 18 

months after their first entry into the homeless residential services system for homeless people. 

When a family had more than one “stay” in a homeless program during the observation period, we 

often found that the composition of the household changed over the family’s total period of 

homelessness. Change took a variety of forms: different adults appeared together with children; 

different children appeared together with adults; adults appeared without children during some 

program stays and with children in others; two adults were present at some times and not at others. 

Exhibit 5.3 shows the percentage of families with more than one program stay in each of the sites and

also the extent of change in household composition. 

Exhibit 5.3: Changes in Household Composition among Homeless Families 

Families with change 

in composition 

(entire study cohort) 

Families with more 

than one program 

stay 

Families changing 

composition among 

those with more than 

one program stay 

Houston 25% 28% 65% 

Washington, DC 34% 42% 76% 

Kalamazoo 13% 32% 35% 

Upstate SC 17% 35% 43% 

At every site, at least one quarter of the families had more than one program stay, and a substantial 

fraction of those changed household composition when comparing household membership at the start 

of one program stay to the next. In the District of Columbia, which has the highest rates of

composition change, more than a third of the study families changed in composition between stays 

during their period of sheltered homelessness. 

Multivariate analysis presented later in this chapter will show that, after controlling for many other 

potential cost drivers including total days spent in homeless programs, families that changed

composition had substantially higher costs to the homeless services system than those that did not. 

5.3. Patterns of Family Homelessness and Associated Homeless 

System Costs 

5.3.1 Homeless System Utilization 

Central to costs to the homeless services system is how the system is used and, in particular, how 

many days a family spends in residential programs for homeless people. As shown in Exhibit 5.4, we 

found that the average total time that families spent in homeless programs during their period of 

homelessness varied dramatically across the four communities in the study, from just over 3 months 

in Kalamazoo to more than 9 months in DC. 

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The exhibit does not reflect lengths of stay for families in DC who used only a program--Community

Care Grants—that places families directly from a central intake system into permanent housing and 

provides them with case management and short-term rental assistance. The “stays” reported to the 

HMIS for Community Care Grants reflect long periods of program enrollment during which families 

may receive case management provided by the homeless system but are not in the residential system

for homeless families. Such lengths of stay are not comparable to lengths of stay within emergency

shelter, transitional housing, or permanent supportive housing. The observation period in DC was 

longer—30 months rather than 18 months. The figures in parentheses on Exhibit 5.4 show lengths of 

stay and other patterns for the DC families for the first 18 months after they became homeless and 

show that DC still has the longest lengths of stay of any of the four communities. 

The communities with relatively shorter lengths of stay, Kalamazoo and Houston, had a more skewed 

distribution, as shown by the difference between the average days spent in homeless programs and the 

medians and lowest quartiles (Exhibit 5.4). In Houston, half the study sample spent fewer than two 

months in homeless residential programs, and a quarter of the families were sheltered for 15 days or

less. In Kalamazoo, half the study sample was in a program for a month or less, and a quarter of the 

families stayed 5 or fewer days. In DC, by contrast, the quarter of the sample with the briefest

periods of sheltered homelessness still was in the system for more than a month. 

Long periods spent by families in residential programs for homeless people may reflect housing 

market characteristics—for example a tight and expensive housing market and long waiting lists for 

assisted housing in Washington, DC—but may also reflect the way the homeless services system is 

organized and the relative attractiveness of the emergency and transitional housing facilities available

in the community. Other factors that may affect long stays in DC include a central intake and 

screening process that may divert some families who otherwise would be short-stayers. In addition, 

DC had both congregate emergency shelters and “second stage” emergency shelters that provided

private apartments without the time limits imposed by federal law on many transitional housing 

programs. Kalamazoo and Houston’s systems may be structured to move families out faster. 

Exhibit 5.4: Use of the Homeless System by the Study Cohorts of First-Time Homeless 

Families during an 18-Month Perioda 

Average 

days in 

homeless 

programs 

Median 

days in 

homeless 

programs 

25th 

percentile 

days in 

homeless 

programs 

Average 

number of 

program 

stays 

Average “Gap 

Days” 

between 

staysb 

Houston 114 50 15 1.4 29 

DC 289 (223) 168 (129) 46 (38) 2.6 (2.1) 92 (35) 

Kalamazoo 94 31 5 1.5 61 

Upstate SC 186 103 27 1.4 25 

a

For DC, the figures outside the parentheses are for the full 30-month observation period. The figures inside the 

parentheses show utilization patterns by the same families for the first 18 months following their entry into the

homeless services system.

b

Includes the total of all days during entire period of homelessness when no family members were in residential 

programs for homeless people. If a family had only one program stay or consecutive stays, the gap would be 0 days. 

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Families in the homeless services system

experienced between 25 and 92 “gap

days” on average—that is, days during the 

family’s entire period of homelessness 

when no family members were in a 

residential program for homeless people. 

We cannot tell whether families were 

living in their own housing units or 

unstably housed with family or friends 

during these periods. It is unlikely that all 

family members were homeless on the 

street (DC, for example reports to HUD 

that there are no families with children 

among its street homeless population) or

that all members of the family were 

incarcerated or in hospitals or other 

inpatient programs.4 

Multivariate analysis shows that, even 

after controlling for other factors that may

influence lengths of stay, such as the type 

of program used (emergency shelter, 

transitional housing, or a combination of 

the two) and a large number of family

demographic characteristics, the 

community in which a family was 

homeless had a powerful effect on its 

length of stay. Exhibit 5.5 reports the 

results of the multivariate analysis. When 

multiplied by 100, the coefficients for the 

covariates can be interpreted as 

percentage differences from the reference 

category, since the outcome variable is in 

logarithm scale. Compared with 

Kalamazoo (the reference category), DC

families were sheltered 91 percent longer, 

Upstate South Carolina families 71 

percent longer, and Houston families 45 

percent longer. 

Exhibit 5.5: Regression Analysis of the Length of 

Stay for First-Time Homeless Families 

Families in DC a 

Families in South Carolina 

Families in Houston 

Site 

Household Characteristics 

0.913*** (0.115) 

0.714*** (0.135) 

0.449*** (0.098) 

Total length of stay (log scale) 

Any change in household composition 

during the study period 

Total number of adults in household 

Total number of children in household 

0.443*** (0.104) 

-0.045 (0.183) 

0.077** (0.032) 

Transitional Housing-only program 

type 

Program Types Used 

2.436*** (0.100) 

Emergency Shelter and Transitional 

Housing-only program type 

1.988*** (0.137) 

Other program type 

Demographics 

1.921*** (0.164) 

Female adult-only household type 

Male adult-only household type 

African American household head 

-0.361* (0.210) 

-0.127 (0.271) 

-0.132 (0.097) 

Household head ages 18-24 

Household head of other race 

Household head ages 25-30 

-0.269** (0.113) 

-0.182 (0.191) 

-0.057 (0.105) 

Household head ages 51 or above 

Household head ages 41-50 

0.538* (0.281) 

0.145 (0.123) 

Household with youngest child born 

after study entry 

Household youngest child ages 6-12 

Household youngest child ages 13-17 

Household head race missing 

Household head age missing 

0.224 (0.238) 

0.103 (0.101) 

0.176 (0.162) 

-0.312 (0.245) 

-0.522 (0.634) 

Constant 

Observations 

R-squared 

Youngest child age missing 

2.812*** (0.407) 

1285 

0.48 

-0.183 (0.299) 

Reference categories are: clients in Kalamazoo, Emergency 

Shelter-only program type, mixed-adult household type, white 

household head, household head ages 31-40, household youngest 

child ages 0-5 

a Excluded CCG/SAFAH-only families in DC 

Standard errors in parentheses. 

*significant at 10%; **significant at 5%; ***significant at 1% 

Not unexpectedly, the most powerful factor for determining families’ lengths of stay in the homeless 

services system was the type of program they used. (Again, this analysis does not include families 

who used only the Community Care Grants program in DC, for which lengths of stay reflect a period 

Some of these “gaps” may represent incomplete HMIS data. Not every provider in these communities 

contributes data to the HMIS. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–7 

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of case management rather than shelter within the homeless services system.) Controlling for other

factors, including the community in which the family was served, those using only transitional 

housing spent 3.45 times as many days in the homeless services system, and those using both 

emergency shelter and transitional housing spent approximately three times as many days as those 

who were only in emergency shelters. This model and others for which results are reported in this 

chapter were quite successful in explaining patterns and costs of family homelessness, as 

demonstrated by their large R-squared statistics. 

Among the demographic characteristics tested, having more children had a small but statistically 

significant positive effect on length of stay, and changing household composition during the period of 

homelessness led to a 44 percent longer length of stay, after controlling for study site and type of 

program used. Race was not found to have a statistically significant effect on lengths of stay among 

study cohort families. This is an interesting finding, as the 2007 AHAR found that long-stayers in 

emergency shelter (among all families, not just first-time homeless families) were disproportionately

African American (HUD, 2008). 

Additional multivariate analysis predicting lengths of stay for first-time homeless families can be 

found in Appendix D.2.5. 

Even controlling for length of stay, the program type a family uses is a powerful determinant of costs 

to the homeless services. Exhibit 5.6 shows the number of families in the study cohort using each 

type of residential program for homeless people across the four study sites. In every community, 

more families used emergency shelter than transitional housing. The numbers of families shown in 

the exhibit to have used each type of program sum to more families than the study cohort because 

some families used both emergency shelter and transitional housing or some other combination of 

programs 

As shown in Chapter 3, emergency shelter and transitional programs have roughly equivalent daily

costs when congregate shelters are compared with facility-based transitional models and apartmentbased shelters are compared with scattered-site transitional models (See Exhibit 3.6). However, the 

costs of particular programs within each type of emergency shelter and transitional housing varied

widely at each site. In addition, the first-time homeless families in our study cohort sometimes used 

particular programs that were either more expensive or less expensive than the typical emergency or

transitional program serving families in that community. For example, in Houston the study cohort 

used extensively the most expensive transitional program, more costly in part because it offers many

on-site services. In DC, use of the least expensive emergency shelter program by the study cohort

was relatively rare. Whereas in Kalamazoo, the study cohort tended to use a particularly inexpensive 

transitional housing program;6 in Upstate South Carolina, first-time homeless families often used a 

relatively expensive emergency shelter program with a high ratio of staff to families served. 7 

5	 The coefficient of 2.4 indicates that these families spent 2.4 additional days for each reference day, or 3.4

times the reference category. 

6	 One of the property-based transitional housing programs in Kalamazoo has very low housing operating

costs, moderate service costs, and very low administrative overhead. The property also has very low

market value, and adding an estimate for capital costs would have increased the daily cost by only $1. 

7	 The program is heavily staffed by volunteers, and we included an estimate of the value of their time in the 

program cost. 

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Exhibit 5.6: Numbers of First-Time Homeless Families using Basic Types of Residential 

Programs for Homeless People by the Study Cohorts of First-Time Homeless Families 

Houston DC Kalamazoo Upstate SC 

Emergency shelter 400 317 271 109 

Transitional housing 131 107 91 63 

Permanent 16 26 11 0 supportive housing 

Other program 6 119 n/a 1 typesa 

a

Other types include outreach (Houston) and the Community Care Grants program (DC). We have not included

families who used only these programs in the multivariate analysis of the determinants of the use of program types or

in the multivariate analysis of the determinants of total program costs per family. Among other reasons, the meaning

of a “day” is ambiguous for these programs 

As shown in the exhibit, few first-time homeless families in any community used permanent

supportive housing (PSH). Permanent supportive housing is available only to families with a 

disabled adult. However, an examination of overall usage of permanent supportive housing during 

the study period also suggests a capacity constraint. Most PSH units available for families were 

already occupied by families who had become homeless before the start of our study period. 

We conducted multivariate analysis (Multinomial Logit model) to determine which types of families 

are most likely to use which types of residential program for homeless people. In this analysis, 

families who used Permanent Supportive Housing were grouped with the “other” category. Families 

that used only the Community Care Grants program in DC were not included in the model, so across 

the four study communities the “other” category usually means permanent supportive housing, either 

alone or in combination with emergency shelter or transitional housing. The results are reported in

Exhibit 5.7. The regression coefficients for the model are expressed in odds ratio format, with values 

greater than one showing that a particular type of household is more likely to use a program type than 

the reference group. The coefficients for the community in which a family is homeless show that 

families in Upstate South Carolina are more likely to use transitional housing in combination with 

emergency shelter than families in other communities, which may reflect a stronger pattern of 

referrals from emergency shelter to transitional housing in that community compared with others. 

Families in DC are relatively more likely than those in other communities to use an “other” program

type, which reflects the relatively greater availability of permanent supportive housing units for 

families in that community. 

The model shows that families with only adult women are not more likely to use transitional housing 

(alone or in combination with emergency shelter) than the small number of families in the study

sample that have only adult men or that have both men and women. The odds ratio for families with 

only adult women is greater than one, but the result is not statistically significant. The only 

demographic characteristic that helps explain which families use transitional housing, is whether the

family has a child born during the family’s period of homelessness. Such families are eight times as 

likely as those without a child born homeless to use both emergency shelter and transitional housing,

suggesting that these vulnerable families often get referred from emergency shelter to transitional

housing and pass whatever screening criteria transitional programs may use. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–9 
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Finally, the model shows that African American families and families with a younger head of 

household (18 to 24 years) are only about a quarter as likely to use the “other” program type 

(basically permanent supportive housing) as white families or relatively older families. This suggests

that young families and African American families who become homeless for the first time are 

relatively less likely than other first-time homeless families to have a disabling condition that made 

them vulnerable to becoming homeless. Having an adult household member with a disability

condition is a requirement for receiving permanent supportive housing. 

Exhibit 5.7: Regression Analysis of Program Types used by First-Time Homeless Families in 

Kalamazoo, DC, South Carolina, and Houston 

Program type Category (ES only; 

TH only; ES and TH only; Other) 

Multinomial Logit Model 

Base category = Emergency Shelter Only 

Transitional 

Housing Only 

Emergency Shelter 

and Transitional 

Housing Only Other 

Clients in DCd 0.852 (0.201) 1.346 (0.414) 9.246*** (3.822) 

Clients in South Carolina 1.622 (0.404) 3.433*** (1.080) 0.224 (0.237) 

Clients in Houston 0.990 (0.186) 0.984 (0.283) 1.433 (0.562) 

Total number of adults in household 1.102 (0.445) 1.220 (0.603) 2.156 (0.849) 

Total number of children in household 0.972 (0.064) 0.890 (0.080) 1.127 (0.096) 

Male adult-only household type 0.965 (0.579) 0.899 (0.643) 1.732 (1.190) 

Female adult-only household type 1.512 (0.705) 0.925 (0.509) 1.369 (0.688) 

African American household head 0.934 (0.173) 1.155 (0.302) 0.286*** (0.101) 

Household head of other race 0.713 (0.268) 0.164 (0.171) 0.000 (0.000) 

Household head ages 18-24 0.747 (0.168) 1.009 (0.316) 0.265** (0.118) 

Household head ages 25-30 0.961 (0.199) 1.370 (0.395) 0.925 (0.290) 

Household head ages 41-50 1.034 (0.261) 1.829 (0.585) 1.319 (0.424) 

Household head ages 51 or above 0.780 (0.465) 1.391 (0.948) 0.553 (0.451) 

Household with youngest child born 

after study entry 1.376 (0.745) 7.974*** (3.403) 1.124 (0.703) 

Household youngest child ages 6-12 0.763 (0.158) 1.013 (0.274) 1.016 (0.303) 

Household youngest child ages 13-17 1.164 (0.365) 1.035 (0.440) 1.454 (0.640) 

Household head race missing 0.432 (0.247) 0.290 (0.306) 0.198 (0.215) 

Household head age missing 0.575 (0.757) 0.000 (0.000) 0.000 (0.000) 

Youngest child age missing 3.324* (1.685) 0.912 (0.987) 3.284 (2.813) 

Constant 0.222 (0.197) 0.086* (0.094) 0.029*** (0.028) 

Observations 1285 

Log likelihood -1109.4261 

Reference categories are: clients in Kalamazoo, mixed-adult household type, white household head, household head ages 31-40,

household youngest child ages 0-5. Coefficients for households with missing values are included in the full model in Appendix 

Sections D.2.3 and D.2.4. 

Coefficients in relative risk ratio format 

Standard errors in parentheses. *significant at 10%; **significant at 5%; ***significant at 1% 

d Excluded CCG/SAFAH-only families in DC 

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Additional multivariate analysis predicting the type of program used by first-time homeless families 

can be found in Appendix Sections D.2.3 and D.2.4. 

5.3.2 Costs to Homeless System of First-Time Family Homelessness 

The cost for serving each first-time homeless family is the sum of the costs of each program stay by

one or more family members. The cost of each stay is the daily cost of the particular program used by 

the family times the number of days in the stay. The average cost to the homeless services system for 

each family in the study cohort ranges from only $3,184 in Kalamazoo, to $9,663 in Upstate South 

Carolina, to $11,627 in Houston, to $20,031 in Washington DC, as shown in Exhibit 5.8. The cost 

per family in DC drops to $16,205 if we consider only costs for program stays that occurred during

the first 18 months after a family enters the residential system, but is still much higher than any of the

other study communities. 

Exhibit 5.8: Average Homeless System Cost per Family 

Kalamazoo 

Upstate South 

Carolina Houston Washington, DCa 

Average Cost per $3,184 $9,663 $11,627 $20,031 Family 

a

The DC cost per family does not include families who used only the Community Care Grants program. Including such 

families would drop the average cost per family in DC to $17,962. 

With the exception of DC, these costs are substantially lower than the average costs identified by 

Culhane et al. in their study of homelessness in four other communities. 8 However, like patterns of 

utilization, the distribution of costs for each family in our study cohort is quite skewed, more so in 

some communities than in others. In Upstate South Carolina, the highest-cost 10 percent of the study

cohort accounts for 32 percent of the total cost to the system, while in Houston the 10 percent highestcost group accounts for 57 percent of the total system cost. In every study site, the lowest-cost half of 

the families accounts for less than one-seventh of the total cost incurred by the community for

serving first-time homeless families, although this ranges from 13 percent in Upstate South Carolina 

to 5 percent in Houston. 

The multivariate analysis of homeless costs includes covariates for sites, length of stay, program

types used and other variables that reflect program use patterns, including number of stays, and 

number of “gap days.” We also included whether the family changed composition during the period 

of homelessness, and the following basic family demographic characteristics: age of adults, age of 

children, number of adults, number of children, gender of head of household and race of head of

household. Exhibit 5.9 presents the results of this analysis. Since the outcome variable is in 

logarithm scale, the coefficients for the covariates can be interpreted as percentage differences from

the reference category when multiplied by 100. 

Appendixes D.2.1 and D.2.2 show how we arrived at this final model specification, using two 

different model construction approaches. Approach 1 starts with the basic building block of costs per 

family, first adding length of stay (Model 1) to dummy variables controlling for site differences. 

Culhane et al. (2007) found average costs per family to be $24,000 in New York City over three years and 

$19,690 in Massachusetts over two years. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–11 

8 
5–12 Chapter 5. First-time Homelessness for Families and its Associated Costs

 

 

 

 

 

 

 

 

Model 2 adds program type to site dummy variables and length of stay. Models 3 and 4 add program

use, number of stays, number of gap days between stays, and whether the family changed

composition between homeless stays. The final models (5 and 6) add basic family demographic 

characteristics. See Appendix D.2.1 for detailed results for all 6 models in Approach 1. 

Exhibit 5.9: Regression Analysis of Total Homeless Costs 

Total 

homeless 

costs 

(log scale) (cont.) 

Total 

homeless 

costs 

(log scale) 

Site Demographics 

Washington, DC a 0.836*** African American household head -0.290*** 

(0.103) (0.084) 

Upstate South Carolina 0.693*** Household head of other race -0.042 

(0.119) (0.166) 

Houston, TX 0.862*** Household head ages 18-24 -0.038 

(0.086) (0.099) 

Homeless System Utilization and Program Types 

Length of stay (in days) divided by 30 0.219*** Household head ages 25-30 0.020 

(0.008) (0.091) 

Transitional Housing-only program type 0.475*** Household head ages 41-50 0.086 

(0.111) (0.107) 

Emergency Shelter and Transitional 0.437*** Household head ages 51 or above 0.156 

Housing-only program type 

(0.133) (0.245) 

Other program type -0.427*** Household with youngest child born -0.465** 

after study entry 

(0.158) (0.209) 

Total number of stays 0.031 Household youngest child ages 6-12 0.205*** 

(0.024) (0.088) 

Total gaps between stays (in days), 0.028*** Household youngest child ages 13-17 0.195 

divided by 30 

(0.009) (0.141) 

Household Composition 

Any change in household composition 0.350*** Household head race missing -0.191 

during the study period 

(0.099) (0.213) 

Total number of adults in household -0.024 Household head age missing -0.802 

(0.160) (0.551) 

Total number of children in household 0.055** Youngest child age missing -0.061 

(0.028) (0.260) 

Male adult-only household type -0.230 Constant 6.283*** 

(0.236) (0.355) 

Female adult-only household type -0.245 Observations 1285 

(0.183) R-squared 0.64 

Reference categories are: Kalamazoo, MI, Emergency Shelter-only program type, mixed-adult household type, white household head,

household head ages 31 - 40, household youngest child ages 0-5.

Standard errors in parentheses. *significant at 10%; **significant at 5%; ***significant at 1% 

a

Excluded CCG/SAFAH-only families in DC
 

Approach 2 (Appendix D.2.2) starts with site dummies and basic family demographics (Model 1) and 

then adds program type (Model 3), length of stay (Model 4), and then numbers of stays and gap days

(Model 5). Models 2 and 6 also add the variable that reflects whether the household changed 

composition. See Appendix D.2.2 for detailed results for all 6 models in Approach 2. These 

alternative model specifications enable us to grasp the interactions among the variables in the full

model. 

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The analysis shows that DC, Upstate South Carolina, and Houston all have costs per family 70-90 

percent higher than Kalamazoo (the reference category). The lower cost per family in Kalamazoo 

reflects the use by first-time homeless families of particular emergency shelter and transitional

housing programs that have low costs. For example, the average daily cost of the transitional housing

programs used by the study cohort in Kalamazoo is only $22, much lower than the daily cost of 

transitional housing used by the study cohorts in the other three communities. Kalamazoo has several 

transitional housing programs, with a wide range of daily costs per unit, as described in Chapter 3. 

The differences in total cost per family among the other three communities are not very large when

controlling for type of program used and patterns of use such as lengths of stay. Coefficients range 

from .693 to .862 and show that the study cohort in Houston used slightly more expensive programs

within particular program types compared with the study cohorts in DC and Upstate South Carolina. 

Houston has a transitional housing program with very high operating and services costs, totaling $177 

per day. 

Overall, the regression results show that each additional 30 days spent in residential homeless 

programs compared to the mean length of stay of 144 days adds about 22 percent to the cross-site 

average total family cost to the homeless services system of $10,311. The effect of long lengths of 

stay in DC and Upstate South Carolina compound the already high costs in these communities. A 

model that does not control either for length of stay or for program type (Approach 2, Model 1) shows 

that first-time homeless families in DC and Upstate South Carolina cost the homeless services system

more than twice as much as families in Kalamazoo. The coefficients are 1.630 for DC and 1.442 for 

Upstate South Carolina. Families in Houston cost twice as much as families in Kalamazoo. (The 

coefficient is 1.016). 

Families who used emergency shelter together with transitional housing and no other programs (8 

percent of the study cohort across the three sites) cost 44 percent more than families that use just 

emergency shelter, whereas families that use just transitional housing (13 percent of the study cohort) 

cost 48 percent more than families that use just emergency shelter. Those who used “other” 

combinations of programs beyond emergency shelter and transitional housing incurred 43 percent 

lower costs than those who used only emergency shelter. These lower costs reflect the relatively low 

cost of permanent supportive housing for the small number of families in the study cohorts that used 

it.9

 As detailed in Chapter 3, the cost of permanent supportive housing to the homeless services 

system is low compared with both emergency shelter and transitional housing since services are 

primarily provided by mainstream systems, rather than directly by the homeless services system. 

The model results also revealed some differences in total cost per family related to family

characteristics. Families that change composition during their period of homelessness have costs 

about 35 percent higher than families that do not change. Despite the correlation between “gap days” 

spent in between program stays and changes in family composition, gaps (measured in 30-day

increments) also have a statistically significant, although small, positive effect on costs per family to 

the homeless services system. Given that length of stay and program types are also controlled, these 

This model did not include families in DC who used only the Congregate Care Grants or SAFAH 

programs. SAFAH provides housing placement assistance. Congregate Care Grants provides short-term

rental assistance and longer-term case management for families who never enter the residential system for 

homeless families. The resulting costs are extremely low for each day that the HMIS counts a family as 

being in the program. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–13 

9 
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results suggest that families with unstable housing and unstable family composition on average use 

more expensive programs within each program type. 

African-American families (70 percent of the study cohort across the four communities) have costs 29 

percent lower on average than white families. The implication is that, within each site and each 

program type, African American families are using relatively less expensive homeless services 

programs. This could be because African-American families, shown by other research to be homeless 

at higher rates than other poor families, have fewer service needs and are homeless related to poverty

and limited social supports that do not require intensive social services to address. Use of less 

expensive programs could also reflect an informal or clinical bias that results in fewer referrals or

admissions for African-American families into more intensive programs. 

In the full model, there is no significant difference in cost between families headed by people between 

the ages of 18 and 24 those headed by 31 to 40 year olds. Without controls for program types and 

length of stay, those between 18 and 24 cost about a third less than those between 31-40 (Approach 2, 

Models 1 and 2). Adding a control for program type reduces this difference to 25 percent (Model 3).

The difference disappears when the control for length of stay is added (Model 4). Thus, younger 

families are using less expensive types of programs and using them for shorter periods of time than 

relatively older families. 

Larger families (those with additional adults or additional children) cost the homeless services system

little more than smaller families. An additional child (compared to the mean of 2.12 children) 

produces a modest 6 percent increase in costs. Additional adults or adults of different genders have

no discernable effect on costs, and this result holds for models with and without a control for whether 

the composition of the family changed. To some extent, these results may stem from the way we 

collected program costs. We did not distinguish between the costs of different amounts of space 

needed for different families (e.g., numbers of beds or bedrooms) or for other costs that might vary by

family size such as the number of meals provided. We simply assumed that a particular program

incurs on average the same cost for each family using the program. As a whole, larger families do not 

use programs that, across all families served, have higher costs than the programs used by smaller 

families. 

We did find a relationship between the age of a family’s children and its costs to the homeless 

services system. Families whose youngest child is grade school age (6 to 12 years) cost 21 percent 

more than families with younger children. Families with children in that age range may choose to use 

programs—or be directed to programs—with more costly housing types or with additional services, 

compared with other first-time homeless families. 

5.3.3 Costs to the Homeless System for “Path Groups” of Families Who Use the System in 

Similar Ways 

To understand better the heterogeneity of the homeless experience and its associated costs among 

first-time homeless families, we used multivariate cluster analysis to categorize families into “path 

groups,” based on their total lengths of stay, number of discrete stays, total number of “gap days,” and 

types and sequences of programs used. Cluster analysis was conducted independently for each site, 

and each of the communities was found to have paths that were not replicated precisely at the others. 

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However, the following broad categories of path groups emerged in each of the four study sites. 

• Brief users of emergency shelter 

• Heavy users of transitional housing 

• Repeat users of residential homeless programs with long gaps 

Exhibit 5.10: Common Paths Taken by First-Time Homeless Families 

Brief users of 

emergency shelter 

(% of study cohort) 

Heavy users of 

transitional housing 

(% of study cohort) 

Repeat users of one 

or more program 

types with long gaps 

(% of study cohort) 

Houston 66% 29% 5% 

DCa 33% 30% 16% 

Kalamazoo 61% 24% 16% 

Upstate South Carolina 49% 42% 10% 

Percentages within each site may sum to greater than 100 percent due to rounding. 

a

DC percentages exclude those who were served exclusively by the Community Care Grants program. In addition, eleven

percent of families in DC followed paths not found in other sites, See Section 5.3.4. 

Exhibit 5.10 shows the size of these groups across the four communities. Brief users of emergency

shelter make up roughly two-thirds of the families in Houston and Kalamazoo, almost half of the 

families in Upstate South Carolina, and one-third of the families in DC. Heavy users of transitional 

housing are more than a quarter of the study cohort in Houston, DC, and Kalamazoo, and 42 percent 

in Upstate South Carolina. “Long gappers,” families with multiple program stays and long 

cumulative periods in between stays, make up a relatively small portion of all first-time homeless 

families. They are most common in DC and Kalamazoo. 

The path groups are characterized by their shelter use patterns, but analysis of demographic 

characteristics and mainstream program involvement helps to describe further the differences among 

the groups. Exhibit 5.11 summarizes some of the ways in which families who followed particular 

path groups differ from other first-time homeless families in the study cohort. 

Brief Users of Emergency Shelter have one or two stays in emergency shelters, spend a few days to 

a few months there, and then do not return to the residential system for homeless people.10 Across 

our four study communities, they had relatively younger and smaller households and, based on their 

use of mainstream systems, had relatively lower needs than other families in the study cohort (Exhibit 

5.11). 

10 This pattern held in DC, where we were able to follow families over a 30-month period after their first 

appearance in the homeless services system. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–15 
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 - 

 

 

 

 

 

 

Exhibit 5.11: Selected Characteristics of First Time Homeless Family Path Groups 

Brief users of 

emergency shelter 

Heavy users of 

transitional housing 

Repeat users of one or 

more program types with 

long gaps 

Compared with other First-Time Homeless Family Path Groups at each site: 

Younger adults and Fewer men More men 

children More likely to be white More likely to be “other” 

Houston Least involvement with 

mental health treatment 

Heavy users of mental 

health system 

race 

68% experienced 

and criminal justice household change 

systems High arrest rates 

Demographics not Fewer men More men 

distinct from rest of Somewhat younger 92% experienced 

cohort adults and children household change 

DC Lower use of Among highest use of High rates of involvement 

substance abuse substance abuse and with child welfare 

services mental health services High use of substance 

abuse services 

Younger adults, smaller More men 58% experienced 

Kalamazoo households 

Lower arrest rates 

More likely to be white household change 

High arrest rates 

Lower use of Medicaid 

Younger adults and Demographics not More men 

Upstate South children, smaller distinct from rest of More likely to be white 

Carolina households cohort 64% household change 

Lower use of Medicaid High arrest rates 

Across the four study sites, this group represented between 33 percent and 66 percent of each cohort, 

but accounted for only 9 percent to 30 percent of total homeless system cost. Exhibit 5.12 shows the 

average household cost to the homeless services system for the path groups in each community 

following this pattern. They range from under $1000 to almost $9,000, depending on a combination 

of the average number of days spent in programs (shown on the Exhibit) and the relative cost of 

programs used. For example, costs in Upstate South Carolina are relatively high for its brief-user 

families compared with the number of days spent in programs, because many first-time homeless 

families used a very expensive type of emergency shelter. 

Exhibit 5.12: Average Household Cost to the Homeless Services System for Brief Users 

of Emergency Shelter 

Average Total 

Length of Stay 

Average Total Cost 

per Family 

Houston Emergency Shelter Short Stayers 37 days $2,321 

Houston Emergency Shelter Repeat Users 101 days $5,748 

DC Congregate Emergency Shelter Short Stayers 67 days $5,098 

Kalamazoo Emergency Shelter Single Use Short 15 days $1,172 

Stayers 

Kalamazoo Emergency Shelter Repeat Users 48 days $2,977 

SC One-Week Single Stayers 9 days $784 

SC One-Month Returners 31 days $2,508 

SC Three-Month Single Stayers 88 days $8,890 

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Heavy Users of Transitional Housing use transitional housing exclusively, in combination with 

emergency shelter, or (in a few cases) together with permanent supportive housing. Their average 

length of stay ranges from 8 to 18 months, depending on the community and the specific path 

revealed by the cluster analysis for that community (Exhibit 5.13). 

Across the four communities, heavy users of transitional housing were somewhat more likely to be 

white and had a smaller percentage of men. However, in Kalamazoo this group includes more men, 

probably because one of the primary transitional housing programs in Kalamazoo accommodates

two-adult families. In DC, heavy users of transitional housing are on average somewhat younger 

families than other path groups. 

Unlike Culhane et al., (2007) we did not find that these “long stayers” in the residential services 

system for homeless families were less likely to be heavy users of mainstream behavioral health 

services than the study cohort as a whole. In Houston, they were heavy users of the mental health 

system, and in DC they had among the highest rates of use of mental health and substance abuse

services of the path groups.11 However, Culhane et al. (2007) looked only for use of intensive 

behavioral health services such as inpatient or acute care (in Philadelphia and Massachusetts),

whereas we recorded any contact with the mental health system (in Houston and DC) or the substance 

abuse agency (in DC). 

Like Culhane et al. (2007), we found that the long periods of time spent in the homeless services 

system made this by far the most costly group of families. Exhibit 5.13 shows that the average cost 

per family to the homeless services system for heavy users of transitional housing ranged from $6,474 

in Kalamazoo, a community with the relatively small percentage of such families and frequent use of 

a particularly inexpensive transitional housing program by first-time homeless families,12 to $38,742 

in Washington DC for a group that first used emergency shelter and then moved to transitional 

housing, with an average total length of stay of 551 days. Heavy users of transitional housing 

represented only 24 percent to 42 percent of the families in each community, but incurred between 47

percent and 82 percent of total homeless system costs. 

11	 Culhane et al.’s “long stayers” group does not distinguish between long stayers in emergency shelter and 

long stayers in transitional housing. Our most comparable group may be a path group in DC (discussed 

below in Section 5.3.4) that uses apartment-style emergency shelters as well as congregate emergency 

shelters and has long stays. The homeless services system in DC may be more similar to New York City 

and Philadelphia than the systems in our other study communities, in which we did not find a path group of

long-term users of emergency shelter. This path group in DC has rates of involvement with the behavior

health systems similar to rates for heavy users of transitional housing and a higher rate of involvement with

the child welfare agency. 

12	 One of the property-based transitional housing programs in Kalamazoo has very low housing operating

costs, moderate service costs, and very low administrative overhead. The property also has very low

market value, and while we did not record capital costs for any of the programs in Kalamazoo, Houston, or

DC, adding an estimate for capital costs would have increased the daily cost by only $1. In contrast, one of 

the transitional housing programs that was heavily used by the Houston family study cohort, representing 

47 percent of the transitional housing stays by families in Houston, has high operating costs and extremely 

high service costs. The overall program costs are two to seven times higher than other transitional 

programs in Houston, and the services alone are almost triple those of the other family facility-based 

transitional housing programs for which we collected costs. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–17 
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Exhibit 5.13: Cost to the Homeless Services System for Heavy Users of Transitional Housing 

Average 

Total 

Length of 

Stay 

Average Total 

Cost per 

Family 

Average 

Monthly Cost 

Per Family 

(including gap 

days) 

Local TwoBedroom Fair 

Market Rent FY 

2006b 

Houston Multi-Program Users 

Houston Housing-Program 

Users 

236 days 

284 days 

$26,913 

$35,344 

$2,544 

$3,584 $743 

DC Progressing Long-Stayersa 

DC Transitional Housing Onlya 

551 days 

477 days 

$38,742 

$31,822 

$1,960 

$2,001 $1,225 

Kalamazoo Long Stayers 289 days $6,574 $664 $612 

SC Progressing Long-Stayers 

SC Transitional Housing Only 

329 days 

375 days 

$16,036 

$15,478 

$1,358 

$1,226 $599 

a

If only the first 18 months following the family’s first entry into the homeless services system are counted, the average cost

per family for DC is $31,951 for progressing long-stayers and $25,771 for those who use only transitional housing.

b

FY2006 FMR is provided for Greenville, SC MSA, which is part of the Upstate South Carolina CoC geography and appears 

to have the highest FMR in the CoC (HUD, 2005) The FMR does not include the monthly fee paid to a public housing agency 

for administering the voucher program, which ranged from $50 to $90 per unit per month in these four communities. (HUD, 

2007) 

The exhibit also shows the cost per family standardized to a one-month cost and compares it to the 

cost of housing a family similar in size to most homeless families with a Housing Choice Voucher, 

assuming that the family’s share of the rent would be the same in both cases—that is, that transitional 

housing, like the voucher program, would require a family rent payment of 30 percent of income. 

The far greater cost of transitional housing in every community except for Kalamazoo to some extent 

may reflect the use of more expensive residential structures by transitional housing programs, but 

probably mainly reflects higher costs associated with on-site supervision for some programs and case 

management and other services for all transitional housing programs. 

Whether the additional cost of transitional housing produces offsetting benefits, compared with

placing a homeless family directly into permanent housing with a voucher, is beyond the scope of this 

study. For example, the services provided in connection with transitional housing might enable a 

parent to become economically self-sufficient and pay the cost of a private market rent from earned

income. The short-term cost of transitional housing then might offset the cost of a longer-term

voucher rent subsidy. The evidence we have to date suggests that is not the case. Burt (forthcoming 

2009) interviewed former users of transitional housing deemed by program staff to have left 

successfully. She found that longer stays in transitional housing were associated with some positive

outcomes, but that the most successful leavers of transitional housing did so with a voucher. 

Repeat Users of Residential Homeless Programs with Long Gaps may use just emergency shelter 

or may use a combination of emergency shelter and transitional housing. What distinguishes this 

relatively small group of families (5 to 16 percent of the study cohort) is that they leave the residential

homeless services system and then return—not a few days later, but after long absences. The 

cumulative “gaps” in service during their entire periods of homelessness range from 134 days for the 

path group in South Carolina (where the “gapper” pattern was less pronounced than in other 

communities) to 515 days for families following this path in the District of Columbia, who have an 

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average of 7.2 discrete program stays and on average remain in a residential program for only 38 days

at a time. Their average gap ranges from two and a half months in DC to six months for one of the 

groups in Kalamazoo (Exhibit 5.14). 

Exhibit 5.14: Patterns of Use of the Residential Homeless System for “Long Gapper” FirstTime Homeless Families 

Average 

Number of 

Program 

Stays 

Average Days 

per Program 

Stay 

Average 

Cumulative 

gap days 

Average gap 

between each 

stay 

Houston Emergency Shelter 

Long Gappers 3.4 stays 19 days 346 days 144 days 

DC Long Gappers 7.2 stays 38 days 515 days 79 days 

Kalamazoo Emergency Shelter 

Long Gappers 3.1 stays 12 days 378 days 180 days 

Kalamazoo Multi-Program 

Long Gappers 3.3 stays 44 days 275 days 120 days 

Upstate South Carolina SixMonth Returners 2.3 stays 77 days 134 days 103 days 

Note: The average gap is average cumulative gap days divided by one fewer than the average number of stays, since gaps 

have to take place between stays. 

We do not know the extent to which these “long gappers” attempt to establish themselves as 

leaseholders between homeless program stays or how frequently they temporarily move in with 

family or friends. Suggestive characteristics of these families are that they experience very high rates

of change in household composition and often include men at some point during their periods of 

sheltered homelessness (Exhibit 5.15). Thus, their housing instability may be linked to unstable 

situations involving family conflict or, in some cases, arrests and jail time. 

Families with long gaps had high arrest rates in Houston, Kalamazoo, and Upstate South Carolina. In 

Upstate South Carolina, 71 percent of this group of families had a family member arrested at some

point during the study period. We did not obtain criminal justice data for DC. In Washington, DC, 

the only community for which we were able to obtain any data at all from the child welfare system,

we found that 55 percent of this group of families had a service record with the child welfare agency

during the year before homelessness or following the start of homelessness. 

Compared with all first-time homeless families in the community, families in the long-gapper group 

in Upstate South Carolina were relatively more likely to be white rather than African American. In 

Kalamazoo, they were somewhat more likely to be African American than the cohort overall (Exhibit

5.15). In DC, where almost the entire study cohort is African American, the long gapper group 

includes more families identifying their race as white, Asian, or “other.” In Houston, where the longgapper group makes up only 5 percent of the study cohort, this group is slightly more likely to be 

African American than the study cohort as a whole. At the same time, a relatively high percentage of 

long gappers in Houston (23 percent) reported their race as “other” or refused to identify their race. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–19 
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Exhibit 5.15: Selected Demographic Characteristics of “Long Gappers” 

Change in 

Household 

Composition 

Percent of 

Adults who are 

Men 

Percentage African 

American: 

Gappers/ 

study cohort 

Houston Emergency Shelter Long 68% 28% 67% / 61% Gappers 

DC Long Gappers 92% 24% 89% / 93% 

Kalamazoo Emergency Shelter Long 61% 16% 67% / 61% Gappers 

Kalamazoo Multi-Program Long 53% 10% 68% / 61% Gappers 

Upstate South Carolina Six-Month 64% 18% 35% / 53% Returners 

Because of the relatively small number of days spent in the homeless services system, the cost to the 

system for this group of highly unstable families is relatively low. Across the four sites, the group 

represented only between 5 percent and 16 percent of each cohort and incurred between 1.5 percent 

and 20 percent of total costs. As shown in Exhibit 5.16, cost per family ranges from $3,295 for a 

group in Kalamazoo that used only emergency shelter to $17,314 for a group in Washington DC that 

spent a relatively long time in residential programs, despite being out of the system for long periods 

as well over their total period of homelessness. 

Exhibit 5.16: Average Cost Per Family to the Homeless Services System for Repeat 

Users of the Residential Services System with Long Gaps 

Average Total Average Total Cost 

Length of Stay per Family 

Houston Emergency Shelter Long Gappers 63 days $3,885 

DC Long Gappers 273 days $17,314 

Kalamazoo Emergency Shelter Long Gappers 38 days $3,295 

Kalamazoo Multi-Program Long Gappers 144 days $5,925 

Upstate South Carolina Six-Month Returners 176 days $12,475 

Opportunities for cost savings to the homeless services system through helping these families to 

achieve stable rather than unstable housing when they leave shelter seem to be largest in Washington

DC and in Upstate South Carolina. In DC we tracked families for a longer period after they first 

became homeless, 30 months instead of 18 months, and this is reflected in the relatively large number

of days spent in homeless programs, almost 10 months on average and the large number of stays, 

7.2.13 The high cost in DC reflects both this relatively long length of stay for a “gapper” group and 

13	 If only the first 18 months following the family’s first entry into the homeless services system are counted, 

the average number of stays per family for DC long gappers is 4.7 and the average total length of stay is

164 days. The average total cost per family is $10,462. 

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the high cost of the particular programs used. In DC and perhaps in other communities as well, cost

offsets may be possible within the homeless services system, as well as for mainstream public 

systems, if costs over a period of many years are considered. 

The group most similar to long gappers in the Culhane et al. (2007) study of New York City, 

Philadelphia, Columbus OH, and Massachusetts is “Episodic” users of the shelter system, but this 

group has longer lengths of stay, ranging from 148 days in Columbus to 385 days in New York. The 

“Episodic” group has considerably higher homeless system costs than the costs of the “long-gapper” 

groups in Houston, Kalamazoo, and Update South Carolina: $17,168 in Columbus, $19,043 in 

Philadelphia, $21,450 in Massachusetts, and $38,500 in New York. Only in Washington DC are the 

costs for “long gappers” similar to the costs of “Episodic” users in the Culhane et al. study. 

The longer stays and higher cost measured by Culhane et al. (2007) may be in part a result of how 

total days in the homeless service system are measured (they ignore program exits if the family

returns to shelter within 30 days) and also a three-year observation period in New York and 

Philadelphia. At the same time, the costs per day of shelter used by Culhane, based on “jurisdictional 

reimbursement rates” are high compared with the cost per day for many of the programs for which we 

collected cost data directly from financial records. Columbus reimburses programs at $116 per day, 

Massachusetts at $110 per day, Philadelphia at $94 per day, and New York City at $100 per day. By

comparison, we found the average cost of congregate emergency shelters used by our study cohort 

was $71 per day in Houston, $85 per day in DC, $75 per day in Kalamazoo, and $81 per day in

Upstate South Carolina. 

Unlike heavy users of transitional housing, the outcomes of long-gapper families’ use of the homeless 

services system as it currently is constituted are unambiguously negative. An alternative treatment 

model for these families that focuses on their family instability rather than their housing instability

may be needed. 

5.3.4 Costs to the Homeless System of Other Patterns of First-time Homelessness in 

Washington DC 

Washington DC has two program types not found at the other sites, and families using those 

programs are not included in the path groups discussed in Section 5.3.3. 

Apartment-style Emergency Shelters in DC are considered emergency shelters because, unlike 

transitional housing programs, they do not have admission requirements other than homelessness and 

because they are not subject to the two-year time limit for federally funded transitional housing. 

During the period in which we conducted the study, almost all families using the three facilities that 

comprised this program type went there after an initial stay in a congregate emergency shelter.14 

Apartment-style emergency shelters had a cost per day for first-time homeless families in the study

cohort of $79.80, slightly lower than the average cost of congregate shelters (despite providing each 

family with a self-contained apartment) and slightly higher than the daily cost of transitional housing. 

We identified a separate path group in DC consisting of families who used both congregate and 

apartment-style emergency shelters and no other type of residential program, 9 percent of the study 

14	 Subsequently, DC’s main congregate emergency shelter for families was closed down, and the central

intake center for homeless families began sending families directly to apartment-style emergency shelters. 

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cohort of first-time homeless families.15 Selected characteristics of this path group are shown in 

Exhibit 5.17 and compared with the characteristics of the path groups that used transitional housing. 

In many ways this path group is similar to the group that used both emergency shelter and transitional 

housing. Lengths of stay are similar, and the total cost per family to the homeless services system is 

similar. The only notable demographic characteristics for the group using both types of emergency

shelter but not transitional housing are the high percentage that have five or more persons in the 

household and the high percentage of male adults. Other demographic characteristics, not shown on 

the exhibit, are similar to those of other path groups. This path group also had the highest rate of 

service encounters with the child welfare agency of any of the DC path groups, 56 percent. These 

family characteristics may help explain the long stays within what is supposed to be an emergency

shelter system: large families and families that include adult men may be hard to place into 

transitional housing programs or into permanent housing in the private market. 

Other factors that may influence the long lengths of stay for families using both congregate and 

apartment-style emergency shelter may be the fairly rich services available in the apartment-style 

programs16 and the relative attractiveness of these apartments that come with some restrictions on 

privacy and independence but are rent free in a housing market with high rents and long waiting lists 

for assisted housing. 

Exhibit 5.17: First-Time Homeless Families Using both Congregate and Apartment-Style 

Emergency Shelter (and not transitional housing) in Washington DC 

Total cost per 

family 

Average 

length of stay 

Families with 5 

or more persons 

Percent of 

adults who are 

men 

DC Congregate and 

Apartment ES $38,444 513 days 42% 23% 

DC Progressing LongStayers $38,742 551 days 29% 16% 

DC Transitional Housing 

Only $31,822 477 days 13% 4% 

The Community Care Grants program in Washington, DC, places qualifying families in 

mainstream permanent housing immediately after intake, without a shelter stay. The Continuum of 

Care considers this diversion program a key element in its homeless services system. The central 

intake center first determines that a family qualifies as homeless because the family cannot be 

stabilized in its own housing unit or someone else’s for more than a month—that is, that the 

alternative to the CCG program would be a placement into emergency shelter. A further assessment 

determines whether the family should be admitted to emergency shelter or could become a successful 

15	 The small size of this group is somewhat surprising, given the capacity of this type of shelter to serve 93

families at a time. However, the long lengths of stay for families using apartment-style emergency shelter 

in DC meant that many families occupying those units had already become homeless before the start of our 

study period. 

16	 The average daily services cost for apartment-style emergency shelter is $42.32, slightly higher than the 

services cost for scattered-site transitional housing ($29.59) and only slightly lower than the services cost 

for facility-based transitional housing ($44.69). 

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leaseholder immediately. Factors in the assessment are whether the family head has ever been a 

leaseholder, head of household’s employment history, and whether the family has a current problem

with substance abuse or untreated mental illness. 

Ninety-six families in the DC study cohort of first-time homeless families were placed directly into 

mainstream permanent housing the Community Care Grants program, and only eight of these families 

subsequently entered either emergency shelter or transitional housing during the 30-month follow-up 

period for DC. Thus, the program appears to be successful in diverting families away from the 

residential system for homeless families, though it is not clear how many of these families would 

have become homeless without assistance. 

The average cost for each family reimbursed by the DC government was $10,677, which includes 

some combination of move-in expenses, short-term rental assistance (typically for one or two 

months), and case management provided on an as-needed basis for a year on average. Not 

surprisingly given the screening criteria for the Community Care Grants program, the path group that 

is dominated by these families had by far the lowest rates of any path group of service contacts with 

DC’s mental health and substance abuse agencies, less than 14 percent for mental health and only 1 

percent for the substance abuse agency. The rate of involvement with the child welfare agency was 

also low, although still almost 29 percent.17 Because of the program’s screening, had these families 

been placed into emergency shelter, they likely would have stayed relatively short periods of time. 

Whether they would have had short lengths of stay in the residential services system as a whole is 

unclear, because these families may have been considered good candidates for DC’s transitional 

housing programs. 

5.4. Costs Associated with Mainstream System Use by First-Time 

Homeless Families 

The literature on individual homeless persons, particularly those with chronic patterns of 

homelessness, suggests that the costs of providing certain homeless individuals with stable permanent 

housing may be offset by savings from reduced use of mainstream public systems such as emergency

rooms and hospitals by people no longer homeless.18 No similar claim has been made about cost 

offsets that might be produced by ending homelessness for families. In this study, we attempted to

collect data on the use of mainstream systems and associated costs incurred on behalf of homeless 

families before, during, and after their periods of homelessness. This data collection had three 

purposes: 

•	 Helping to characterize the families that follow different patterns of use of the homeless

services system, as described in Sections 5.3.3 and 5.3.4; 

•	 Understanding the extent to which homeless families are connected to mainstream

income and other supports that might avert or soften financial or health crises that lead to 

homelessness; and 

17	 More information on these programs patterns of program use is available in a separate case study on the 

study’s findings for Washington DC. See Khadduri, J., Spellman, B., Sokol, B., Leopold, J., & Rothschild, 

L. (2009a). 

18	 See the discussion in Chapter 4. 

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•	 Exploring whether savings in mainstream costs might result from reducing family 

homelessness. 

As has been true for other studies that have attempted to match data on users of homeless services 

systems to mainstream data, we were not able to obtain data for all mainstream systems in each

community. For DC, we were able to learn which members of the study cohort of first-time homeless 

families had service records with the Medicaid, child welfare, mental health, and substance abuse 

systems between July 2003 and June 2008, but we did not obtain cost data, and we do not know the 

timing of those service encounters in relation to the family’s period of homelessness. 

For Houston, we obtained client-level service utilization and cost data for City and Harris County 

arrests and jail stays, and we imputed associated court costs. We also obtained data on mental health 

treatment, and stays in the state psychiatric hospital, but we did not obtain data on Medicaid, income 

supports such as Food Stamps and Temporary Assistance for Needy Families (TANF), or on service 

encounters with the child welfare system. 

For Kalamazoo, we obtained data on the use and costs of Medicaid managed care payments, 

Medicaid fee-for-service care, and state emergency financial assistance, aggregated by path groups of 

families and by the periods before, during, and following homelessness, on both program utilization 

and costs. We obtained client-level data from local law enforcement agencies on arrests and jail 

costs. Here again, we have no data on Food Stamps, TANF, or the child welfare system. 

For Upstate South Carolina, we obtained data aggregated by path groups of families and by the

periods before, during, and following homelessness on both program utilization and costs for 

Medicaid, Food Stamps, and the criminal justice system, but not for TANF or the child welfare 

system. 

Thus, for the mainstream domain which may have the greatest potential for cost offsets for a family

homeless population—child welfare—we have data only for DC and only evidence of some

encounter with the system, not how serious or how costly the encounter was. 

5.4.1 Rates of Mainstream System Involvement by First-Time Homeless Families 

Exhibit 5.18 shows the rates at which families in the study cohort were involved with the mainstream

systems for which we were able to collect data. Use of Medicaid and Food Stamps is high, more than 

90 percent in the three places for which we have Medicaid data and 92 percent for Food Stamps in 

Upstate South Carolina. Earlier studies have shown that homeless families are able to access the 

income supports available in general to poor families with children (Burt, Aron, and Lee, 2001). We 

have no data on TANF, other than a statement from the South Carolina data warehouse administrator 

that the match rate to TANF records for the study cohort was low.19 Without information on the 

timing of receipt of TANF by the families in the Upstate South Carolina study cohort, we cannot infer 

whether the low rate reflects families being sanctioned or exhausting their time limit for TANF 

assistance before becoming homeless. The match rate would be expected to vary by state because of 

the flexibility in state administration of TANF, and the low match rate for a study cohort in Upstate

South Carolina may not be typical. 

19	 The small number of matches and associated privacy concerns was stated as the reason for not providing

TANF data even in aggregate tables. 

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Exhibit 5.18: Rates of Utilization of Selected Mainstream Systems by First-Time Homeless 

Families 

DC Houston Kalamazoo Upstate SC 

Medicaid 95% 94% >90%a 

Food Stamps 92% 

Child Welfare 43% 

Criminal Justice 8% 42% 34% 

Mental Health 36% 16%
 

Substance Abuse 9%
 

Emergency financial >39%b
 

assistance
 a More than 90 percent of the cohort received both Medicaid Managed Care and Medicaid Fee For Service treatment. A 

de-duplicated rate of involvement was not provided by the State. 

b De-duplicated data across types of financial assistance types was not provided. Thirty-nine percent of families received 

rental assistance, which was the greatest proportion for each type. Thirty-three percent of families received cash

assistance and 17 percent received food assistance. Only one family received mortgage assistance and four families 

received security or utility-deposit assistance. 

The emergency financial assistance program used by at least 39 percent of the study cohort in

Kalamazoo is a state-funded program operated through local non-profits and intended to help families 

through financial crises that can lead to homelessness by providing them with cash, food assistance, 

mortgage payments, rental payments, or security and utilities deposits. 

The high rate of service encounters with the child welfare system in DC is interesting, although we do 

not know the extent to which they happened in response to immediate threats to children’s well being 

and we do not know the extent to which they led to out-of-home placement of children. While we 

have no information about service encounters with the child welfare system in our other study 

communities, considered together with the high rates of involvement with the criminal justice systems 

in Kalamazoo and Upstate South Carolina, we might infer that rates of involvement with child

welfare among first-time homeless families would be high in those communities as well. 

In Upstate South Carolina, 53 percent of family members between the ages of 18 and 24 had at least 

one arrest during the study period, which extended from a year before the start of homelessness for 

each family through December 2006. Fifty-four percent of families that changed composition during 

their period of homelessness had a family member who was arrested, as did 71 percent of the Upstate 

South Carolina families we have identified as “long gappers.” White families were more than twice 

as likely to have a member arrested as African-American families. This could be a geographic effect 

(Upstate South Carolina covers a large area), or it could suggest that black families in Upstate South 

Carolina become homeless as a result of extreme poverty,20 while white families are more likely to 

experience a domestic crisis that triggers both extreme housing instability and an encounter with the 

criminal justice system. Across the three communities for which we were able to obtain data on 

involvement with the local criminal justice system, we found that many adult women were arrested, 

but arrest rates were higher for adult men than for adult women. 

20	 Suggested also by the fact that a higher percentage of brief users of emergency shelter in Upstate South 

Carolina are black, compared to families following other patterns of use of the homeless services system. 

Chapter 5. First-time Homelessness for Families and its Associated Costs 5–25 
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The relatively lower involvement with the criminal justice system among first-time homeless families 

in Houston is difficult to interpret, but consistent with the relatively smaller percentage of families in 

Houston with a “long-gapper” pattern of homelessness (5 percent, vs. 10 percent in Upstate South 

Carolina and 16 percent in Kalamazoo). 

5.4.2 Costs to Mainstream Systems of First-Time Family Homelessness 

The fragmentary nature of our data on mainstream system costs for the three communities for which 

we have cost information—Houston, Kalamazoo, and Upstate South Carolina—makes it difficult to 

assess the potential opportunities for cost savings through reducing family homelessness. Exhibit 

5.19 shows what we know about the magnitude of costs to the mainstream systems. The exhibit 

shows average costs for each family over the entire study period, which extended from one year 

before the start of homelessness to an average of three years after the beginning of homelessness. 

Across the study cohorts, most costs were incurred for basic social safety net programs, Medicaid and 

food stamps. For those at the income levels of most homeless families, reducing food stamps costs 

does not make sense. Food stamps benefit levels are set by formula based on family size and income, 

and there is little potential for “excess” or inefficient use of the program by homeless families.21 

Some residential homeless programs, especially emergency shelters, may provide food, and families 

may be less likely to use Food Stamps during their period of literal homelessness. 

Exhibit 5.19: Average Costs for Selected Mainstream Domains per First-Time Homeless 

Family during the Entire Study Period 

Houston Kalamazoo 

Upstate South 

Carolina 

Medicaid $21,770 $15,615 

Food Stamps $7,248 

Criminal Justice $409 $597	 $175 

Mental Health $722 

Note: The study period varies for each family, depending on when the family became homeless compared to the last date

for which mainstream costs were collected. Patterns change little when costs are measured over a uniform period, such as 

one year, for each family. 

Homeless families might use Medicaid in ways that are more costly than other families participating 

in the program—for example, by using emergency room visits in place of routine outpatient care. 

The evidence we have from the two communities for which we have Medicaid costs is mixed. In 

Kalamazoo, Medicaid costs for the children in the study cohort of homeless families were 26 percent 

higher than statewide average Medicaid costs for children. Medicaid costs for adults were 78 percent

higher than the statewide average (Kaiser Family Foundation, n.d.). The data only distinguish 

between services covered by managed care and services covered by fee-for-service, and the 

distribution of costs across these types is the same as for other Medicaid recipients in Michigan. 

Without more detail on types of services received, we cannot tell whether homeless family members

have higher medical needs or whether homeless families are using the system inefficiently. 

21	 This is not to say that fraudulent use of the program is non-existent, but Food Stamps fraud is unlikely to

vary based on whether a family is homeless or housed. 

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In Upstate South Carolina, Medicaid costs for the cohort of homeless families are similar to statewide 

averages for children who do not have disabilities and for adults who are neither elderly nor disabled. 

The type of services used by the study cohort compared with the general Medicaid population shows 

that homeless families were more likely to use standard medical services such as visits to doctors’

offices and less likely to use outpatient hospital care (Kaiser Family Foundation, n.d.). 

Exhibit 5.20 shows costs per family for each of the mainstream domains, during the periods before,

during, and following homelessness. The costs are standardized to a one-month period to take into 

account the different lengths of the three periods—in particular, the relatively short period during 

homelessness for most families.22 In both Kalamazoo and Upstate South Carolina, the use of 

Medicaid-reimbursed services rose during the family’s period of homelessness, which could suggest 

that health crises contributed to homelessness or could reflect the success of the homeless services 

system in referring family members to needed medical care. 

While the high rate of arrests for family members in Kalamazoo and Upstate South Carolina is 

troubling, the relatively brief interactions with criminal justice and low costs for this domain do not 

seem to provide major opportunities for cost offsets for first-time homeless families. Criminal justice 

costs, adjusted for differences in time periods, dropped during the period of homelessness in Houston 

and Kalamazoo and then rose to higher levels following homelessness (Exhibit 5.20). In Upstate

South Carolina, after adjusting for differences in the lengths of time periods, the number of arrests of 

members of the study cohort was very similar before, during, and following homelessness. Neither 

homelessness nor stable housing seems to have reduced the likelihood of criminal justice encounters. 

That said, criminal justice costs are incomplete at each study site. For Kalamazoo, we have arrest and 

jail costs, but not court costs. For Upstate South Carolina, we have only arrest records, and we 

imputed a cost of $200 per arrest, based on arrest costs for other study sites. For no community do 

we have costs to state or federal criminal justice systems. It is possible that more complete data

would identify additional cost saving opportunities. 

Exhibit 5.20: Mainstream Costs Per Family Per Month Before, During, and Following 

Homelessness 

Mental 

Medicaid 

Criminal Financial Food State 

Health Justice Assistance Stamps Hospital 

Kalamazoo 

Pre-Homelessness $657.58 $13.33 $5.18 

During Homelessness $929.59 $12.99 $22.05 

Post-Homelessness $471.90 $19.36 $21.55 

South Carolina 

Pre-Homelessness $319.66 $4.65 $187.30 

During Homelessness $433.70 $4.70 $229.34 

Post-Homelessness $493.28 $4.86 $190.78 

Houston 

Pre-Homelessness $13.01 $6.55 $0.00 

During Homelessness $32.87 $1.57 $0.00 

Post-Homelessness $20.67 $16.36 $3.02 

22 The period following homelessness depends on when during the tracking period the family’s homelessness 

ended and also may be different from the period preceding homelessness, which is one year for all families. 

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Mental health costs in Houston averaged only $409 per family but were much higher, $4594, for the 

16 percent of families that received at least one mental health service. The use of mental health 

services by first-time homeless families in Houston rose during the period just before first entry into a 

residential homeless program, peaked in the first 90 days after the start of homelessness, remained 

high for 18 months and then began to decline, as shown in Exhibit 5.21. This suggests that 

homelessness, or the crisis leading to it, exacerbates mental health issues or, alternatively, that a 

mental health crisis leads to housing instability and homelessness. The higher mental health costs 

following entry into a homeless residential program may reflect needed engagement in ongoing

mental health care and, therefore, may not represent an opportunity for cost saving. However, it is 

also possible that alternative housing and mental health interventions could provide more costeffective assistance. 

Exhibit 5.21: Mental Health Encounters of First-Time Homeless Families in Houston 

Compared to Date of First Homeless Entry 

Total Encounters

450 

400 

350 

300 

250 

200 

150 

100 

50 

0 

Date of First 

Entry 

<-360

-360--271-270--181

-180--91

-90--1

0-89

90-179

180-269270-359360-449450-539540-629630-719720-809810-900 

Days from First Entry 

Monthly costs per family of the state-funded financial assistance used by many families in the study

cohort in Kalamazoo were very low in the period before homelessness (Exhibit 5.20), as were the 

number of families using financial assistance during the pre-homelessness period (not shown on the 

exhibit).23 This pattern suggests that most families receiving prevention funds prior to becoming 

homelessness did not in fact become homeless and provides evidence for the success of efforts to 

prevent homelessness through short-term financial assistance. 

23	 For more detail, see the separate case study on Kalamazoo (Sokol, B., Spellman, B., Khadduri, J., &

Leopold, J., 2009a). 

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5.4.3 Mainstream Costs for First-Time Homeless Families by Path Group 

The costs and patterns just described for the entire study cohorts of first-time homeless in each 

community do not suggest opportunities for cost savings, with the possible exception of Medicaid 

costs in Kalamazoo and mental health in Houston. The literature on individual homeless people has 

focused on potential cost offsets among subsets of the homeless population—for example, individuals 

with chronic patterns of homelessness or homeless individuals with mental illness.24 We examined 

patterns of use of mainstream services for homeless families following particular paths when using 

the homeless services system to determine if one of these path groups has patterns of use of 

mainstream services that could provide opportunities for cost savings or offsets. 

In Kalamazoo, the “long gapper” groups had the highest Medicaid costs. The average Medicaid cost

for families in these groups was $31,177 compared to the cohort average of $21,770. In Upstate 

South Carolina, Medicaid costs were fairly consistent across the path groups, but twenty percent of 

families whose composition changed during homelessness had a family member with an in-patient 

hospitalization during the period of homelessness. These findings suggest that further study of

patterns of homelessness and medical costs for families with unstable membership might reveal 

opportunities for savings in medical costs. 

Heavy users of transitional housing in Kalamazoo had similarly high Medicaid costs before and 

during the period of homelessness, but costs dropped following homelessness. Possibly, families in

this group addressed pre-existing health issues during their stays in the homeless system. Or, they 

may have learned to sustain their ongoing healthcare needs after homelessness by using relatively 

lower-cost medical services. 

Criminal justice costs were highest for the “long-gapper” groups in Kalamazoo, $1,153 per 

household, nearly twice the overall average for the study cohort of $597. As noted, this does not 

include court costs. Similarly, in Upstate South Carolina, criminal justice costs were particularly high

for the “long-gapper” groups. In Houston, however, the highest criminal justice costs were for a 

group of heavy users of transitional housing, possibly incurred by one member of multi-adult 

households while others are in transitional housing. 

Overall, families who have repeat episodes of homelessness, difficulty maintaining stable housing, 

and frequent changes in family composition probably incur, over time, substantial costs to public 

systems that could be reduced by appropriate interventions. This might be more obvious if we had 

been able to obtain consistent mainstream system data across all four sites or cost information from

the child welfare system at one or more of our study communities. However, the appropriate

interventions for these families are not as obvious as placing chronically homeless, mentally ill 

individuals in permanent supportive housing. A long-term rent subsidy to stabilize the family in 

mainstream permanent housing might help, but it likely is not sufficient to address the problems 

associated with unstable household composition, which may include domestic violence, other family

conflict, problems with substance abuse, or chronic health problems. 

24 See Chapter 4 for a discussion of this literature. 

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5.5. Policy Implications and Recommendations for Further 

Research 

This study of the patterns and costs associated with first-time homeless families in four communities: 

•	 Confirms earlier research that long stays in the homeless services system are very 

expensive and makes explicit that most families with long periods of sheltered 

homelessness use transitional housing, either exclusively or in combination with 

emergency shelter. Groups of families that we identified as heavy users of transitional 

housing typically cost the homeless services system at least $15,000 dollars. In some 

communities, these costs were in the $30,000-40,000 range, which was similar to the 

costs for “long-stayer” families found by Dennis Culhane and his colleagues in other 

communities. Unlike Culhane’s research, this study found some indication that families 

used transitional housing for extended periods had high needs, based on their heavy

involvement with mainstream behavioral health systems. 

•	 Shows that housing vouchers typically are less expensive than transitional housing per 

day or per month. This is most pronounced in Houston, where the monthly cost of a twobedroom voucher during our study period was $743, while the average monthly cost of 

transitional housing was over $4,000. The voucher cost in the high-cost DC housing 

market was much higher, $1,225 per month for a two-bedroom Fair Market Rent, but the 

cost of transitional housing was still higher. In Upstate South Carolina, cost of 

transitional housing was about double the cost of a voucher. Whether the cost of 

transitional housing is ultimately lower than the cost of a permanent voucher—because 

transitional housing is temporary—is an open question. 

•	 Identifies a group of highly troubled families that cycle in and out of the homeless

services system and have very unstable household composition, often including men for 

part of the total period of homelessness. Their rates of involvement with the criminal 

justice system are high. Their repeat episodes of homelessness are comprised of 

relatively short stays in the residential homeless system separated by “gaps” of several 

months during which they evidently are unable to become stably housed in their own or 

someone else’s housing unit. These families are not particularly costly to the homeless 

services system because of their relatively small number of days in the system. The 

public system costs of their housing instability may be high, and over time savings in 

mainstream costs might offset the cost of stabilizing these families in permanent housing.

We do not have enough mainstream system data over a long enough period of time to 

determine this. Unlike heavy users of transitional housing, the outcomes of “longgapper” families’ use of the homeless services system as it currently is constituted are 

unambiguously negative. An alternative treatment model for these families that focuses 

on their family instability rather than their housing instability may be needed. 

•	 Shows that African-American families, shown by other research to be homeless at higher 

rates than other poor families, have generally brief stays in the homeless service system

and, because they use less expensive programs within each program type, they have

relatively low costs to the homeless services system. In some communities African 

American families are less likely than other families to follow the “long gapper” pattern 

of homelessness. All of these factors suggest that they may become homeless mainly 

because of extreme poverty and limited social supports, and that more complex 

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interventions—beyond income and housing supports—may not be needed to prevent or 

end homelessness for many of these families. However, the use of less expensive 

programs could also be the result of fewer referrals or admissions to higher-cost

programs, which may warrant follow-up to ensure that informal discrimination is not 

preventing access to important homeless system resources. 

•	 Shows that, among the domains for which we were able to collect data, homeless families 

are well-connected to Medicaid and Food Stamps prior to homelessness and that the 

highest rates of mainstream utilization and costs for homeless families are the medical 

costs reimbursed by Medicaid. Our data do not permit us to determine whether homeless 

families use the health care system in inefficient ways or whether Medicaid costs might 

be reduced by preventing or ending homelessness. The limited information we have from 

Kalamazoo suggests this might be the case. 

•	 Concludes that short-term costs to the criminal justice system, while troubling, do not 

appear high enough to suggest opportunities for offsets. We were not able to collect cost 

data for the use of the child welfare and foster care systems by homeless families in any

of the study communities. This is an area in which additional research might find 

opportunities for cost offsets. 

•	 Suggests that local policies designed to prevent families from becoming homeless and

divert those on the brink of homelessness can succeed. Very few families using the 

Community Care Grants program in DC subsequently became homeless during a 30 

month tracking period. Because the program screens for lease-holding history, 

employment history, and active substance abuse, it is likely that families diverted from

homelessness would have used the emergency shelter system for short periods only. On 

the other hand, they might have been out-placed from emergency shelter into transitional 

housing. Similarly in Kalamazoo, financial assistance intended to prevent homelessness 

seems to have been largely successful, as few families in the study cohort received such 

assistance before becoming homeless. To confirm the success of this type of program

would require tracking the results of prevention efforts directly—and ideally randomly

assigning families to receive or not receive the limited funds available for such programs. 

Because the daily cost of emergency shelter typically is just as high as the cost of transitional housing 

and sometimes is higher, moving families out of emergency shelter and into transitional housing

quickly makes sense for families who are not placed immediately into permanent housing. In some

communities, emergency shelters for families may operate more like transitional housing, but are 

being used like emergency shelters—that is, by many households for relatively short periods. Careful 

program evaluation may be required to determine whether the services rendered are appropriate to the 

needs for which they are allocated and whether there are opportunities for cost savings by cutting 

costs of individual programs. 

As for transitional housing itself, analysis of cost effectiveness is needed to determine if long stays in 

transitional housing are justified either by improved outcomes for adults and children25 or by 

reductions in costs to mainstream services system. The data we collected on the use of Medicaid by

homeless families in Kalamazoo permits us to speculate that families who have used transitional 

25	 HUD is now conducting an experimental design evaluation that will compare the outcomes of transitional 

housing with those of other approaches for serving homeless families. 

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housing subsequently use the health care system in a more cost-effective way, but we do not really

know if health costs would have tapered off naturally or with an alternative less expensive housing 

intervention. More detailed analyses of use of health care by homeless families, and its costs, would 

be valuable. 

Since the cost of permanent supportive housing to the homeless services system is low and families

typically are well-connected to mainstream systems before they become homeless, quickly moving 

families who qualify out of emergency shelter and into this type of housing makes sense. More data 

collection and analysis is needed to determine the total costs to public systems of permanent 

supportive housing and whether providing services through mainstream systems is more costeffective than services provided directly by residential programs for homeless people and paid for by

their budgets. The services model used for permanent supportive housing, with housing and services 

managed and funded separately, may be more efficient than the services model used for transitional 

housing because it is better able to scale services to individual family needs. 

Furthermore, it matters who pays for the services, even if they are ultimately paid for by public 

programs. Using funds appropriated to homeless programs for services can divert resources from

providing for immediate shelter needs of homeless families and from programs that place them into 

long-term, stable housing. 

Overall, exiting the homeless system did not yield a reduction in costs to mainstream services systems 

for first-time homeless families. From the limited data we have, costs to the criminal justice system

went up following homelessness. Much more data are needed about other systems that may be 

affected by homelessness, in particular the child welfare system. 

First-time homeless families who appear in the residential system for homeless people, leave, and 

then come back after long “gaps” and often with changes in family composition are expensive to the 

homeless services system when their costs are considered on a daily basis, as they appear to use 

relatively expensive programs. However, their relatively short lengths of stay mean that they do not 

create high total costs per family. Among homeless families, this is the group with the greatest 

potential for savings to mainstream systems. More research is needed on the complete costs over

time of these “long gappers” to both homeless and mainstream systems. Also needed is the 

development of knowledge on how best to stabilize these families, based on interventions that are 

coordinated across mainstream sectors, including the child welfare and criminal justice systems. 

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6. Implications for Policy and Future Research 

Around the country, communities are grappling with how to use their limited resources to efficiently

and effectively respond to homelessness. In these uncertain economic times, many more individuals 

and families may experience first-time homelessness; thus, it is even more critical for communities to 

act prudently to use resources to meet the changing demand. This study presents findings that help to 

improve our understanding of homelessness and its associated costs; it presents ideas about

opportunities for cost savings; and it develops an approach for measuring costs that, coupled with 

other evaluation methods, can help communities understand the cost-effectiveness of different 

homelessness interventions. 

Throughout this report, we identified two types of findings with associated policy implications. One, 

different populations use homelessness programs differently and some populations are associated 

with greater costs. Communities may want to consider adjusting current interventions or developing

new strategies to target people more efficiently. Second, we found that the structure of homeless 

programs and the roles they fill within the broader homeless assistance system present opportunities 

for cost savings. 

We identified certain demographic characteristics and patterns of first-time homelessness that were 

associated with greater mainstream system involvement, but the analysis did not identify clear 

opportunities for overall mainstream system cost savings through the implementation of alternative 

responses to homelessness. However, the results also do not eliminate the possibility of mainstream

system cost savings. Analysis of more comprehensive client-level data may yield more conclusive 

findings in this area.1 

This chapter summarizes our recommendations and reiterates ideas for future research that will 

continue to help policymakers and practitioners improve systems that respond to homelessness. 

While all communities can benefit from these findings, the results are not intended to be 

representative of the entire nation or every community. Regression analysis showed that the 

community in which individuals and families received services frequently had a strong effect on both 

length of stay and cost. Thus, local factors and particular Continuum and program-level decisions can 

have a large intervening effect on patterns of homelessness and associated homeless system costs. 

Policymakers should not assume that the findings here, despite spanning multiple different types of 

communities, will necessarily hold true everywhere. They should instead discuss whether the 

patterns of homelessness within their own communities are appropriate, whether their homelessness 

systems are efficient in achieving outcomes for people who become homeless, and whether there are 

opportunities for cost savings through alternative program models. 

We found it very challenging to obtain comprehensive mainstream data from the many federal, state, and

local public agencies, in addition to private providers, that collect them. Future research that relies on 

analysis of mainstream administrative data will need to devote significant effort to the task of identifying

and securing these data. 

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6.1. Policy Implications Related to Different Patterns of Homeless 

System Use 

The study clearly demonstrates that the experience of homelessness and the costs associated with it 

are diverse and wide-ranging across different groups of homeless people. Most first-time individuals 

and families experience homelessness only once or twice and, in response, use emergency shelter for 

a limited period of time at fairly low cost. But some experience much longer stays and some have 

very high associated costs. And others use the system sporadically, moving in and out of homeless 

programs multiple times during long periods. Our analysis suggests that communities should 

consider specific responses to homelessness that target the needs of those who use the system in

different ways. 

6.1.1. Households that Use Only Emergency Shelters for Brief Periods 

The majority of individuals we studied, 57 to 66 percent of the first-time homeless single adults in 

each of the three communities, used only emergency shelter and only stayed briefly. On average, 

“short-stayer” individuals used emergency shelter programs for only one week (Des Moines) to three 

weeks (Jacksonville) at an average cost per household of $321 to $686. Many first-time families, 

ranging from 42 percent in DC to 66 percent in Houston, also had only a few brief stays in emergency

shelter. The stays for families were on average longer than those of the individuals in our cohorts. 

One group of short-stayer families in South Carolina remained in shelter only 10 days, but other 

short-stayer families in all four communities stayed an average of one to three months. The average

costs per short-stayer family ranged from less than $1,000 to almost $9,000, depending on the 

average number of days spent in programs and the relative cost of the programs used. 

These short-stayers all had much lower costs than other groups of first-time homeless individuals and 

families. We surmise that the short-stayers in emergency shelter are those households that may be 

most likely able to avoid homelessness with appropriate prevention assistance. However, the findings 

may suggest different responses for individuals versus families from a cost-perspective, recognizing 

that costs alone should not guide homelessness policy. 

The homeless systems that have been established in the communities in which we studied individuals

offer emergency shelter with low daily costs. For the majority of individuals, the emergency shelters 

seem to provide an immediate, low-cost response to their homelessness. It would be very difficult to 

fund a prevention response at such low cost, particularly since it may be challenging to identify up 

front which of the individuals’ homelessness could be prevented with minimal assistance. Perhaps 

the emergency shelter system is an “adequate” response to an immediate housing crisis for most 

individuals, and a place in which individuals who are not able to quickly resolve their housing crisis 

can be assisted or referred to more intensive interventions. 

In contrast, emergency shelters for families are as expensive on average, if not more expensive, than 

transitional housing and permanent supportive housing offered in the four communities in which we 

had information on homeless families. The average cost per short-stayer family, even for the group in 

South Carolina that used shelter for only 10 days, exceeds a one-month rental subsidy based on local 

Fair Market Rents. The short-stayer families that stayed one to three months had associated costs per 

family of $2,508 to $8,890, significantly higher than several months of rental assistance. If families 

truly only need one to three months of assistance, communities may want to consider shelter 

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diversion or rapid-rehousing interventions that optimize the use of resources to get families back into 

housing. Alternatively, communities could look at the cost structure of current emergency shelter

programs to determine if the environment and services offered are appropriate to the needs of those 

who are using them. If families stay in shelter for brief periods of time, they may not be taking full 

advantage of the non-crisis-related services provided to them; thus it may be possible to reduce costs

by scaling back on the resources offered to families on-site in shelters. For those with greater needs 

who need longer stays or more intensive services, it may be more cost effective to quickly move them

into transitional housing (facility-based or scattered site) or permanent supportive housing. 

6.1.2. Households Who Remain in Homeless Programs for Extended Periods 

The greatest opportunities for homeless system cost savings lie with the individuals and families who 

remain in homeless programs for extended periods. Without an assessment of the outcomes 

associated with the longer lengths of stay, we cannot determine whether the long stays are costeffective. The extremely high costs associated with most of these groups suggest that communities 

should assess whether there are ways to reduce costs of existing programs without diminishing client

outcomes, whether communities are appropriately targeting the high-cost interventions to those who 

benefit from them most, and whether alternative, lower-cost interventions could be developed that 

might be equally or more effective. 

Transitional housing programs provide a starting place for this discussion. Not surprisingly since 

most transitional housing programs are designed for lengths of stay up to two years, those who used 

transitional housing alone or in combination with emergency shelter had lengths of stay in homeless 

programs three times that of households who only used emergency shelter. Even when controlling

for lengths of stay, these households also had costs higher than those who only used emergency

shelter, two times higher for individuals and one-third higher for families. The difference reflects the 

fact that emergency shelters for families are generally similar in cost and sometimes even more 

expensive than transitional housing programs, whereas transitional housing for individuals is 

generally more expensive than shelter. 

For individuals, extended use of transitional housing costs an average of $9,000 to $14,000 per

person, with the exception of those who used a low-cost form of shared transitional housing in Des 

Moines. For families, heavy users of transitional housing averaged between $15,500 and $38,800 per 

family, with the exception of families in Kalamazoo whose costs were $6,574 on average. The 

environment in which transitional housing is provided, a centralized facility versus scattered site

apartments, does not appear to make a consistent difference in program costs, although the 

distribution of costs between housing operations and services does vary somewhat from one model to 

another. Therefore, a program’s housing model is not primarily a cost question, but rather a 

programmatic or philosophical one depending on the subpopulation being served. 

In all cases, the costs to house individuals and families in transitional housing for extended periods 

are significantly higher than rental subsidies based on Fair Market Rents for an equivalent period.

Transitional housing programs generally provide intensive supportive services along with housing 

assistance, so a direct comparison of rental assistance to transitional housing is not appropriate. 

However, communities may want to consider whether alternative interventions or combinations of 

rent subsidies and standalone supportive services could achieve similar outcomes at lower costs. To 

the extent that transitional housing is being used by individuals and families as a form of subsidized 

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permanent housing, actual rent subsidies without extensive services may be much more costeffective. 

Permanent supportive housing is generally less expensive from the perspective of the homeless 

system than other types of residential homeless programs for families, often similar in cost to a deep 

rental subsidy. This is not to suggest that the services come at no cost, but rather that permanent 

supportive housing programs appear to have been successful at helping residents obtain services for 

which they were already eligible through mainstream systems. To the extent that individuals or 

families have disabilities that qualify them for permanent supportive housing, communities should 

expedite their placement into permanent supportive housing programs. This may involve improved 

assessment and triage processes and may also require development of additional permanent 

supportive housing resources to accommodate increased referrals. 

While some mainstream costs are substantial for these groups of heavy users of transitional housing, 

ending their homelessness does not appear to offer clear opportunities to achieve cost offsets. Our 

analysis identified fairly high rates of families who had received some form of mental health or 

substance abuse treatment in the year prior to homelessness among those who used transitional 

housing. So, unlike conclusions from past research, family transitional housing in our study

communities appears to serve those with behavioral health and medical needs. To the extent that 

individuals and families are eligible for assistance in mainstream systems but do not have disabilities 

that qualify them for permanent supportive housing, there may be opportunities to create systematic 

linkages between transitional housing programs and mainstream system to promote appropriate use of 

mainstream systems (e.g., using primary healthcare systems for routine medical care rather than

emergency or acute healthcare systems) and more efficient mechanisms for delivering these services. 

For instance, communities should consider creating transitional housing that is modeled like 

permanent supportive housing. This model would provide housing and limited housing-focused 

services through the homeless (or other housing) system and non-housing services through 

mainstream systems. 

6.1.3. Households Who Use Homeless Programs Multiple Times with Long Gaps Between Stays 

Our analysis also identified a small group of first-time homeless individuals and families who return 

multiple times for homeless assistance but have long gaps between stays. Their patterns suggest that 

the assistance they receive from the homeless system the first and even second or third time is not

sufficient to help them regain stable housing. These households sometimes only use emergency

shelter and other times use a combination of program types. Across the individual sites, costs for 

individuals who repeatedly used homeless programs with long gaps between stays averaged 

approximately $1,000 for groups that only used emergency shelter to as high as $10,705 for a group 

of individuals in Houston who used a range of program types. Costs for families averaged from

$3,295 in Kalamazoo for a group that used only emergency shelter for a total of 38 days across all 

stays to $17,314 for a group in DC that spent an average of 9 months in range of programs. The 

homeless system costs are lower on average for groups with long gaps than those incurred by groups 

with extended stays because the homeless system does not incur costs between program stays. 

Beyond the high levels of housing instability, this group is also of interest because of the nature of its 

involvement with mainstream systems. In Jacksonville, 62 percent of individuals with repeated use 

of emergency shelters and long gaps were arrested or spent time in jail and 26 percent of the 

comparable group in Houston had arrests or jail stays during the period in which we studied 

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mainstream use. In Kalamazoo, 61 percent of families with long gaps had a family member who was 

arrested or spent time in jail during the study period, as did 23 percent in Houston. In South Carolina, 

71 percent of families with long gaps had a family member arrested. For both first-time homeless 

individuals and families, households with long gaps have much higher involvement with the criminal 

justice system than other groups. Since these criminal justice system rates represent a time period 

spanning approximately 3 years, starting 12 months before each household’s first stay in a homeless 

program and generally going through the end of 2006, not all of the involvement occurred during 

homelessness or the gaps between homeless program stays. However, communities may be able to 

use patterns of homelessness to identify individuals and families who would benefit from

interventions designed to reduce repeat offenses and achieve long-term housing stability. Local 

criminal justice agencies may be interested in supporting a joint intervention to assist homeless 

individuals and families with a history of criminal involvement. 

A significant percentage of families with long gaps also had changes in household composition from

one program stay to the next. Half to two-thirds of families with this pattern in Kalamazoo, Upstate

South Carolina, and Houston had a household composition change, and 92 percent of families with 

long gaps in DC had such a change. These high rates of household change are evidence of household 

instability and may also suggest high involvement in child welfare systems. In DC, the only site in 

which we obtained rates of child welfare involvement, 55 percent of the group with long gaps had 

child welfare involvement at some point during the study period. Unfortunately the nature and timing 

of child welfare involvement were not available for DC, and data on child welfare involvement were 

not available for any of the other family sites. However, costs of out-of-home placement by the child 

welfare system can be substantial. The significant housing and family instability experienced by this 

group suggests that neither homeless nor mainstream systems are addressing sufficiently the needs of 

these families. 

Although homeless costs associated with households with long gaps are not nearly as large as those 

for individuals and families with extended stays in homeless programs, the homeless system

resources used by this population are sizable enough to support alternative interventions. Moreover, 

if costs associated with child welfare were captured, the costs for families in this group might be 

substantially higher. Communities should consider systems to identify individuals and families who 

leave homeless programs after a relatively brief stay and then return for a second or third time within 

the next few months. They could be targeted with a specific intervention to address the challenges

they face in retaining permanent housing. For families, it may be possible to identify those who are

likely to cycle in an out of the homeless system by assessing family stability as part of initial intake. 

Communities should consider partnering with the child welfare system to develop interventions to 

promote long-term family and housing stability for these families. 

6.2. Policy Implications Related to Individuals and Families with 

Different Demographic Characteristics 

Homelessness impacts first-time individuals and families with different demographic characteristics 

in different ways, and we found that different demographic groups use homeless programs differently. 

Cutting across the patterns of homelessness described in the last section, we identified several

demographic characteristics that were associated with higher costs: gender for single adults, race for 

single adults, age for all populations, and household change for families. Recommendations for each 

of these demographic groups are discussed in this section. 

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6.2.1. Homeless Costs for Single Women 

Among individuals, single women had fewer stays but used homeless programs 74 percent longer 

than single men. And women dominate groups with certain patterns of homelessness, such as those 

who use more expensive types of programs.2

 Even when controlling for length of stay, program type 

and other demographic characteristics, multivariate regression analysis shows that single women have 

97 percent higher costs than men. We speculate that there are several reasons for the higher costs. 

Women’s needs may be greater, and they may use higher-cost programs that can respond to these

needs. In some sites, single women are served in small programs together with families, usually with 

higher daily costs, whereas single men often are served in large programs with lower daily costs. 

Like single women, most families have fewer but longer stays than single men. Thus, the similar 

patterns of use for both single women and families also may be influenced by the expectations of

program goals and staff. 

Regardless of the reasons, communities may want to reevaluate their systems for serving single 

women. Programs designed to accommodate families require a different physical environment, 

generally with more privacy than that needed for single women. If a community has sufficient

numbers of single women experiencing homelessness, programs or living spaces designed 

specifically to meet the physical and programmatic needs of single women may be able to be

delivered at lower costs per day without affecting quality. To the extent that women are staying in

transitional housing for extended periods due to severe mental illness or other long-term disabilities, it 

may be more appropriate and less costly to quickly place these women in permanent supportive 

housing programs. As with all long-stayers in transitional housing (Section 6.1.2), communities 

should also consider whether alternative interventions such as rapid rehousing with community-based 

assistance could achieve equivalent or better outcomes at lower costs. 

6.2.2. Homeless Costs for Older Individuals and Families Headed by Older Adults 

Relatively older adults, homeless as individuals or as part of families, also had longer lengths of stay

and higher homeless costs than younger adults. Even controlling for length of stay, type of program

used, and other demographic characteristics, costs for individuals older than 40 were 10 percent 

higher for adults than those between 31 and 40 years. Among homeless families, costs for families 

headed by people between 18 and 24 were one-third less than those headed by 31 to 40 year olds. For 

individuals, the reasons for relatively older people using higher cost programs are not clear and may

be due to individual needs and program eligibility. For families, the differences in costs can almost 

entirely be explained by the types of program used and lengths of stay. 

Single women are older on average than women in families with children. This is not surprising as 

women who are older may have grown children and therefore be less likely to be accompanied by

them. Since both age and gender are associated with higher costs for first-time homeless individuals,

communities may want to consider using age and gender in combination with other indicators to 

identify older women with greater needs immediately at intake. Quickly diverting this group to

alternative interventions specifically designed to meet their physical and programmatic needs may be 

more cost-effective. 

Data from victim service providers, such as domestic violence shelters, were not available for this study, so

these findings are for other type of homeless residential services. 

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6.2.3. Homeless Costs of African-Americans 

African-Americans are over-represented among first-time homeless individuals and families in 

comparison to the general population of individuals and families in poverty in each of the 

communities we studied, with the exception of Jacksonville. The multivariate analysis of lengths of 

homelessness and costs reveals contrasting results for African-American individuals and families. 

Among the individuals we studied, African-Americans are more likely to spend longer cumulative 

periods of time homeless, have a greater number of stays, and to incur higher homeless system costs 

than individuals of other races. However among the families we studied, African-Americans are

likely to spend shorter periods of time in homeless programs and to be associated with lower costs. In 

some communities, African-Americans are associated with higher mainstream system costs and in 

some, lower. The conclusions suggest different strategies for African-American individuals than for 

families. 

For individuals, African-Americans are likely to have longer lengths of stay due to their repeated 

episodes of homelessness. The greater costs are somewhat surprising, since African-Americans are 

found at lower rates in the path groups that primarily use transitional housing, the program type 

generally associated with higher costs. However, in Jacksonville these patterns of use—using 

emergency shelters rather than transitional housing–may in part drive the higher homeless system

costs for African-American individuals. African-Americans comprise 73 percent of the emergency

shelter long-stayer group, but only 47 percent of the Jacksonville study cohort. The Jacksonville 

emergency shelter that accommodates long stays is one of the most expensive homeless programs

offered in the community. In Des Moines, the group of individuals that uses the lower cost, shared 

room model of transitional housing has a low rate of African-Americans compared with the Des

Moines study cohort as a whole. To the extent that African-Americans individuals are using 

emergency shelter for extended periods, communities should explore strategies to alert programs to 

these patterns of extended stays, so more appropriate interventions can be deployed. If individuals 

are identified with issues that suggest need for more intensive interventions, they should be placed 

quickly in appropriate permanent supportive housing, transitional housing, or a newly created 

homeless program type that is focused on addressing their specific needs. 

Among families, patterns of homelessness and involvement in healthcare systems suggest that 

African-American families are homeless due to extreme poverty, rather than issues related to mental

illness or substance abuse. If so, communities should explore prioritizing African-American families 

for prevention and rapid rehousing interventions that address housing and income issues with less

focus on services for non-economic issues. It may be particularly appropriate to provide a prevention 

or rapid rehousing intervention for families who have several characteristics associated with shorter 

episodes of homelessness and lower costs, for instance when African-American families headed by

younger adults with younger children request shelter assistance. While communities may feel 

uncomfortable discussing methods of directing assistance based on race, this finding could be 

translated into strategies that identify ways other than race to uncover indicators for families who 

become homeless primarily due to poverty rather than psycho-social issues. 

Alternatively, the low involvement in healthcare systems may also reflect an informal or clinical bias 

that results in lower access by African-American families to mainstream systems or fewer referrals or 

admissions to homeless programs that offer higher-intensity assistance. Therefore, communities 

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should also consider whether informal discrimination at the community level and as part of the case

management process needs to be addressed. 

6.2.4. Potential for Achieving Mainstream Cost Savings 

The question of whether mainstream system costs can be offset by appropriate housing interventions 

is left open by this study. Our analysis suggests that there are few opportunities for mainstream cost 

savings when targeting groups based on their patterns of homelessness; however, consistent with past 

research, significant mainstream system costs may be achievable when targeting individuals or 

families with high levels of inappropriate involvement in mainstream systems prior to homelessness. 

For example, for individuals in Houston we identified patterns of mental health inpatient involvement 

immediately prior to homelessness, which imply that homeless programs may be currently used to 

house some individuals when they leave inpatient facilities. Mainstream systems and homeless 

systems (or ideally mainstream housing systems) may be able to design more appropriate, lower cost 

post-care housing responses that can offset future mainstream and homeless system costs for 

individuals being discharged from inpatient facilities. 

Several demographic groups of first-time homeless individuals in Jacksonville and Houston, the only

sites in which we had data to accommodate regression analysis, are associated with higher 

mainstream costs over the full period in which we studied these individuals when controlling for 

patterns of homelessness.3 First-time homeless single women had higher mainstream costs when 

compared to men for mental health treatment costs (as well as physical healthcare costs and income 

supports in Jacksonville) and lower criminal justice costs. Relatively older adults in both

communities also had lower criminal justice costs. However, age had different effects on costs for 

health care across communities. First-time homeless adults over 40 had higher mental health and 

physical health costs in Jacksonville and lower mental health care costs in Houston. Results for race 

provided a mixed picture. Communities may want to explore whether certain demographic groups 

should be targeted with alternative interventions to ensure appropriate use of mainstream systems. 

The key point is that communities must recognize that mainstream cost savings are most likely not 

readily achievable when targeting homeless individuals or families defined by their use of the 

homeless system, even those who are homeless for extended periods. Instead, communities interested 

in mainstream cost savings should be intentional about identifying and targeting those with high 

mainstream system use as they enter the system. 

6.3. Ideas for Future Research 

This study does not show which homelessness interventions are cost-effective or indicate whether 

mainstream systems are appropriately used during periods of homelessness. But it does illuminate the 

diverse patterns and costs of homeless and mainstream system use that are essential to answer the 

critical policy question of whether instances of higher costs are appropriate as a response to

homelessness for specific subgroups, or whether there are more efficient and effective ways of

meeting people’s needs. 

The mainstream costs were incurred throughout the periods before, during and after homelessness in which 

we studied these individuals. 

6–8 Chapter 6: Implications for Policy and Future Research 

3 
Chapter 6: Implications for Policy and Future Research Chapter 6: Implications for Policy and Future Research 6–9 6-9

 

 

 

 

 

 

 

 

 

 

This research raises a number of additional questions that should be the focus of new research. 

1. Are there specific features of homeless programs, such as program structure or size that 

are consistently associated with higher costs? Understanding specific cost drivers more 

clearly may help communities understand how to design lower-cost interventions. 

2.	 Do some program models have outcomes that justify greater investment? 

3. Are needs and patterns of homelessness for single women distinct enough to warrant 

systems designed specifically for them, such that future homeless system planning would 

focus on three broad populations: single men, single women, and families with children? 

4. Are there individual and family characteristics beyond those identified in this study that 

can be used to predict who is likely to experience extended or high-cost homeless system

use? This study identifies many patterns of homelessness associated with high costs, but 

changing those costs requires directing people to alternative interventions before the costs

have been incurred and communities will need a basis for setting new referral policies. 

5. Are the tentative conclusions drawn here about the relationship of homelessness for 

African-American families and extreme poverty warranted? Are there other factors that 

are important for identifying African-American and other families who are likely 

candidates for prevention or rehousing interventions? 

6. How are costs of the child welfare system related to periods of homelessness? Do the 

conclusions regarding limited opportunities for mainstream cost offsets change when

analyzing a broader range of mainstream domains within the same community? 

7.	 Although mainstream costs appear to be related to homelessness, does desirable and 

undesirable mainstream involvement vary when homeless individuals or families are 

accessing transitional housing as opposed to a shelter, permanent housing or rapid 

rehousing program? For instance, this study did not attempt to understand whether 

individuals had greater inpatient use while in shelter and more routine mental health care

when placed in transitional housing. Understanding the nature of mainstream costs, how 

they change in relation to different types of homeless programs, would help communities 

implement homeless programs that encourage cost-effective use of mainstream systems. 

8. How do mainstream costs vary for the periods in-between homeless program stays as 

compared with during homeless program stays and the periods before and after 

homelessness? This study aggregated the homeless program stays and the gaps between 

them in a single “during homelessness” period. More granular analysis might help 

explain important trends in mainstream use preceding homelessness, during stays in 

different types of homeless program, during times of housing instability between 

homeless program stays, and following homelessness 

While there are many research avenues still to explore, this study contributes substantially to the 

effort to quantify the costs associated with homelessness. Understanding these costs is a critical step 

in ensuring that the resources invested in serving those who are homeless are directed in a manner

that best meets the diverse needs of homeless individuals and families. 

Chapter 6: Implications for Policy and Future Research 6–9 
6–10 6-10 6–10 Chapter 6: Implications for Policy and Future Research Chapter 6: Implications for Policy and Future Research Chapter 6: Implications for Policy and Future Research Abt Associates Inc. 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-1 A–1

 

 

 

 

 

 

 

 

 

 

Appendix A: Costs Associated with First-time 

Homelessness: Individuals in Jacksonville, FL 

A.1. Overview 

This study aims to understand the financial costs associated with 1,972 single adults in Jacksonville, 

Florida who became homeless for the first-time between July 1, 2004 and June 30, 2005. This study

describes how people who become homeless use homeless and mainstream services and the total

costs associated with those services. The mainstream services included in this report are arrests and 

jail stays, Medicaid-funded healthcare costs, mental health services, substance abuse treatment, food 

stamps, and TANF benefits. Mainstream services were tracked for the periods before, during, and 

following homelessness.1 

Of the seven sites included in this study on the costs of first-time homelessness, we were able to 

develop the most comprehensive dataset for Jacksonville: data on utilization and costs for more 

mainstream systems, data for costs of residential homeless programs that include capital costs, and 

data on patterns of homelessness that include people who were contacted by homeless street outreach 

programs but never entered homeless residential programs. 

Eighty percent of the first-time homeless 

individuals in the study cohort for Jacksonville 

were men. The average age was 41 years, and the 

study cohort was evenly split between whites and 

African-Americans (Exhibit 1). Half of the cohort 

had only one stay in a homeless program, and 

more than three-quarters used only emergency

shelters. A small subset of the cohort had 

extended stays in homeless residential programs, 

and they were responsible for the majority of 

homeless costs. Three-fourths of the study cohort 

used mainstream systems before, during, or 

following the period of homelessness (Exhibit 1), 

and the costs of the study cohort to mainstream

systems increased during homelessness. 

A.1.1 Highlights of Cost Findings 

Exhibit 1: The Jacksonville Cohort 

Basic Cohort Information 

Total Persons 1,972 

Average Age 41 

Percent Male 80% 

Percent White 48% 

Homeless Program Utilization 

Length of Homeless Tracking Period 18 months 

Average Number of Stays 3.3 stays 

Average Total Length of Stay 57 days 

Median Length of Stay 10 days 

Mainstream System Utilization 

Incurred costs in at least one mainstream 

system 74% 

Incurred costs in two or more mainstream 

systems 49% 

On average, individuals in the study cohort spent 132 days homeless during the 18-month homeless 

tracking period.2

 During this period, the study cohort incurred a per person total cost of $2,652 for 

homeless and mainstream systems combined. Sixty-two percent of costs were incurred by the 

1	 For the purposes of this study, mainstream systems are those that do not exclusively target people who are 

homeless. 

2 The period of homelessness extends from the first entry into a program for homeless people through the last 

exit from such a program. It may include “gap days” during which a person is not in a homeless program. 

Thus the 132 day average period of homelessness is longer than the 57 day average total length of stay

shown on Exhibit 1. 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–1 
A–2 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-2 

 

 

 

 

 

 

 

homeless system ($1,634), and the remaining 38 percent was spread across mainstream domains. 

Criminal justice was by far the most expensive mainstream domain during homelessness (Exhibit 2). 

Homeless System Costs 

•	 Distribution of Costs: The 

distribution of homeless costs was 

highly skewed. Fifty percent of the 

study cohort had total homeless 

system costs of less than $225 and 

accounted for only 2 percent of total 

homeless costs. Ten percent of the 

study cohort had homeless costs of 

$5,300 or more. These individuals 

accounted for 62 percent of total 

homeless costs. 

Exhibit 2: Costs While Homeless 

Domain 

Average 

Costs per 

Person 

Homeless System Costs $1,634 

Mainstream System Costs (all domains) $1,018 

Income support (Food Stamps and TANF) $138 

Physical Health $219 

Criminal Justice $397 

Substance Abuse $158 

Mental Health $106 

Total Costs While Homeless $2,652 

Homeless System 

Costs Included 

• Operational costs of homeless residential programs,

including facility rents 

• Services provided by homeless residential and 

homeless outreach programs 

• Capital Costs of facilities owned by the program or 

donated 

Costs Not Included 

• Programs not covered by HMIS: Probably not major 

costs; over 90 percent of beds are covered in the 

HMIS either directly or through data merges. 

However, the costs of one large health program that 

targeted the homeless are not included in this study. 

• Costs by Program Type:

Emergency shelters with 24-hour 

staffing and on-site supportive 

services had the highest daily cost 

of homeless residential programs. 

Overnight shelters and permanent 

supportive housing programs with 

low-intensity services had the 

lowest daily cost.3 

•	 Costs by Demographics: The 

average homeless system cost for 

women ($2,754) was more than 

double the average cost for men ($1,337). Women tended to stay in more extensive programs 

than men and have longer program stays. 

•	 Costs by Homeless System Utilization: Not surprisingly, there was a strong correlation 

between length of time spent in homeless programs and homeless costs. Users with long

term stays (six months or more) in transitional housing had the highest average homeless 

costs. 

Cost of Mainstream Systems 

More than $12.4 million, $6,294 per person, in mainstream costs were incurred over the entire study

period, which extended from one year before each person became homeless to December 2006. Like 

costs to the homeless services system, the distribution of mainstream costs across the study cohort 

was highly skewed, with more than a quarter of the study cohort using no mainstream systems and 

another quarter using more than $7,000 in mainstream services during the entire study period. 

The term Permanent Supportive Housing is used here because these programs were considered part of 

Jacksonville’s homeless service system. However, some of these programs were funded with HUD Section

8 SRO Moderate Rehabilitation grants and do not offer intensive supportive services. 

A–2 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 

3 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–3

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-3 

 

 

 

 

 

 

 

 

 

Mainstream Systems 

Costs Included 

• Physical Health (Medicaid Managed Care and Fee For 

Service) 

• Income support (TANF and Food Stamps) 

• Criminal Justice (county and city) 

• Mental Health and Substance Abuse: Medicaid and IDS 

funded 

Costs Not Included 

• Non-Medicaid Primary Health Care: Likely to be high;

as participation in Medicaid was low. 

• Veterans Administration Funded Services: May be high, 

we do not know what percent of the study cohort were 

veterans. 

• Other benefits (SSI/SSDI) 

•	 The event of becoming homeless for 

the first time was associated with a 

sharp increase in costs to mainstream

systems (Exhibit 3).4 This increase 

was most pronounced in the criminal 

justice domain, where average 

monthly costs more than doubled 

during homelessness. 

•	 Persons in the study cohort were 

frequently arrested for crimes such as 

trespassing that appeared to be

directly related to their 

homelessness. 

•	 Mental health was the only domain for which average monthly costs were lower during

homelessness, and persons receiving mental health services had lower homeless costs than 

the rest of the study cohort. 

Exhibit 4.3: Monthly Mainstream Costs in Relation to 

Homelessness 

$0.00 

$100,000.00 

$200,000.00 

$300,000.00 

$400,000.00 

$500,000.00 

Pre During Post 

Mental Health 

Criminal Justice 

Substance Abuse 

Physical Health 

Income Support 

Exhibit 3: Monthly Mainstream Costs in Relation 

to Homelessness 

•	 In regression analysis, demographic characteristics and involvement in mainstream domains 

were stronger predictors of mainstream costs than the path a person takes through the 

homeless service system. In particular, whether or not a person received physical healthcare 

was a very strong predictor of mainstream costs. Age was also a strong predictor, with the 

youngest and the oldest age groups in the study cohort having the highest mainstream costs. 

•	 Overall mainstream costs were far lower than estimates from previous studies, suggesting that 

the experience of becoming homeless does not necessarily lead to long-term, costly

involvement in mainstream service systems. 

Average monthly costs are used here to adjust for the wide variance in the length of the homeless period for 

the study cohort. 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–3 

4 
A–4 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-4 

 

 

 

 

A.2. The Homeless Services System for Single Adults in 

Jacksonville-Duval, Clay Counties 

The Jacksonville-Duval/Clay Counties Continuum of Care (CoC) covers approximately 1,350 square 

miles along the northeastern Florida coastline. The CoC includes a significant portion of the

metropolitan Jacksonville area, including its downtown hub, and has a population of 980,226. 

Exhibit 4 is a map showing the Jacksonville-Duval/Clay Counties CoC. 

Exhibit 4: The Jacksonville-Duval/Clay Counties CoC In January 2005, the CoC 

reported a point in time 

census of 2,930 homeless 

persons, 86 percent of 

whom (2,521) were single 

adults. Of those, 721 were 

without shelter. Nearly

one in every 335 people in

Jacksonville-Duval/Clay

Counties was homeless on 

that single night in 

January.5 

Fifteen primary agencies 

within the CoC provide

shelter, transitional 

housing and permanent housing to homeless people. They are clustered primarily within downtown 

Jacksonville. Several additional agencies do not provide shelter but provide supportive services to 

homeless persons in Jacksonville. Nearly all of the homeless service agencies, including large faithbased organizations that do not receive any public funding, participate actively in the CoC planning 

process. The CoC, led by the non-profit Emergency Services and Homeless Coalition (ESHC), 

establishes priorities for program development and funding. In 2004, ESHC published a 10-Year 

Strategic Plan entitled Ending Homelessness in Jacksonville: A Blueprint for the Future (ESCH, 

2004). The plan encourages the CoC to adopt a “Housing First” approach of moving clients as 

quickly as possible into permanent housing. However, as is true for many jurisdictions that have 

announced intentions to place clients rapidly into permanent housing, Jacksonville’s service system

still reflects, for the most part, a more traditional staged housing framework, wherein clients are 

assumed to move from emergency shelter to transitional housing and from there to independent or 

permanent supportive housing. 

A.2.1	 Homeless Program Types 

Homeless programs in Jacksonville were assigned a program-type based on their role in the homeless 

service system, the level of supportive services they provided, and their expected cost structure. 

5 This estimate is based on the Continuum of Care’s 2005 Homeless Population and Subpopulations chart 

from its annual funding application to HUD (HUD, 2006) and 2005 ACS population estimates for Duval

and Clay Counties (U.S. Census Bureau, n.d.). 

A–4 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-5 A–5

Exhibit 5 shows the program types identified in this analysis, the number of programs in each

category, the number of available beds for each program type, and information on the costs collected 

for these programs. 

Exhibit 5: Jacksonville CoC Program Typology 

Program 

Description 

Number of Number 

Type Programs of Beds Notes on Cost Estimates 

Supportive 

Services 

Only 

This category includes a service center that 

provides food, clothing and job training; a health 

clinic; and a case management program for 

persons with psychiatric disabilities. 

3 N/A 

These programs were not 

included in the case study 

due to lack of standardized 

data on utilization. 

Street 

Outreach 

Street-based outreach and service center, 

offering low demand, engagement-focused 

services. Clients are engaged on the streets and 

come into the center for more extensive 

assistance. Clients typically receive services for 

6-12 months. 

2 N/A 

No data available on level 

of services received so a 

standard “engagement” 

cost was applied to each 

stay. 

Congregate 

Overnight 

Shelter 

Overnight shelters for homeless individuals. 

Programs were all faith-based and offered 

minimal services. 3 180 

One overnight shelter was 

not included in this study 

due to lack of HMIS data. 

Costs were collected 

directly from one of the two 

other programs. 

Congregate 

24-hour 

Emergency 

Shelter 

Emergency Shelter with 24-hour supervision, 

permitting longer lengths of stay and offering 

more extensive services. 1 300 

Costs collected directly. 

Facilitybased 

Transitional 

Housing 

Congregate facilities offering longer lengths of 

stay (up to 2 years) and intensive services, 

typically focused on substance abuse recovery. 

8 450 

Two programs were not 

included in study because 

they did not participate in 

HMIS. Cost data was 

collected directly from 

three of the six remaining 

programs. 

Scattered 

Site 

Transitional 

Housing 

Market-rate housing. Agency holds the lease, but 

clients may take over the lease if/when they 

become self-sufficient. Rent subsidies are 

typically provided for up to two years. Clients 

receive case management and other services. 

2 60 

Costs were collected 

directly from both 

programs. 

Facilitybased PH: 

Minimal 

Services 

Section 8 Moderate Rehabilitation Single Room 

Occupancies (SROs). Clients served were not 

necessarily disabled. Minimal services offered in 

conjunction with program. 

4 450 

Costs were collected 

directly for three of the four 

programs. 

Facilitybased 

PSH: 

Moderate 

to Intensive 

Services 

Permanent Supportive Housing, either SROs or 

group housing. Exclusively serve persons with 

disabilities and offer more intensive services. 5 175 

Two programs were 

excluded due to lack of 

HMIS data. Costs were 

collected directly from two 

of three remaining 

programs. 

Scattered 

Site PSH: 

Moderate 

to Intensive 

Services 

Market-rate housing. Either the agency or the 

client holds the lease. Clients receive permanent, 

deep rental subsidy, case management, and 

other services. 4 165 

One program was 

excluded due to lack of 

HMIS data. For Shelter + 

Care programs, case 

match included as service 

cost. 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–5 
A–6 Appendix A: Costs of Individual Homelessness in Jacksonville, FL

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-6 

 

 

 

 

 

 

 

 

Jacksonville has two homeless outreach programs that provide a variety of services to persons living 

on the streets. In most cases these services are limited to brief interactions such as distributing 

blankets or bus tokens. However, some clients engaged for longer periods of time are placed into 

residential homeless programs. 

Jacksonville has three overnight emergency shelters. These facilities offer minimal services and often

limit the total number of nights clients can stay there. One overnight shelter allows three free nights 

per month and then charges $5 per night. Although overnight shelters are not very large, they serve 

more people than other programs because they have the highest turnover rates. The largest

emergency shelter in the area was placed in a separate category because, unlike the overnight 

emergency shelters, it has 24-hour staffing, on-site supportive services, and no explicit limits on

length of stay. 

Most transitional housing units in Jacksonville are facility-based, meaning that clients are housed in a

single building or a campus of buildings owned or leased by the program. There are a few scatteredsite transitional programs that rent individual apartments in larger complexes where most of the

buildings’ tenants are not homeless. Most transitional housing programs offer supportive services, 

including case management, benefits assistance, and job training. These programs screen out persons 

who are actively using drugs or alcohol and cite employment, sobriety and obtaining permanent 

housing as their primary program goals. 

The majority of permanent supportive housing units in Jacksonville are Section 8 Moderate 

Rehabilitation Single Room Occupancies (SROs). Unlike permanent supportive housing, these 

programs do not exclusively serve persons with disabilities. Aside from meals, these permanent 

housing SROs do not include on-site supportive services. Services are provided through referral.

Jacksonville also has several permanent supportive housing programs that offer more intensive onsite supportive services. Most individuals using permanent housing programs are not included in this 

study because their initial homeless program entry date was prior to July 1, 2004. 

Annual operating budgets were collected for a sample of homeless programs of each type. The 

annual operating costs include the costs of housing operations, program administration and supportive 

services such as food and case management. For programs that own their own facilities, an estimate 

of the capital costs of those facilities was factored into the daily cost. Annual costs were divided by

the annual number of total shelter days provided to derive a daily cost. 

The daily costs were merged with homeless service utilization data to derive the total costs for each 

program stay. The primary source of data used to measure homeless program utilization was HMIS 

data. However, three of Jacksonville’s largest providers did not consistently enter data into the HMIS 

during the study period. These providers had their own separate databases to track the number of 

clients they served, their characteristics, and their lengths of stay. For the study, data extracts from

the HMIS and each of the three provider databases were merged to create a single dataset that 

captured the majority of homeless programs in the Jacksonville CoC. 

Some programs did not participate in HMIS or provide a separate dataset. Those programs are 

missing from the analysis, and, therefore, this study does not provide a complete account of how 

many single adults became homeless during the study period, their service patterns, or their total 

costs. For instance, no data was available for Circle of Love, a medium-size faith-based organization 

A–6 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-7 A–7

 

 

 

 

that operates an overnight shelter and a transitional housing program, or for Volunteers of America’s 

permanent supportive housing programs. Despite these limitations, data was available for over 95 

percent of the total emergency, transitional and permanent supportive housing beds within the CoC. 

Jacksonville has several homeless supportive services only programs whose costs are not included in 

this case study, including a health clinic; a service center that provides meals, clothing and 

employment services; and a case management program for homeless persons with psychiatric 

disabilities. These programs were excluded from the case study because of their lack of consistent 

and standardized HMIS data. 

A.2.2 Homeless Costs by Program Type 

It cost the homeless service system more than $3.2 million to provide shelter and services to the 1,972 

persons in the homeless study cohort during the 18-month homeless tracking period. Exhibit 6 

presents the homeless system costs for each homeless program-type used by the study cohort of firsttime homeless individuals in Jacksonville. Service intensity is the biggest determinant of cost per 

day. Programs that offer an array of on-site services such as healthcare and employment assistance 

have higher daily costs. Facility-based residential programs, where clients are all served in a single 

building or campus, have daily costs similar to those of scattered-site programs that lease market-rate 

apartment units. 

Exhibit 6: Homeless Costs by Program Type 

Type 

Total 

Cost 

Total 

Days 

Average 

Cost Per 

Day 

Total 

Program 

Stays 

Distinct 

Persons 

Served 

Average 

Average 

# of 

Days 

per Stay 

Average 

Cost Per 

Person 

# of 

Stays 

per 

Person 

Outreach and 

Engagementa $15,868 177 $89.65 177 168 1.1 1 $94 

Congregate Overnight 

Shelter $134,183 9,862 $13.61 4,909 1,210 4.1 2 $111 

Congregate 24-hour 

Emergency Shelter $1,733,325 54,046 $32.07 884 700 1.3 61 $2,476 

Facility-based 

Transitional Housing: 

Moderate to Low 

Intensity Services 

$773,714 24,680 $31.35 434 348 1.2 57 $2,223 

Scattered Site 

Transitional Housing: 

Moderate to Low 

Intensity services 

$19,002 686 $27.70 6 6 1.0 114 $3,167 

Facility-based PSH: 

Moderate to Intensive 

Services 

$157,231 5,457 $28.81 33 31 1.1 165 $5,072 

Scattered Site PSH: 

Moderate to Intensive 

Services 

$82,250 2,650 $31.04 13 12 1.1 204 $6,854 

Facility-based PSH: 

Minimal Services $305,696 14,758 $20.71 59 58 1.0 250 $5,271 

a Each outreach engagement was treated as a one-day stay 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–7 
A–8 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-8 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Homeless outreach programs were responsible for less than one percent of total homeless system

costs. Only nine percent of the study cohort had contact with a homeless outreach worker. The 

HMIS data did not offer information on the types of services clients received, so an average cost per 

“engagement” was estimated and applied to each member of the study cohort reported to have 

received outreach services. 

Although congregate overnight emergency shelters served 61 percent of the homeless study cohort, 

they accounted for only 9 percent of homeless days and only 4 percent of homeless system costs. On 

average, a night in an overnight congregate shelter cost $13.61, a significantly lower unit cost than 

any other residential homeless program. Overnight shelters also had the lowest total costs per person 

served because they had much shorter lengths of stay than other residential homeless programs. 

Jacksonville’s congregate 24-hour emergency shelter served 35 percent of the study cohort at 

sometime during the tracking period and accounted for 48 percent of total shelter days and 54 percent 

of homeless costs. This shelter had a daily cost of $32.07, the highest of any residential program, or 

$962 for a one-month stay. By comparison, the 2007 fair market rent for a 1-bedroom apartment in 

Jacksonville was $669. The twenty-four hour emergency shelter had a longer average length of stay

than facility-based transitional housing programs. This could be because the 24-hour shelter has 

fewer program requirements such as maintaining sobriety or paying program rent. Because of the 

slightly higher daily cost and the slightly longer average stay, the total cost per individual of a stay in 

24-hour emergency shelter was higher than the total cost of a stay in a transitional-housing facility. 

Transitional housing programs accounted for 25 percent of total homeless system costs. Facilitybased transitional housing programs had a slightly higher daily unit cost ($31.35) than scattered site

transitional housing ($27.70). However, scattered-site transitional housing programs had a higher 

total per-person cost because their average stay was twice as long. The median stay in facility-based 

transitional housing lasted less than 30 days, possibly because persons in the study cohort had 

difficulty complying with their sobriety requirements or other program rules. 

Although only 5 percent of the study cohort used permanent supportive housing, these programs 

accounted for 17 percent of total homeless costs.6

 The daily costs of permanent supportive housing 

programs varied greatly depending on the level of services provided. Facility based SRO programs 

with minimal services had a daily cost per person of $20.71, while scattered site permanent 

supportive housing programs with more intensive services had a daily cost per person of $31.04. 

Permanent supportive housing programs with more intensive services had significantly shorter 

average lengths of stay than permanent supportive housing programs with services provided through 

referrals. Overall, permanent supportive housing programs had the highest total costs per person 

because their average lengths of stay were greater than other residential programs. 

Several permanent supportive housing programs for people with mental illness did not have data in the 

HMIS, including these program might have increased the number of clients using permanent housing 

programs and their associated costs. However, most of those clients would not have been likely to fall into

our cohort of first-time homeless between July 1, 2004 and June 30, 2005. 

A–8 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 

6 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-9 A–9

 

 

 

 

 

 

 

 

 

 

 

A.3. Homeless System Costs 

A.3.1 Utilization of the Homeless System 

The study cohort’s homeless service utilization was tracked for 18 months from the initial program

entry date for each member of the study cohort. Seventy-eight percent of the study cohort used only 

emergency shelter or street outreach programs, and fifty percent of the study cohort had only one 

program stay. 

The median total length of stay in residential homeless programs was only ten days. A small subset 

of the study cohort stayed in homeless residential programs for six months or more. As a result, the 

average length of stay (57 days) was more than five times the median length of stay. Similarly, a

small subset of persons had five or more program stays. Although fifty percent of the study cohort 

had only one program stay, the average number of program stays was 3.3 (Exhibit 7). 

It was rare for people in the study

cohort to use the homeless service 

system as a continuum, moving from

emergency shelter to transitional or 

permanent housing. Only 22 percent of 

the study cohort used transitional or

permanent supportive housing at all. 

The majority of persons who used 

transitional or permanent housing also 

had an emergency shelter stay (59%). However, of those who used both emergency shelter and 

transitional or permanent housing, 37 percent accessed transitional or permanent housing directly, had 

a program exit, and then had a subsequent stay at an emergency shelter. When people moved from

emergency shelter into transitional or permanent supportive housing, there was often a lag between 

their exit from emergency shelter and their entry into transitional or permanent supportive housing, 

suggesting that their entry into transitional or permanent supportive housing was not the result of a 

referral. 

Exhibit 7. Homeless Program Utilization 

Average number of Homeless Program Stays 3.3 

Percent of study cohort with only one program stay 50% 

Percent of study cohort that used only emergency shelter 

or outreach programs 78% 

Percent of study cohort that used transitional and/or 

permanent supportive housing 22% 

Average (mean) number of days spent in homeless 

programs 

57 

Median number of days spent in homeless programs 10 

A.3.2 Homeless System Costs per Person 

Exhibit 8 shows the distribution of 

costs to the homeless services system

for individuals in the study cohort. The 

average cost per person was $1,634,

while the median was $225. The 

minimum cost for a person represents 

one night in an emergency shelter, and 

the maximum is for a person who 

stayed in a range of homeless programs 

for the entire 18-month period. 

Exhibit 8. Summary of Per Person Homeless 

System Costs 

Average Homeless System Cost Per Person $1,634 

Median Homeless Cost $225 

Minimum Homeless Cost $13.61 

25th Percentile of Homeless Costs $40.82 

75th Percentile of Homeless Costs $1,578 

Maximum Homeless Costs $23,069 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–9 
A–10 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-10 

 

 

 

 

 

 

0 10,000 20,000 30,000 

dual ($) Homeless System Costs per Indivi

0 10 20 30 40 50 60 70 80 90 10 

Percent of Cohort 

50% of cohort 

incurred 2 % of 

homeless costs 

0 

Distribution of Homeless System Costs for Cohort 

10% of cohort 

incurred 62 % 

of costs 

As shown in Exhibit 8, half the study cohort had a total homeless cost of less than $225. Almost all 

of these individuals either used just emergency shelter or had a street outreach contact followed by an 

emergency shelter stay and spent only a 

few days total in shelter. These Exhibit 9: Distribution of Homeless Costs 

individuals accounted for only 2 percent 

of total homeless costs. Ten percent of the 

study cohort had a total homeless cost of 

$5,300 or more. These individuals 

accounted for 62 percent of total homeless 

costs. 

Exhibit 9 shows the cumulative 

distribution of homeless system costs for 

the individuals in the study cohort. The 

distribution of homeless system costs is 

heavily skewed by a small percentage of 

users responsible for the majority of total 

costs. 

A.3.3 Homeless Costs by Demographic 

Characteristics 

The average total homeless cost of women in the study 

cohort was more than double the average costs of men, 

as shown in Exhibit 10. Women were more likely to

have long stays in emergency shelter. Fifty-five 

percent of persons who spent 6 months or more in 

emergency shelter were women, even though women 

made up only 20 percent of the homeless study cohort.

This finding is consistent with other studies that have 

found that women typically have longer lengths of 

stay in residential homeless programs (HUD, 2008). 

Not only did women have longer homeless program stays, they also typically used more expensive 

programs. Multivariate regression analysis, shown in Appendix B.3.1, measures the effect each 

independent variable has on homeless costs, holding other variables constant. The outcome variable 

is in log form, and these coefficients can be understood as percentage differences from the reference

category for each categorical variable. Model 4 in Appendix B.3.1 shows the effect of gender on 

homeless costs, controlling for the length of stay spent in homeless programs, number of program

stays, gaps between homeless stays, race, and age. The female variable has a co-efficient of 1.21, 

meaning that women had 121 percent higher homeless costs after controlling for other variables. The 

relationship between gender and homeless costs was statistically significant at the .01 level. 

Exhibit 10: Homeless Costs by Gender, 

Race and Age 

Average Homeless Cost 

Gender 

Men $1,337 

Women $2,754 

Race 

White $1,348 

African-American $1,928 

Age 

18 to 24 $1,197 

25 to 30 $1,327 

31 to 40 $1,466 

41 to 50 $1,689 

51 and older $2,152 

A–10 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-11 A–11

 

 

 

 

 

 

 

The average total homeless cost for African-Americans ($1,928) was nearly $600 higher than the 

average homeless cost for whites ($1,348) (Exhibit 10).7 African-Americans had longer average 

lengths of stay than whites. However, even after controlling for length of stay and other variables, 

African-Americans still had 39.4 percent higher costs than whites (Appendix B.3.1). This finding was 

statistically significant at the .01 level. 

Exhibit 10 also shows that costs per individual increase with age, with those over 50 having the

highest cost per person. Older persons were more likely to progress from emergency shelter to 

transitional or permanent supportive housing or to be placed directly in permanent supportive 

housing, possibly because they were more likely to have a documented disability. However, 

multivariate regression analysis found that the effect of age on total homeless cost per person was not 

statistically significant after controlling for homeless program utilization, suggesting that the greater 

cost per person for older individuals is associated only with longer stays (Appendix B.3.1, Model 4). 

A.3.4 Costs by Homeless Path Group 

First-time homeless individuals followed eight distinct “paths” through the homeless services system

in Jacksonville. These paths were assigned based on a multivariate cluster analysis that included as

variables the number of nights spent in homeless programs, number of homeless stays, length of gaps 

(in days) between homeless stays, and the types and sequences of programs used while homeless. 

Exhibit 11 presents the Jacksonville path groups, the percentage of the study cohort in each path, the

path groups’ demographic characteristics, their lengths of stay, and the average cost to the homeless 

system for each person in the path group. Appendix B.1 provides more information on the 

demographic characteristics of each path group, and Appendix B.2 shows their utilization of homeless 

programs. 

Two-thirds of the study cohort, 1,302 people, fell into either the “ES Short Stayer” or the “Street/ES 

Short Stayer” path group. These people had brief stays in emergency shelter or a brief engagement

with a homeless outreach program followed by a stay in emergency shelter. The majority of people 

in these path groups spent three days or less in homeless programs and typically used only overnight 

emergency shelter rather than the more costly 24-hour emergency shelter. Therefore, the total 

homeless cost per person for these path groups were very low compared to the rest of the study 

cohort. The individuals in these path groups were overwhelmingly male and somewhat more likely to 

be white than individuals in other path groups. 

Two percent of the study cohort had a single stay in emergency shelter that lasted more than six 

months. “Emergency Shelter Long Stayers” was the only path group with more women than men. 

This path group also had the highest percentage of African-Americans. “Emergency Shelter Long 

Stayers” had the second highest total homeless system cost per person of any path group, $9,756. 

The forty-four persons in this path group had a higher total homeless cost ($429,274) than the 746 

“Emergency Shelter Short Stayers” ($419,768). 

7 Information on ethnicity was not available from the Homeless Management Information System (HMIS). 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–11 
A–12 Appendix A: Costs of Individual Homelessness in Jacksonville, FL

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-12 

 

 

 

 

Exhibit 11: Jacksonville Homeless Path Groups 

Path Name Description 

% of 

Study 

Cohort 

Average 

Age 

Percent 

Male 

Percent 

White 

Average 

Length 

of Stay 

Average 

Homeless 

Cost 

Total 

Homeless 

Cost 

Single ES 

Short 

Stayers 

A single stay in 

emergency shelter 

lasting less than 6 

months 

38% 40 80% 51% 18 $563 $419,768 

Street/ES 

Short 

Stayers 

This pattern includes 

outreach 

engagements followed 

by short emergency 

shelter stays, as well 

as multiple, brief 

shelter stays 

28% 41 85% 52% 29 $853 $474,039 

Single ES 

Long Stayers 

A single stay in 

emergency shelter 

lasting 6 months or 

more 

2% 41 46% 25% 304 $9,756 $429,274 

Multiple ES 

Long 

Gappers 

Multiple emergency 

shelter stays with 

significant gaps in time 

between stays 

10% 42 95% 37% 40 $910 $179,249 

Sequential 

Short 

Stayers 

Brief use of transitional 

housing, sometimes 

following emergency 

shelter. A few 

members of this path 

ended the sequence 

with a short stay in 

PSH following 

emergency shelter or 

transitional housing. 

Total length of stay 

less than 6 months. 

10% 41 65% 50% 54 $1,585 $310,652 

Sequential 

Long Stayers 

Long stays in 

transitional housing, 

sometimes following a 

stay in emergency 

shelter. A few 

members of this path 

ended the sequence 

with a short stay in 

PSH. Total length of 

stay greater than 6 

months. 

2% 47 67% 50% 364 $10,416 $374,961 

Circlers Use of emergency 

shelter following 

transitional or 

permanent supportive 

housing. 

7% 43 79% 38% 135 $3,987 $566,200 

Permanent 

Supportive 

Housing 

Long 

Stayers 

Long stays in 

permanent supportive 

housing, sometimes 

preceded by a stay in 

emergency shelter 

3% 46 67% 42% 338 $8,493 $467,126 

A–12 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-13 A–13

 

 

 

Ten percent of the study cohort had a high number of stays in emergency shelter spread out over a 

long period of time. Ninety-five percent of “Emergency Shelter Long Gappers” were male and two

thirds were African-Americans. “Long Gappers” had an average of 11 distinct program stays during

the study period, and most of these stays lasted only a few days (Appendix B.2). On average, 398

days elapsed between the first shelter entry for “Emergency Shelter Long Gappers” and their last 

shelter exit during the study period. However, “ES Long Gappers” spent an average of only forty 

days in emergency shelter. Some “ES Long Gappers” may be chronically homeless persons 

alternating among spending the night in emergency shelters, living on the streets or in other tenuously

housed situations, and staying in other institutions. The average homeless cost for this path group 

was $910, lower than the overall study cohort average. 

Ten percent of persons in the study cohort were “Sequential Short Stayers”. This path group ended 

the homeless “path” in transitional or permanent housing and had a total length of stay of less than six 

months. Two percent of persons in the study cohort were “Sequential Long Stayers”. This path

group ended the homeless “path” in transitional or permanent housing and had a total length of stay of 

six months or more. Although people in these two path groups are characterized as “sequential” users

of the homeless service system, the majority (56 percent) used only transitional housing. 

“Sequential Long Stayers” had a total homeless cost per person of $10,416, the highest of any path 

group. Together the 36 “Sequential Long Stayers” incurred $374,961 in total homeless costs, 

$64,000 more than the total homeless costs of the 196 “Sequential Short Stayers” ($310,652). 

“Sequential Long Stayers” and “Sequential Short Stayers” both were somewhat more likely to be 

women than the study cohort as a whole. Long Stayers were older on average than other path groups, 

with an average age of 47, compared to 41 for the overall study cohort (Appendix B.1). 

Seven percent of the study cohort, 142 people, were “Circlers”, meaning that they exited transitional 

or permanent supportive housing only to have a subsequent homeless program stay in emergency

shelter or transitional housing. Compared to other path groups using transitional or permanent 

housing, “Circlers” were more likely to be male and more likely to be African-American. Because of 

their relatively short lengths of stay, their average costs were lower than costs for the “long-stayer” 

path groups. 

Three percent of the study cohort, 55 persons, had long stays in permanent housing. “Permanent 

Supportive Housing Long Stayers” had a higher average age than the study cohort as a whole. 

Although this group had an average length of stay of 338 days and the highest median length of stay

of any path group (384 days, compared with 371 for sequential long-stayers), they typically stayed in

SRO units with minimal services and low daily costs (Appendix B.2). Thus, their total cost per 

person was considerably less than the costs per person of the long-term stayer groups that spent most 

of their time in transitional housing or emergency shelter. 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–13 
A–14 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-14 

 

 

 

 

 

 

 

 

 

 

A.4. Mainstream System Costs 

Of the six sites in the Cost of Homelessness study, Jacksonville provides the most complete picture of 

mainstream service costs associated with first-time homelessness. 

Administrative data on mainstream 

service systems were collected through 

the University of South Florida (USF), 

which acted as an intermediary. USF 

manages behavioral health data for the 

State and was able to link our homeless 

study data with mainstream datasets to 

produce the analysis needed for this 

case study. The study includes data 

for: Medicaid-funded physical 

healthcare; state and Medicaid funded mental health and substance abuse services; Temporary

Assistance to Needy Families (TANF); food stamps; and jail and arrest data from the Duval County

Sheriff. The data on physical healthcare cover both capitation plans (Medicaid managed care) and fee 

for service encounters. The capitation plan costs reported in the study represent the costs incurred by

the medical providers for the visits and services provided, rather than the amount of the premiums 

paid by the State for the managed care. 

Exhibit 12. Percent of Study Cohort Utilizing Mainstream 

Systems During the Study Period 

One or more mainstream domains 74% 

Two or more mainstream domains 49% 

Income support 52% 

Criminal Justice 38% 

Mental Health 25% 

Substance Abuse 22% 

Physical Health (Medicaid funded) 20% 

Not included in the study are physical healthcare costs not covered by Medicaid, such as emergency

room visits for the uninsured, and medical and other services provided through the Veterans 

Administration. We also did not collect data on SSI/SSDI income support or on service encounters 

and costs that members of the study cohort might have had with the child welfare system.8 

Mainstream service costs were analyzed for the periods before, during and after homelessness. The 

pre-homelessness period was defined as the 12 months prior to the first homeless program entry for 

an individual in the study cohort. During homelessness was defined as the period between a cohort 

member’s initial entry into a homeless program and his or her final exit from a homeless program.9 

The after homelessness period was defined as the period between a person’s final program exit date 

and the end of the study period December 31, 2006. The entire study period lasted between 2.5 and 

8	 Members of the study cohort were served only as single individuals during the study period. However, 

some of them may have been parents of minor children with encounters with the child welfare system, just 

as some received TANF income. 

9	 If clients were still in a homeless program 18 months after their initial program entry, they were given an

exit date of 18 months (548 days) after their initial entry. For persons who had more than one homeless 

program stay, the during-homelessness period includes time when those persons were not actually residing

in homeless programs and many not have actually been homeless. For example, a person in the study

cohort might go to an overnight shelter for one night on July 3, 2004, exit the shelter to live in his own

apartment, and then have a subsequent one night stay in an overnight shelter on December 21, 2005. 

Although this person’s total length of stay in homeless programs was two nights, his total period “during 

homelessness” was 536 days. 

A–14 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-15 A–15

 

 

 

 

 

 

 

 

 

 

 

 

3.5 years, depending on a client’s initial homeless program entry date.10 Exhibit 12 shows the 

percentage of the study cohort using each mainstream system at some point during the entire study

period. 

Exhibit 13 summarizes the mainstream system costs of the Jacksonville study cohort of first-time 

homeless individuals. The average total mainstream system cost per person in the study cohort was 

$6,294. Some mainstream costs are positive, as persons in the study cohort received necessary

benefits or services. Other mainstream costs were less positive, for example, incarceration or 

involuntary psychiatric hospitalizations. 

Like homeless costs, the distribution of 

mainstream costs was heavily skewed, 

with a majority of the study cohort with

relatively low costs and a small subset 

with very high costs. The skew is 

reflected in the large gap between the 

mean mainstream cost ($7,136) and the 

median mainstream cost ($1,602). 

More than a quarter (26 percent) of the

study cohort made no use of 

mainstream services during the study 

period, so the 25th percentile cost per person is zero. 

Exhibit 13. Summary of Total Mainstream System Costs 

Total Mainstream Costs $12,410,933 

Percent of study cohort that incurred mainstream 

costs 74% 

Average mainstream costs per person $6,294 

Average mainstream costs per person incurred 

during homelessness $1,018 

25th percentile of mainstream cost $0 

Median mainstream cost $1,602 

75th percentile of mainstream cost $7,136 

Maximum mainstream cost $180,814 

Exhibit 14 shows the total 

monthly mainstream costs

for the entire study cohort 

for each major domain in the 

periods before, during and 

after homelessness. Monthly

averages are used to control 

for the difference in length

between the before, during

and after homelessness timeperiods. Total monthly

mainstream costs for almost 

all domains were highest 

during homelessness. The 

biggest reason for the

increase was a 125 percent spike in criminal justice costs during homelessness. The Duval County 

Department of Corrections spent an average of $178,072 per month on the homeless study cohort 

during this period. 

Exhibit 14: Total Monthly Mainstream Costs for the Study Cohort 

Before, During, and After Homelessness 

Criminal 

Justice 

Physical 

Health 

Mental 

Health 

Income 

Support 

Substance 

Abuse 

All 

Domains 

Average Monthly Costs by Time Period 

Prior $79,274 $89,923 $78,091 $42,595 $26,622 $317,198 

During $178,072 $98,206 $47,328 $61,526 $70,992 $456,124 

Post $73,950 $81,049 $76,908 $58,568 $37,862 $327,746 

Percent of Costs Incurred by Time Period 

Prior 25% 28% 25% 13% 8% -

During 39% 22% 10% 13% 16% -

Post 23% 25% 23% 18% 12% -

Overall 26% 25% 22% 16% 11% -

10	 The total length of the mainstream tracking period varied based on when persons in the study cohort first

entered the homeless service system. Persons with a program entry date of July 1, 2004 had a total study 

period of 3.5 years (July 1, 2003 – December 31, 2006). Persons with a program entry date of June 30, 

2005 had a total study period of 2.5 years (June 30, 2004-December 31, 2006). The average mainstream

study period was 1,090 days. 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–15 
A–16 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-16 

 

 

 

 

 

 

 

Criminal justice was the most expensive mainstream domain for the study cohort, accounting for 26 

percent of overall mainstream costs and 39 percent of mainstream costs incurred while the study

cohort was homeless (Exhibit 14). Criminal justice costs include the costs of making an arrest

($244.50/arrest) and putting someone in jail (a $165 processing fee plus $60 for each night spent in 

jail). Criminal justice costs do not include court costs or prison costs. Thirty-eight percent of the 

study cohort had at least one encounter with the criminal justice system (Exhibit 12). 

Exhibit 14 shows a 125 percent increase in monthly criminal justice costs for the study cohort during

homelessness, suggesting that persons are more likely to incur criminal justice costs while they are

homeless. Trespassing was the most commonly cited cause for arrest, followed by possession of a 

controlled substance, petty theft, public intoxication, and driving with a suspended license – all nonviolent offenses. 

The monthly costs by time period show a sharp spike in criminal justice costs during homelessness.

However, a more granular analysis of the criminal justice data shows that jail stays increase 

dramatically directly before and after first contact with a homeless program (Exhibit 15). The 

dramatic increase in jail stays (and jail costs) is obscured in Exhibit 14 because monthly costs are 

averaged out over the entire 12-month “pre-homelessness” period. Exhibit 15 suggests a connection 

between the event of becoming homeless and the likelihood a person goes to jail. In some cases a jail 

stay may have disrupted a person’s housing arrangement and precipitated his homelessness; in other 

cases, being homeless might have made people more likely to be arrested for vagrancy crimes such as

trespassing or loitering.11 

Exhibit 15: Jacksonville Jail Stays Relative to Homelessness 

0 

20 

40 

60 

80 

100 

120 

Total Jail Stays for Study Cohort

1st Day in 

Homeless System 

12 Months Prior11 Months Prior10 Months Prior

9 Months Prior8 Months Prior7 Months Prior6 Months Prior5 Months Prior4 Months Prior3 Months Prior2 Months Prior

1 Month Prior

1 Month Post

2 Months Post3 Months Post4 Months Post5 Months Post6 Months Post7 Months Post8 Months Post9 Months Post

10 Months Post11 Months Post12 Months Post13 Months Post14 Months Post15 Months Post16 Months Post17 Months Post18 Months Post 

Time Relative to First Day in Homeless System 

11	 Other research analyzing rates of homelessness among ex-offenders found that individuals released from

state prisons or jails have a greater risk of homelessness than individuals with similar characteristics who 

have not been recently incarcerated. The same research also found that certain demographic characteristics 

and longer periods of incarceration were associated with greater risks of homelessness after release. 

(Graham, D., Locke, G., Bass Rubenstein, D. & Carlson, K., unpublished) 

A–16 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-17 A–17

 

 

 

 

 

 

 

 

 

 

 

 

 

Unfortunately, the administrative data used in this study is insufficient to investigate these 

relationships more thoroughly. This level of analysis requires client-level utilization data, which we 

did not receive for the other mainstream systems in Jacksonville. 

Exhibit 16 shows the results of 

multivariate analysis we conducted 

to understand which characteristics 

of the study cohort and its patterns 

of homelessness are related to 

criminal justice costs.12 In these 

models, the regression coefficients

represent the differences in dollar 

costs between individuals with and 

without a particular characteristic. 

The first model in Exhibit 16 

includes the number of homeless 

stays, length of stay in homeless 

programs, the number of gap days

spent between homeless program

stays, age, gender, and race. The 

coefficients in these models should 

be interpreted as the effect (in 

dollars) having a particular 

characteristic has on a person’s

criminal justice costs, controlling 

for all other characteristics included 

in the model. According to this

model, there is not a strong

association between the number of 

homeless program stays and 

criminal justice costs or between 

length of stay in homeless 

programs and criminal justice costs. 

However, there is a strongly

significant relationship between 

sporadic use of the homeless 

service system and criminal justice 

costs. People who had long gaps 

between homeless program stays 

had higher criminal justice costs. 

The gap days variable has a 

coefficient of 149.9, meaning that for every 30 days spent between homeless program stays, criminal 

justice costs increased by almost $150. The first model in Exhibit 16 also shows a strong relationship 

between gender and criminal justice costs, with women having almost $1,000 lower criminal justice 

Exhibit 16. Multivariate Regression Models for 

Criminal Justice Costs 

Model without 

Model with mainstream 

involvement 

mainstream 

involvement 

Patterns of Homelessness 

Total Number of Stays -34.855 -16.612 

(21.201) (18.684) 

Total length of stay (in days), 

divided by 30 

11.861 -40.961* 

(27.582) (24.685) 

Total gaps between stays (in 

days), divided by 30 

149.972*** 46.678** 

(25.196) (22.557) 

Demographics+ 

Females -992.334*** -699.162*** 

(249.377) (239.654) 

African-Americans 380.364* 391.015** 

(195.320) (173.505) 

Other Races 814.333 1,037.067** 

(535.575) (470.540) 

Ages 18-24 91.847 20.461 

(380.230) (335.731) 

Ages 25-30 -59.916 30.047 

(341.461) (300.492) 

Ages 41-50 -639.606*** -442.451** 

(240.925) (212.209) 

Ages 51 and above -1,094.955*** -451.928* 

(291.206) (257.551) 

Mainstream Involvement 

Income Support (TANF and 

food stamps) N/A 162.643 

(180.981) 

Physical Healthcare N/A -522.385** 

(247.343) 

Mental Health N/A 133.297 

(211.859) 

Substance Abuse N/A 1,003.905*** 

(211.772) 

Criminal Justice N/A 3,973.550*** 

(178.374) 

Constant 1,820.685*** 61.876 

(220.352) (214.513) 

Observations 1972 1972 

R-Squared .04 .26 

+ Reference categories are males, whites, and ages 31-40. 

Standard errors in parentheses. *significant at 10%; **significant at 5%; 

***significant at 1% 

12	 Appendix B.4 provides a complete set of regression models, which include controls for missing variables. 

Appendices B.5 and B.6 provide alternate regression models that control for homeless path group and 

homeless cost respectively, rather than homeless service utilization. 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–17 
A–18 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-18 

 

 

 

 

 

costs than men. Age was also strongly associated with criminal justice costs, as persons over 40 had 

lower criminal justice costs than persons between 31 and 40. 

The second regression model shown in Exhibit 16 controls for both patterns of use of the homeless 

services system and for use of the mainstream domains, including criminal justice, with which the 

study cohort had encounters.13 Thus, individuals with criminal justice encounters had criminal justice 

costs almost $4,000 greater (the coefficient is 3973.55) than those without such encounters (whose 

criminal justice costs would be zero). Because this model controls for whether or not a person 

becomes involved in the criminal justice system, the coefficients indicate the extent of a person’s 

involvement and not the likelihood of his involvement. 

Thus, individuals who received substance abuse services as well as criminal justice services incurred 

an additional $1,004 in criminal justice costs, while those who used Medicaid reimbursed health care 

had criminal justice costs $522 lower. Even after controlling for the differential use of mainstream

services, across the entire study cohort women had criminal justice costs about $700 lower than men. 

The model shows that African American individuals have higher criminal justice costs than whites, as 

do those identifying themselves as belonging to “other” races. Not surprisingly, relatively older 

members of the study cohort have lower criminal justice costs than younger people. 

After controlling for involvement in mainstream domains, there is still a significant relation between 

gap days and criminal justice costs. However the relationship is much weaker, as the coefficient 

decreases from 149.9 to 46.7. After controlling for involvement in mainstream domains, there is a 

negative correlation between length of stay in homeless programs and criminal justice costs. 

However, the effect is slight and only significant at the 10 percent level. Apparently, peoples’ 

characteristics that are not directly related to homelessness—whether they are arrested, whether they 

have needs that bring them into contact with substance abuse services, whether they lack routine 

medical care—are much more powerful determinants of their criminal justice costs than their patterns 

of use of homeless programs. Gender and race also are more powerful predictors of criminal justice 

encounters than are patterns of use of the homeless services system. 

Income support was used by just over half of the study cohort. Fifty-two percent of the study cohort 

received food stamps during the study period, while only three percent of persons in the cohort

received TANF. The low utilization of TANF benefits was expected because most persons in the

study cohort were single men, and many of the women may not have qualified for TANF because 

they did not have children living with them. Income support costs increased 44 percent while persons 

in the study cohort were homeless and decreased only slightly after clients exited homeless programs 

(Exhibit 14). It is unclear how persons living in residential homeless programs, who in many cases 

were provided free meals, used their food stamp benefits. 

Multivariate analysis results indicate that income support costs were positively associated with longer 

homeless lengths of stay. The first regression model shown in Exhibit 17 shows that each additional 

30 days in homeless residential programs is associated with an additional $80 in income support 

across the study cohort. An alternate model that controls for homeless path groups (Appendix B.5.1, 

Model 2) shows that those with long stays in emergency shelter had a $2,327 higher income support 

cost per person. The models control for the gender of the individual and also show that women have 

13 Both models are shown in their entirety in Appendices B.4.1 and B.4.2 respectively. 

A–18 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-19 A–19

 

 

 

 

 

 

 

 

 

 

much higher income support amounts than men. The second model in Exhibit 17 shows that people 

who also receive physical health care have higher income support amounts than those who do not. 

Overall, the pattern 

seems to identify a

group better connected 

to programs that 

alleviate poverty than

other first-time 

homeless individuals. 

Substance Abuse 

services were used by

22 percent of the study

cohort (Exhibit 12). 

The monthly cost of 

substance abuse 

treatment for the study

cohort spiked 167 

percent during 

homelessness, from 

$26,622 to $70,992 

and decreased to 

$37,862 after persons 

in the study cohort 

exited homeless 

programs (Exhibit 14). 

Substance abuse 

treatment was the least 

expensive mainstream

service domain during 

the study period, 

having the lowest 

costs in the periods 

before and after 

homelessness. 

However, it was the 

third most expensive 

domain while people 

in the study cohort were homeless. 

Exhibit 17. Multivariate Regression Models for Income Support Costs 

Model without mainstream Model with mainstream 

involvement involvement 

Patterns of Homelessness 

Total number of stays -5.599 -2.596 

(10.013) (8.964) 

Total length of stay (in days), divided 

by 30 

80.128*** 40.700*** 

(13.027) (11.843) 

Total gaps between stays (in days), 

divided by 30 

0.982 -12.295 

(11.900) (10.822) 

Demographics+ 

Females 1,770.719*** 833.108*** 

(117.779) (114.976) 

African-Americans 280.946*** 135.253 

(92.248) (83.241) 

Other Races -174.340 -115.260 

(252.948) (225.746) 

Ages 18-24 416.656** 185.669 

(179.580) (161.070) 

Ages 25-30 248.953 92.079 

(161.269) (144.164) 

Ages 41-50 -152.958 -242.203** 

(113.787) (101.810) 

Ages 51 and above -104.207 -210.229* 

(137.534) (123.563) 

Mainstream Involvement 

Income Support (TANF and food 

stamps) N/A 

1,445.796*** 

(86.828) 

Physical Healthcare N/A 1,423.293*** 

(118.666) 

Mental Health N/A -255.665** 

(101.641) 

Substance Abuse N/A -123.407 

(101.600) 

Criminal Justice N/A 7.975 

(85.577) 

Constant 394.947*** -112.587 

(104.071) (102.915) 

Observations 1972 1972 

R-Squared 0.16 0.34 

+ Reference categories are males, whites, and ages 31-40. 

Standard errors in parentheses. *significant at 10%; **significant at 5%; ***significant at 1% 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–19 
A–20 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-20 

 

 

 

 

 

 

 

 

 

 

 

 

 

Path groups that involved the use of transitional housing programs (“Sequential” Stayers and 

“Circlers”) had higher substance abuse costs than path groups associated with only the use of 

emergency shelter.14 The relationship between use of transitional housing programs and substance 

abuse costs holds both when the use of mainstream systems is controlled for in the model and when it 

is not (Exhibit 18). Most 

transitional housing programs cited 

achieving sobriety as a principal 

program goal, and these programs 

may have referred their clients to 

mainstream drug treatment 

programs. An alternative 

specification of the model shows 

that each 30-day increase in the 

length of stay in a homeless 

program is associated with a $61 

increase in substance abuse costs 

(Appendix B.4.1). The first 

regression model in Exhibit 18, 

which does not control for the use of 

mainstream services, shows that 

heavy users of permanent 

supportive housing also have high 

substance abuse costs, but the 

coefficient is no longer significant 

in the second model, which does 

control for mainstream involvement. 

A possible explanation is that, while 

users of permanent supportive 

housing are more likely to incur 

substance abuse costs than other 

path groups, their substance abuse 

costs are not higher than other 

people who receive substance abuse 

treatment. Receiving mental health 

treatment was associated with a 

$451 increase in substance abuse 

costs, for persons who received

substance abuse treatment (Exhibit

18). Gender appears to have no 

effect on substance abuse costs. 

Mental health services were the 

third most expensive mainstream

service domain across the entire study period but the least expensive domain during the homelessness 

Exhibit 18. Multivariate Regression Models for 

Substance Abuse Costs 

Model without 

Model with 

mainstream 

involvement – 

controlling for 

homeless 

mainstream 

involvement -

controlling for 

homeless 

path group 

Homeless Path Group+ 

Single ES Long Stayers -12.359 -267.271 

(448.596) (400.888) 

Multiple ES Long Gappers 349.426 29.563 

(231.315) (209.701) 

Street/ES Short Stayers 312.461* 126.469 

(160.581) (143.937) 

PSH Long Stayers 1,174.122*** 583.988 

(402.976) (362.491) 

Sequential Short Stayers 883.603*** 414.067** 

(231.450) (207.256) 

Sequential Long Stayers 1,345.077*** 862.500* 

(494.468) (440.936) 

Circlers 491.023* 130.110 

(263.855) (238.325) 

Mainstream Involvement 

Income Support (TANF and 

food stamps) N/A 

146.196 

(125.848) 

Physical Healthcare N/A 239.911 

(172.276) 

Mental Health N/A 451.142*** 

(147.491) 

Substance Abuse N/A 2,951.154*** 

(147.036) 

Criminal Justice N/A -9.928 

(123.700) 

Constant 587.542*** -179.410 

(164.758) (158.159) 

Observations 1972 1972 

R-Squared 0.02 0.23 

+ Reference categories are Single Emergency Shelter Short Stayers, males, 

whites, and ages 31-40. 

Both models also controlled for age, gender, and race. The full models are shown 

in Appendix B.4.1 and B.4.2. 

Standard errors in parentheses. *significant at 10%, **significant at 5%; 

***significant at 1% 

14	 Appendix B.7 shows mainstream involvement and per person costs by time period and homeless path 

group. 

A–20 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-21 A–21

 

 

 

 

 

 

 

 

 

 

period, as shown on Exhibit 14. The exhibit shows that during homelessness, total mental health 

costs went down for the study cohort, even as substance abuse costs rose. This may reflect a 

substitution effect between similar services during the period of homelessness. However, regression

models that look for determinants of mental health costs across the entire study period show no 

statistically significant differences in cost between persons who have and have not received substance 

abuse treatment (Exhibit 19). This means that, persons in the study cohort that received substance 

abuse treatment and also received mental health services had higher substance abuse costs than those 

who only received substance abuse treatment. However, persons who received mental health services 

and also received substance 

abuse treatment did not have 

higher mental health costs than 

persons that only received 

mental health services. 

Both before and after 

controlling for involvement in 

mainstream systems, AfricanAmericans have significantly 

lower mental health costs than 

white individuals (Exhibit 19). 

“Sequential Short Stayers”, 

those with short stays in 

transitional or permanent 

supportive housing, have 

higher mental health costs in 

both regression models 

(Appendix B.5.1, Appendix

B.5.2). Aside from this, the 

path group regression analysis 

showed no significant 

relationship between homeless 

service use and mental health 

costs. Among those persons 

who had mental health 

treatment, people who received 

Medicaid funded physical 

health care incurred an 

additional $3,204 in mental 

health costs (Exhibit 19). 

Physical health care was the 

least likely mainstream domain 

to be utilized by the 

Jacksonville cohort. 

Exhibit 19. Multivariate Regression Models for 

Mental Health Services Costs15 

Model without Model with mainstream 

mainstream involvement involvement 

Demographics 

Female 1,663.730*** 34.806 

(441.617) (454.595) 

African-American -907.569*** -745.157** 

(345.888) (329.119) 

Other Race 575.892 358.007 

(948.438) (892.559) 

Ages 18-24 1,237.724* 286.685 

(673.342) (636.842) 

Ages 25-30 636.365 334.982 

(604.686) (569.998) 

Ages 41-50 237.133 244.497 

(426.649) (402.536) 

Ages 51 and older 1,065.059** 1,003.213** 

(515.691) (488.545) 

Mainstream Involvement 

Income Support (TANF and 

food stamps) N/A -623.605* 

(343.301) 

Physical Healthcare N/A 3,203.957*** 

(469.182) 

Mental Health N/A 4,531.870*** 

(401.871) 

Substance Abuse N/A 131.791 

(401.706) 

Criminal Justice N/A -7.631 

(338.355) 

Constant 1,183.239*** 92.949 

(390.217) (406.907) 

Observations 1972 1972 

R-Squared 0.02 0.13 

+ Reference categories are Single Emergency Shelter Short Stayers, males, whites, and 

ages 31-40. 

Both models also controlled for number of homeless program stays, homeless length of 

stay, and gaps between homeless stays. The full models are shown in Appendix B.4.1 and 

B.4.2 

Standard errors in parentheses. 

*significant at 10%; **significant at 5%; ***significant at 1% 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–21 
A–22 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-22 

 

 

 

 

 

While used by only 20 percent of the study cohort, it had the second highest total cost (Exhibit 14). 

Physical health care costs did not change significantly in the periods before, during and after persons 

in the study cohort were homeless (Exhibit 14).16 Long-stayers in permanent supportive housing had 

by far the highest physical health care costs of any path group. Their average physical health care 

cost was $9,300, 239 percent higher than the per person physical health care costs of the next highest 

path group (Appendix B.7). Most permanent supportive housing programs serve exclusively people 

with disabilities, and these individuals may have physical as well as mental health conditions. No 

other path group had a significant association with physical health care costs after controlling for 

16 Appendix B.7 shows the per person costs and involvement rates in physical health care by time period and

homeless path group. 

A–22 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-23 A–23

 

 

 

 

 

 

 

 

 

 

 

demographic characteristics. However, 

there was a significant association between 

physical health care costs and the length of 

time spent in homeless programs. The first 

model in Exhibit 20 shows that, for every 

thirty days spent in homeless programs, 

physical health care costs increase $199. In 

the second model, which controls for 

mainstream involvement, each 30-day

increase in homeless length of stay is 

associated with a $157 increase in physical 

health care costs (Exhibit 20). This 

indicates that not only are persons with long 

stays in homeless programs more likely to 

receive Medicaid funded physical health 

care, they also are likely to receive it more 

frequently and/or receive more expensive 

services. The models that include 

involvement in other mainstream systems 

show that people who receive mental health 

services also have substantially higher 

physical health care costs than other 

members of the study cohort (Exhibit 20). 

The models that do not control for receipt 

of mainstream services show that women 

have much higher physical health care costs 

than men. However, once receipt of 

physical health care and other mainstream

services is controlled for, women have 

lower costs than men (Exhibit 20).

Apparently, individual homeless men are 

less likely than individual homeless women 

to receive Medicaid-reimbursed physical 

health care services, but when they do, their 

treatment is more expensive. 

Exhibit 20. Multivariate Regression Models for 

Physical Health Care Costs 

Model without Model with 

mainstream mainstream 

involvement involvement 

Patterns of Homelessness 

Total number of stays -74.742** -34.522 

(36.628) (33.302) 

Total length of stay (in days), 

divided by 30 

198.681*** 157.377*** 

(47.651) (44.000) 

Total gaps between stays (in 

days), divided by 30 

13.062 4.806 

(43.528) (40.207) 

Demographics+ 

Females 2,170.849*** -951.443** 

(430.825) (427.168) 

African-Americans 560.360* 284.895 

(337.435) (309.262) 

Other Races 209.352 163.165 

(925.260) (838.707) 

Ages 18-24 646.639 -508.376 

(656.886) (598.418) 

Ages 25-30 128.096 -476.145 

(589.908) (535.607) 

Ages 41-50 47.339 63.805 

(416.223) (378.249) 

Ages 51 and above 912.642* 421.008 

(503.089) (459.069) 

Mainstream Involvement 

Income Support (TANF and 

food stamps) N/A 

-312.324 

(322.588) 

Physical Healthcare N/A 7,847.323*** 

(440.874) 

Mental Health N/A 1,159.145*** 

(377.624) 

Substance Abuse N/A 878.769** 

(377.469) 

Criminal Justice N/A -571.797* 

(317.940) 

Constant 477.218 -219.240 

(380.681) (382.356) 

Observations 1972 1972 

R-Squared 0.04 0.21 

+ Reference categories are males, whites, and ages 31-40. 

Standard errors in parentheses. *significant at 10%; **significant at 5%; 

***significant at 1% 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–23 
A–24 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-24 

 

 

 

 

 

 

 

 

 

A.5. Total Homeless and Mainstream Costs 

The average total homeless and mainstream cost for each individual in the study cohort was $7,927. 

The median total system cost for persons in the study cohort was $3,057 (Exhibit 21). The average 

cost was inflated by a small subset of persons with overall homeless and mainstream system costs of 

more than $20,000. 

Exhibit 22 shows the distribution of 

overall costs during the homeless 

period across the homeless services 

system and mainstream domains. 

Sixty-two percent of overall costs incurred during homelessness were borne by homeless programs 

and 38 percent was borne by mainstream systems. The average monthly costs for all mainstream

domains except for mental health were highest during homelessness. Criminal justice was the most 

expensive mainstream domain during homelessness, accounting for 15 percent of total costs in this 

period. 

Exhibit 21. Summary of Total Costs 

Total Costs (mainstream and homeless) $15,632,202 

Average (mean) total cost per Person $7,927 

Median total cost $3,057 

Average Costs incurred while homeless $2,651 

Exhibit 22: Distribution of Costs During Homelessness 

Entitlements, 5% Criminal Justice, 

15% 

Substance Abuse, 

6%
 

Mental Health, 4% 

Medicaid, 8% 

Homeless Services, 

62% 

Exhibit 23 shows the average total costs of the study cohort by path group and time period. More 

detail about the differences in mainstream utilization and costs by path group is provided in Appendix 

B.7. The three path groups associated with long homeless residential stays (“Single ES Long 

Stayers”, “Transitional Housing Long Stayers”, and “Permanent Housing Long Stayers”) had the 

highest overall costs. PSH Long Stayers had a total average cost of $23,930, the highest of any path 

group, primarily because their physical healthcare costs were much higher than any other path group. 

Exhibit 23: Average Homeless and Mainstream Costs by Time Period and Path Group 

ES Short 

Stayers 

Street/ES 

ES Long 

Stayers 

ES Long 

Gappers 

Sequential Sequential 

Circlers 

PSH Long 

Stayers 

Short Short Long 

Stayers Stayers Stayers 

Mainstream Costs Before 

Homelessness $1,822 $1,571 $3,314 $1,260 $3,313 $2,439 $1,624 $4,808 

Homeless Costs $563 $853 $9,756 $910 $1,585 $10,416 $3,987 $8,493 

Mainstream Costs During 

Homelessness $259 $711 $2,953 $1,841 $1,054 $2,385 $2,057 $6,198 

Mainstream Costs After 

Homelessness $3,288 $3,456 $3,384 $2,563 $4,533 $846 $2,499 $4,432 

Total $5,932 $6,771 $19,407 $6,574 $10,485 $16,086 $10,167 $23,931 

A–24 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-25 A–25

 

 

 

 

 

 

The high healthcare costs for users of permanent supportive housing were expected because many of 

Jacksonville’s permanent supportive housing programs exclusively served people with disabilities, 

and these individuals are older than the study cohort as a whole and may have chronic physical 

conditions as well as mental health problems. More than half of PSH Long Stayers also had some 

involvement with the criminal justice system during the study period. Compared to other path

groups, mainstream costs for PSH Long Stayers remained fairly consistent before and after becoming 

homeless. 

“Sequential Long Stayers”, persons who had long stays in transitional housing, had the highest 

homeless costs of any path group, but only average mainstream costs. Their average total costs 

($16,086), were well below the overall costs of long-term stayers in emergency shelter or permanent 

supportive housing. The mainstream costs of “Sequential Long Stayers” dropped dramatically after 

homelessness, a possible indication that their lives were more stable as a result of their homeless stay 

or stays. Another interpretation is that this group of users was higher functioning than other path 

groups and thus had less frequent and less expensive involvement with mainstream systems after 

exiting homeless programs. 

People with a single long stay in emergency shelter had an average total cost of $19,407. This small 

path group, only two percent of the study cohort, had the second highest homeless ($9,756) and 

mainstream ($9,651) costs per person of any path group. This group appeared to be more connected 

to mainstream supports then other path groups. They were the most likely to receive both income 

supports (86 percent) and physical healthcare (39 percent). 

“Sequential Short Stayers” and “Circlers” had nearly identical total costs per person, $10,485 and 

$10,167 respectively. Sequential Short Stayers had much higher mental health costs before becoming 

homeless than any other path group (Appendix B.7). Unlike Sequential Long Stayers, the average 

mainstream costs of Sequential Short Stayers remained high after exiting homeless programs. 

“Circlers” had high average criminal justice costs during homelessness; suggesting that in some cases

a jail stay helped trigger homeless recidivism and entry into emergency shelter. However, both of 

these path groups had lower overall costs than long term users of transitional or permanent housing 

because they spent less time in residential homeless programs. 

Surprisingly, “Multiple Emergency Shelter Long Gappers” the group that most closely resembles the

chronically homeless in their patterns of homelessness, had the lowest average mainstream costs

before becoming homeless of any path group (Exhibit 23). Although Long Gappers had high

criminal justice costs during homelessness, their overall mainstream costs were significantly lower 

than users of transitional or permanent housing or long-term stayers in emergency shelter because 

they were less connected to mainstream services like food stamps and healthcare. Long Gappers also

had low homeless costs because, despite their many homeless program stays, their cumulative number 

of nights in shelter was low and they used inexpensive overnight shelters. “Single ES Short Stayers”, 

the most common path group representing 38 percent of the study cohort, had the lowest total cost per 

person. “Street ES Short Stayers” also had overall costs significantly lower than the cohort average. 

There was a U-shaped relationship between age and total cost, as demonstrated in Exhibit 24. The 

18-24 year old age group had the highest total costs per person. Although their homeless costs were 

low, their income support costs were significantly higher than other age groups, and they also had 

high Medicaid and mental health costs. Persons over 50 also had significantly higher total costs than 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–25 
A–26 Appendix A: Costs of Individual Homelessness in Jacksonville, FL Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-26 

 

 

 

 

 

 

 

 

 

 

 

 

 

other age groups. Older persons had significantly higher homeless and Medicaid costs compared with 

persons between the ages of 25 and 49. 

Exhibit 24: Total Homeless and Mainstream 

Costs by Age 

$0 

$2,000 

$4,000 

$6,000 

$8,000 

$10,000 

$12,000 

18 to 24 25 to 

30 

31 to 40 41 to 50 51 and 

older 

Criminal Justice 

Substance Abuse 

Mental Health Income 

Income Supports 

Physical Healthcare 

Homeless System 

Multivariate regression analysis shows that 

homeless service patterns, gender, race, and 

mainstream system involvement all had

significant effects on overall costs. Holding

constant demographic and mainstream system

variables, long term stayers in transitional 

housing (“Sequential Long Stayers”) had the 

highest overall costs, 438 percent higher than 

short-term stayers in emergency shelter (Exhibit 

25). After controlling for homeless path groups, 

mainstream involvement, and other 

demographic characteristics, women had 93 

percent higher overall costs than men (Exhibit

25). 

Similarly, African-Americans had 41-percent 

higher overall costs than whites (Exhibit 25).

The entire difference in overall costs for African 

Americans was because of higher homeless 

costs. There was no significant difference in 

mainstream costs between African-Americans 

and those who are white (Appendix B.3.1, 

Models 5 and 6; Appendix B.3.2, Models 5 and 

6.) 

Involvement in mainstream systems was highly 

correlated with total costs for the homeless and 

mainstream systems combined. In most cases, 

persons involved in mainstream systems had 

higher overall costs. For instance, controlling 

Exhibit 25. Multivariate Regression Models for 

Overall Homeless and Mainstream Costs 

Model with mainstream 

involvement -controlling for 

homeless path group 

Homeless Path Group+ 

Single ES Long Stayers 3.890*** (0.240) 

Multiple ES Long Gappers 1.519*** (0.126) 

Street/ES Short Stayers 0.721*** (0.086) 

PSH Long Stayers 3.892*** (0.217) 

Sequential Short Stayers 1.800*** (0.124) 

Sequential Long Stayers 4.378*** (0.264) 

Circlers 2.902*** (0.143) 

Demographics+ 

Females 0.931*** (0.100) 

African-Americans 0.408*** (0.072) 

Other Races 0.348*** (0.196) 

Mainstream Involvement 

Income Support (TANF and food 

stamps) 

0.542*** (0.075) 

Physical Healthcare 0.405*** (0.103) 

Mental Health -0.203** (0.088) 

Substance Abuse 0.429*** (0.088) 

Criminal Justice 0.192*** (0.074) 

Constant 3.620*** (0.095) 

Observations 1972 

R-Squared 0.49 

+ Reference categories are Single Emergency Shelter Short 

Stayers, males, and whites. 

Both models also controlled for age. The full models are shown in 

Appendix B.3.2, which also includes models for homeless costs 

and overall mainstream costs. 

Standard errors in parentheses. a significant at 10%; b significant 

at 5%; c significant at 1% 

A–26 Appendix A: Costs of Individual Homelessness in Jacksonville, FL 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–27 A–27 

for other factors, persons receiving income supports had 54 percent higher costs than persons that did 

not receive income supports (Exhibit 25). The only exception to this was mental health. Controlling 

for homeless path group, demographics, and receipt of other mainstream services, people who used 

the mental health system had 20 percent lower overall costs than people who did not receive mental 

health services (Exhibit 25). The most likely explanation for this is that persons who received mental 

health services spent less time in homeless programs and had lower homeless costs. 

A.6. Implications 

This case study is consistent with past research showing great diversity in the ways people use the 

homeless service system. It also finds a similar diversity in the effects of becoming homeless on use 

of mainstream services. Particularly for homeless costs, but also for mainstream costs, a small subset 

of the study cohort was responsible for the majority of costs. Homeless interventions that target 

intensive users of homeless and mainstream services have the greatest potential for cost savings. 

More research is needed to understand what separates the majority of first-time homeless persons 

having brief and relatively inexpensive involvement with homeless and mainstream systems from the 

small subset with long periods of homelessness and costly involvement in homeless and mainstream 

systems. However, this case study did have several findings with direct implications for homeless 

policymakers. 

A.6.1. Findings Associated with Homeless Paths 

The small subset of the study cohort with long stays in emergency shelter, transitional, or permanent 

supportive housing had by far the highest costs over the entire period. People with longer homeless 

stays and higher homeless costs across program types also incurred higher costs for physical 

healthcare, income supports, and substance abuse treatment. Additionally, in many cases placement 

into service- rich, long-term homeless residential programs tends to increase costs to mainstream 

service systems rather than offset them. The current expenditures may also be justified by client 

needs and outcomes. However, homeless prevention and housing-based assistance targeting the most 

intense users of the homeless system may be able to equally meet needs and yield cost savings for 

both homeless and mainstream systems. 

Short-term users of transitional housing had much higher mental health costs before becoming 

homeless than long-term users of emergency shelter or transitional housing. This could be an 

indication that people with the greatest barriers to independent living may have more difficulty 

successfully using homeless programs. It also suggests that people with long stays, and therefore 

those who incur the highest homeless costs, may not be the people with the greatest barriers to 

housing. 

People with the most glaring need for assistance, those with long episodes of homelessness 

characterized by sporadic short stays in overnight shelters, actually had very low overall costs 

because they were not well connected to homeless or mainstream services. However, many people in 

this path group appeared to be stuck in a cycle of homelessness and incarceration. Criminal justice 

was the most expensive mainstream system for this group across the entire study period, and criminal 

justice costs spiked considerably around the time of initial entry into a homeless program, suggesting 

that people exiting jails are at increased risk of homelessness and persons with multiple homeless 

program stays are at increased risk of incarceration. In many cases, persons in the study cohort were 

arrested for public nuisance crimes like loitering or trespassing on public property, that were directly 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-27 
A–28 Appendix A: Costs of Individual Homelessness in Jacksonville, FL

related to their homelessness. This reflects a need for better discharge planning and greater 

coordination between law enforcement, homeless service providers, and mental health and substance 

abuse service providers to prevent repeated homelessness and criminal justice involvement. 

A.6.2. Findings Associated with Gender, Age and Race 

There were substantial differences in the experiences of men and women. Women had longer stays in 

homeless programs, used programs with higher daily costs, and thus had significantly higher 

homeless costs. In part this could be because women chose to stay in residential programs until they 

had secured stable housing while men often alternated between shelter and other tenuous living 

arrangements. However, the pattern also reflects the design of the homeless system itself. Overnight 

emergency shelters tend to only serve single men while transitional housing programs are more likely 

to serve single women and families. Therefore, it is possible that single women are more likely to use 

transitional housing even to address short-term housing needs. Both transitional housing for 

individuals and programs serving families are generally more expensive than emergency shelter for 

individuals. Emergency shelter programs that are geared to the specific short-term needs of single 

women might yield cost savings, reducing the percentage of women who need the more intensive 

assistance provided in transitional housing. 

The youngest and oldest members of the Jacksonville study cohort had the highest overall costs. 

People between 18 and 25 incurred significantly higher costs in mainstream systems, particularly 

income supports and mental health services, than the rest of the study cohort. People over 50 had 

higher homeless and physical healthcare costs. 

First-time homeless African-American individuals also had higher overall costs and homeless costs, 

though not necessarily higher mainstream costs. This is related to their disproportionate use of a 

single long-term emergency shelter, one of the most expensive homeless programs in the community. 

To the extent that African-Americans individuals are using emergency shelter for extended periods as 

a form of permanent housing, communities should explore alternative, lower-cost housing strategies.

Alternatively, for those who remain in shelter due to intensive needs that prevent them from resolving 

their homelessness, they should be referred to lower-cost transitional or permanent supportive 

housing programs that can more appropriately address their needs. In either case, systems should be 

implemented to alert programs to these patterns of extended stays, so more appropriate interventions 

can be deployed. 

Targeting prevention or rapid rehousing interventions to individuals who have several of the 

demographic characteristics associated with higher costs, or even raising awareness among program 

staff on the different ways in which various demographic groups tend to use the homeless system, 

may help ensure that individuals are directed to providers that best match their particular needs and 

also provide additional opportunities for cost savings. 

A.6.3. Concluding Findings on the Cost of Homeless Programs 

Except for overnight shelters with minimal services, the monthly costs of a stay in a homeless 

residential program were substantially higher than the fair market rent for a one-bedroom apartment 

in Jacksonville. It is worth exploring whether the cost of issuing a permanent housing voucher, even 

with accompanying additional services administered by the homeless system or through mainstream 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-28 
Appendix A: Costs of Individual Homelessness in Jacksonville, FL A–29 A–29 

systems (as is the case with permanent supportive housing programs), might be comparable to longterm placement in transitional housing. 

This study provides an outline of the different ways that people who become homeless use homeless 

and mainstream services and the associated costs. However, this study did not collect data on clients’ 

outcomes after exiting homeless residential programs or their long-term use of mainstream services 

after homelessness. This type of data would be necessary to compare the cost-effectiveness of 

various homeless interventions. Absent detailed health records for the study cohort, it is not possible 

to determine whether the low rates of involvement in healthcare and substance abuse treatment 

indicate a lack of need or a failure to connect persons in the study cohort to needed services. Finally, 

this case study is one piece of a larger study of the costs of homelessness, encompassing six 

communities. One of the key findings of the overall study is that the costs of homelessness vary 

greatly based on location and the characteristics of the study population. Policymakers should be 

wary of using cost estimates from this or other communities as a proxy for their own population and 

are encouraged to use their own administrative data to determine the costs of homelessness in their 

own communities. 

Appendix A: Costs of Individual Homelessness in Jacksonville, FL A-29 
A–30 Appendix A: Costs of Individual Homelessness in Jacksonville, FL

References

Emergency Services and Homeless Coalition of Jacksonville, Inc. [ESHC]. (2004). Ending 

Homelessness in Jacksonville: A Blueprint for the Future. Jacksonville, FL: ESHC. Retrieved 

from http://www.endhomelessness.org/files/2014_file_JacksonvilleFL.pdf 

Housing and Urban Development (HUD). (2006). HUD’s 2005 Continuum of Care Homeless 

Assistance Programs: Homeless Populations and Subpopulations. Retrieved from 

http://www.hud.gov/offices/cpd/homeless/local/reports/2005_fl_510_pop_sub.pdf

Housing and Urban Development (HUD). (2008). The Third Annual Homeless Assessment Report to 

Congress. Retrieved from the HMIS.info Web site: 

http://www.hmis.info/ClassicAsp/documents/Final%20AHAR%20Report.pdf 

U.S. Census Bureau. (n.d.). 2005 American Community. Retrieved from the American Factfinder 

website: http://factfinder.census.gov

Abt Associates Inc. Costs of Individual Homelessness in Jacksonville, FL A-30 
Abt Associates Inc. Appendix B: Jacksonville Tables B1 Appendix B: Jacksonville Tables B.1. Demographic Characteristics of Homeless Path Groups Characteristic Single ES Short Stayers Street/ES Short Stayers Single ES Long Stayers Multiple ES Long Gappers Sequential Short Stayers Sequential Long Stayers Relapsers PSH Long Stayers All Paths Total Individuals 746 556 44 197 196 36 142 55 1972 % of Study Population 38% 28% 2% 10% 10% 2% 7% 3% 100% Gender Males 80% 85% 46% 95% 65% 67% 79% 67% 80% Females 20% 15% 55% 5% 33% 28% 20% 29% 19% Gender not reported 0% 0% 0% 0% 1% 5% 1% 4% 0% Ages (at Client Start Date) 18 to 24 10% 8% 2% 6% 11% 3% 4% . 8% 25 to 30 13% 10% 14% 10% 8% 3% 5% 9% 11% 31 to 40 28% 28% 32% 24% 27% 14% 25% 15% 27% 41 to 50 31% 36% 32% 43% 34% 42% 47% 42% 36% 51 to 61 14% 13% 18% 16% 17% 22% 16% 31% 15% 62 and older 0% 0% 0% 0% 0% 0% 0% 0% 0% Age not reported 4% 4% 2% 2% 4% 17% 3% 4% 4% Average Age at Client Start Date 40 41 41 42 41 47 43 46 41 Race White 51% 52% 25% 37% 50% 50% 38% 42% 48% Black or African-American 45% 42% 73% 58% 46% 39% 54% 53% 47% Asian 1% 1% 2% 1% 0% 0% 1% 0% 1% American Indian or Alaska Native 1% 1% 0% 1% 1% 0% 1% 2% 1% Other 2% 2% 0% 2% 1% 0% 1% 2% 2% Race not reported 1% 3% 0% 1% 3% 11% 5% 2% 2%
B-2 Appendix B: Jacksonville Tables Abt Associates Inc.

B.2. Homeless Service Utilization by Homeless Path Group

Single ES

Short

Stayers

Street/ES

Short

Stayers

Single ES

Long

Stayers

Multiple

ES LongGappers

Sequential

Short

Stayers

Sequential

Long

Stayers Relapsers

PSH

Long

Stayers All Paths

Number of Clients 746 556 44 197 196 36 142 55 1,972Percent of Clients 38% 28% 2% 10% 10% 2% 7% 3% 100%Total Number of StaysAverage 1 3.1 1 10.9 2.4 5.6 7.6 2.7 3.325th Percentile 1 2 1 4 1 2 3 1 150th Percentile (Median) 1 2 1 8 2 2 5 2 275th Percentile 1 4 1 14 3 3 9 3 3Percent of Individuals withOnly One Stay

100.0% 12.4% 100.0% 0.0% 50.0% 22.2% 0.0% 36.4% 49.9%

Total Length of Stays (inDays)Average 18 29 304 40 54 364 135 338 5725th Percentile 1 3 215 12 11 266 38 172 250th Percentile (Median) 2 6 269 24 33 371 83 384 1075th Percentile 17 20 372 47 84 469 199 505 56Total Gap Between Stays(in Days)Average 0 58 0 358 71 49 182 68 7550th Percentile (Median) 0 17 0 363 0 0 159 2 0Total Homeless Period(in Days)Average 18 87 304 398 125 413 317 406 132
Abt Associates Inc. Appendix B: Jacksonville Tables B-3

B.3. Multivariate Analysis of Total Costs, Homeless Costs, and Total

Mainstream Costs

B.3.1 Models Excluding Usage of Each Domain as Covariates

Outcome variables: The outcome variable for model 1 and model 2 is total costs (homeless and

mainstream) in log scale. The outcome variable for model 3 and model 4 is homeless costs in log scale.

The outcome variable for model 5 and model 6 is total mainstream costs in log scale.

Description: All models control for gender, race and age. Models 1, 3, 5 are with control based on path

groups; models 2, 4, and 6, are with control based on underlying utilization data. These models do not

include utilization of each particular mainstream domain as covariates.

Model (1)

Total

Costs –

Homeless

Path Group

Model

Model (2)

Total Costs -

Homeless

Service

Utilization

Model

Model (3)

Homeless

Costs –

Homeless

Path Group

Model

Model (4)

Homeless

Costs -

Homeless

Service

Utilization

Model

Model (5)

Mainstream

Costs –

Homeless

Path Group

Model

Model (6)

Mainstream

Costs –

Homelesss

Service

Utilization

Model

Single ES Long

Stayers+

4.109*** 4.119*** 0.376

(0.247) (0.257) (0.242)

Multiple ES Long

Gappers

1.678*** 1.707*** 0.190

(0.127) (0.133) (0.135)

Street/ES Short

Stayers

0.789*** 0.874*** 0.108

(0.088) (0.096) (0.100)

PSH Long Stayers 4.229*** 4.077*** 0.595***

(0.222) (0.231) (0.222)

Sequential Short

Stayers

1.899*** 1.848*** 0.274**

(0.127) (0.133) (0.139)

Sequential Short

Stayers

4.555*** 4.473*** 0.406

(0.272) (0.284) (0.284)

Circlers 3.076*** 3.054*** 0.210

(0.145) (0.151) (0.153)

Total Number of Stays 0.023*** 0.023*** -0.033***

(0.007) (0.007) (0.008)

Total length of stay (in

days), divided by 30

0.410*** 0.409*** 0.034***

(0.009) (0.009) (0.010)

Total gaps between

stays (in days), divided

by 30

0.086*** 0.086*** 0.034***

(0.008) (0.008) (0.010)
B–4 B-4 Appendix B: Jacksonville Tables Appendix B: Jacksonville Tables Abt Associates Inc.

Model (1)

Total

Costs –

Homeless

Path Group

Model

Model (2)

Total Costs -

Homeless

Service

Utilization

Model

Model (3)

Homeless

Costs –

Homeless

Path Group

Model

Model (4)

Homeless

Costs -

Homeless

Service

Utilization

Model

Model (5)

Mainstream

Costs –

Homeless

Path Group

Model

Model (6)

Mainstream

Costs –

Homelesss

Service

Utilization

Model

Female+ 1.235*** 1.073*** 1.460*** 1.208*** 0.672*** 0.625***

(0.094) (0.078) (0.102) (0.086) (0.097) (0.097)

Black+ 0.437*** 0.360*** 0.457*** 0.394*** -0.048 -0.032

(0.074) (0.061) (0.078) (0.065) (0.081) (0.080)

Other race 0.302 0.307* 0.352 0.351* -0.007 -0.041

(0.202) (0.167) (0.217) (0.182) (0.225) (0.224)

Age: 18-24+ 0.118 0.165 0.093 0.155 0.598*** 0.590***

(0.143) (0.118) (0.153) (0.128) (0.154) (0.153)

Age: 25-30 0.102 0.114 0.062 0.108 0.228 0.215

(0.129) (0.106) (0.136) (0.113) (0.141) (0.140)

Age: 41-50 0.053 0.113 0.034 0.089 -0.083 -0.058

(0.091) (0.075) (0.097) (0.081) (0.100) (0.099)

Age: 51 or above 0.206* 0.096 0.198* 0.090 0.140 0.160

(0.110) (0.091) (0.116) (0.097) (0.123) (0.122)

Gender missing 0.706 0.343 0.935 0.427 0.399 0.411

(0.526) (0.434) (0.574) (0.479) (0.562) (0.557)

Race missing 0.581** 0.775*** 0.634** 0.834*** -0.005 0.020

(0.263) (0.217) (0.279) (0.233) (0.289) (0.287)

Age missing -0.656** -0.448** -0.715** -0.532** 0.032 0.066

(0.270) (0.222) (0.294) (0.245) (0.316) (0.312)

Constant 3.944*** 4.030*** 3.810*** 3.893*** 7.731*** 7.810***

(0.091) (0.069) (0.095) (0.074) (0.103) (0.093)

Observations 1972 1972 1901 1901 1465 1465

R-squared 0.46 0.63 0.45 0.61 0.07 0.08

Notes: + Reference categories are: Single Emergency Shelter Short Stayers, Men, Whites, Age 31 to 40.

Standard errors in parentheses. *significant at 10%; **significant at 5%; ***significant at 1%
Abt Associates Inc. Appendix B: Jacksonville Tables Appendix B: Jacksonville Tables B–5 B-5

B.3.2 Models Including Usage of Each Domain as Covariates

Outcome variables: The outcome variable for model 1 and model 2 is total costs (homeless and

mainstream) in log scale. The outcome variable for model 3 and model 4 is homeless costs in log scale.

The outcome variable for model 5 and model 6 is total mainstream costs in log scale.

Description: All models control for gender, race and age. Models 1, 3, 5 are with control based on path

groups; models 2, 4, and 6, are with control based on underlying utilization data. These models include

utilization of each particular mainstream domain as covariates.

Model (1)

Total

Costs –

Homeless

Path Group

Model

Model (2)

Total Costs

- Homeless

Service

Utilization

Model

Model (3)

Homeless

Costs –

Homeless

Path Group

Model

Model (4)

Homeless

Costs -

Homeless

Service

Utilization

Model

Model (5)

Mainstream

Costs –

Homeless

Path Group

Model

Model (6)

Mainstream

Costs –

Homelesss

Service

Utilization

Model

Single ES Long Stayers 3.890*** 3.905*** 0.450**

(0.240) (0.251) (0.184)

Multiple ES Long

Gappers

1.519*** 1.532*** 0.067

(0.126) (0.131) (0.104)

Street/ES Short Stayers 0.721*** 0.801*** 0.038

(0.086) (0.094) (0.076)

PSH Long Stayers 3.892*** 3.727*** 0.247

(0.217) (0.227) (0.170)

Sequential Short

Stayers

1.800*** 1.753*** 0.177*

(0.124) (0.130) (0.106)

Sequential Short

Stayers

4.378*** 4.296*** 0.353

(0.264) (0.276) (0.216)

Circlers 2.902*** 2.878*** 0.142

(0.143) (0.149) (0.117)

Total Number of Stays 0.026*** 0.025*** -0.018***

(0.006) (0.007) (0.006)

Total length of stay (in

days), divided by 30

0.393*** 0.391*** 0.020**

(0.009) (0.009) (0.008)

Total gaps between stays

(in days), divided by 30

0.075*** 0.074*** 0.014*

(0.008) (0.008) (0.008)

Female+ 0.931*** 0.869*** 1.117*** 0.981*** 0.044 0.034

(0.100) (0.083) (0.110) (0.092) (0.081) (0.081)

Black+ 0.408*** 0.346*** 0.424*** 0.377*** -0.011 0.004

(0.072) (0.060) (0.077) (0.064) (0.062) (0.062)

Other race 0.348* 0.342** 0.390* 0.382 ** 0.060 0.034

(0.196) (0.162) (0.211) (0.177) (0.171) (0.170)

Age: 18-24+ 0.058 0.125 0.034 0.114 0.238** 0.225*

(0.140) (0.116) (0.149) (0.125) (0.118) (0.117)

Age: 25-30 0.072 0.093 0.037 0.088 0.105 0.093

(0.125) (0.104) (0.132) (0.111) (0.107) (0.107)

Age: 41-50 0.037 0.093 0.027 0.076 -0.045 -0.036
B–6 B-6 Appendix B: Jacksonville Tables Appendix B: Jacksonville Tables Abt Associates Inc.

Model (1)

Total

Costs –

Homeless

Path Group

Model

Model (2)

Total Costs

- Homeless

Service

Utilization

Model

Model (3)

Homeless

Costs –

Homeless

Path Group

Model

Model (4)

Homeless

Costs -

Homeless

Service

Utilization

Model

Model (5)

Mainstream

Costs –

Homeless

Path Group

Model

Model (6)

Mainstream

Costs –

Homelesss

Service

Utilization

Model

(0.088) (0.073) (0.094) (0.079) (0.076) (0.075)

Age: 51 or above 0.218** 0.109 0.211* 0.102 0.158* 0.166*

(0.107) (0.089) (0.114) (0.095) (0.094) (0.094)

Any Food Stamp or

TANF Costs

0.542*** 0.430*** 0.541*** 0.423*** 0.577*** 0.587***

(0.075) (0.062) (0.080) (0.068) (0.068) (0.068)

Any Physical Healthcare

Costs

0.405*** 0.239*** 0.458*** 0.285*** 1.433*** 1.413***

(0.103) (0.085) (0.111) (0.093) (0.078) (0.078)

Any Mental Health

Costs

-0.203** -0.126* -0.213** -0.145* 0.832*** 0.831***

(0.088) (0.073) (0.094) (0.079) (0.068) (0.067)

Any Substance Abuse

Costs

0.429*** 0.357*** 0.419*** 0.372*** 0.644*** 0.637***

(0.088) (0.073) (0.093) (0.078) (0.066) (0.066)

Any Criminal Justice

Costs

0.192*** 0.127** 0.248*** 0.160** 1.104*** 1.094***

(0.074) (0.062) (0.079) (0.067) (0.063) (0.063)

Gender Missing 0.665 0.328 0.921* 0.433 0.110 0.108

(0.510) (0.423) (0.557) (0.468) (0.427) (0.425)

Race Missing 0.579** 0.772*** 0.622** 0.830*** 0.006 0.035

(0.256) (0.212) (0.271) (0.227) (0.220) (0.219)

Age Missing -0.582** -0.404* -0.624** -0.479** 0.235 0.246

(0.263) (0.218) (0.287) (0.240) (0.242) (0.240)

Constant 3.620*** 3.766*** 3.468*** 3.619*** 6.117*** 6.172***

(0.095) (0.074) (0.100) (0.080) (0.101) (0.096)

Observations 1972 1972 1901 1901 1465 1465

R-squared 0.49 0.65 0.49 0.64 0.47 0.47

Notes: + Reference categories are: Single Emergency Shelter Short Stayers, Men, Whites, Age 31 to 40.

Standard errors in parentheses. *significant at 10%; ***significant at 5%; ***significant at 1%.
Abt Associates Inc. Appendix B: Jacksonville Tables Appendix B: Jacksonville Tables B–7 B-7

B.4. Multivariate Analysis of Costs by Domain, with Homeless

Utilization as Covariates

B.4.1 Models Excluding Usage of Each Domain as Covariates

Outcome variables: The outcome variable for these models is total costs associated with each domain in

their original metric (dollar amounts).

Description: All models control for homeless utilization data, gender, race, and age homeless utilization.

These models do not include utilization of each particular mainstream domain as covariates.

Criminal

Justice

Income

Supports

Physical

Healthcare Mental Health

Substance

abuse

Total Number of Stays -34.855 -5.599 -74.742** -15.781 -15.465

(21.201) (10.013) (36.628) (37.545) (14.559)

Total length of stay (in days), divided by

30

11.861 80.128*** 198.681*** -47.273 60.639***

(27.582) (13.027) (47.651) (48.844) (18.941)

Total gaps between stays (in days),

divided by 30

149.972*** 0.982 13.062 -18.746 40.846**

(25.196) (11.900) (43.528) (44.618) (17.302)

Female+ -992.334*** 1,770.719*** 2,170.849*** 1,663.730*** 257.364

(249.377) (117.779) (430.825) (441.617) (171.251)

Black+ 380.364* 280.946*** 560.360* -907.569*** -378.032***

(195.320) (92.248) (337.435) (345.888) (134.129)

Other race 814.333 -174.340 209.352 575.892 -745.892**

(535.575) (252.948) (925.260) (948.438) (367.788)

Age: 18-24+ 91.847 416.656** 646.639 1,237.724* -192.726

(380.230) (179.580) (656.886) (673.342) (261.110)

Age: 25-30 -59.916 248.953 128.096 636.365 -196.469

(341.461) (161.269) (589.908) (604.686) (234.486)

Age: 41-50 -639.606*** -152.958 47.339 237.133 15.568

(240.925) (113.787) (416.223) (426.649) (165.447)

Age: 51 or above -1,094.955*** -104.207 912.642* 1,065.059** -43.218

(291.206) (137.534) (503.089) (515.691) (199.976)

Gender missing -690.350 90.055 1,894.993 -953.652 702.451

(1,392.916) (657.863) (2,406.404) (2,466.687) (956.538)

Race missing -575.680 287.534 -673.060 1,133.490 -422.936

(696.237) (328.827) (1,202.820) (1,232.952) (478.117)

Age missing -1,842.868*** -7.848 1,816.595 9.502 636.696

(713.407) (336.937) (1,232.484) (1,263.359) (489.908)

Constant 1,820.685*** 394.947*** 477.218 1,183.239*** 727.681***

(220.352) (104.071) (380.681) (390.217) (151.319)

Observations 1972 1972 1972 1972 1972

R-squared 0.04 0.16 0.04 0.02 0.02

Notes: + Reference categories are: Men, Whites, Age 31 to 40.

Standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%.
B-8 Appendix B: Jacksonville Tables Abt Associates Inc.

B.4.2 Models Including Usage of Each Domain as Covariates

Outcome variables: The outcome variables for these models are total homeless costs, total mainstream

costs, and costs associated with each domain, all in log scale.

Description: All models control for homeless utilization data, gender, race, and age homeless utilization.

These models include utilization of each particular mainstream domain as covariates.

Total Costs (log scale)

Homeless

Costs

Mainstream

Costs

Medicaid

Costs

Mental

Health

Costs

Substance

Abuse

Costs

Entitlement

Costs

Criminal

Justice

Costs

0.025*** -0.018*** -0.057 -0.025 -0.007 -0.012* Number of Homeless -0.005

Program Stays (0.007) (0.006) (0.039) (0.025) (0.027) (0.007) (0.011)

0.391*** 0.020** 0.034 -0.020 0.045** 0.027*** -0.041 H *** omeless Length of Stay

(cost per additional 30 days) (0.009) (0.008) (0.022) (0.022) (0.022) (0.008) (0.014)

0.074*** 0.014* 0.021 -0.004 0.024 -0.008 0.025 Homeless Gap Days (cost **

per 30 additional days

between stays)

(0.008) (0.008) (0.025) (0.022) (0.022) (0.008) (0.011)

Females 0.981*** 0.034 0.128 -0.021 -0.237 0.470*** -0.557***

(0.092) (0.081) (0.188) (0.196) (0.226) (0.083) (0.141)

African-Americans 0.377*** 0.004 -0.023 -0.316* -0.280 0.123* 0.158

(0.064) (0.062) (0.177) (0.166) (0.175) (0.068) (0.100)

Other Races 0.382** 0.034 -0.387 0.234 -1.263*** -0.121 0.462

(0.177) (0.170) (0.516) (0.389) (0.457) (0.196) (0.298)

Ages 18 – 24 0.114 0.225* 0.569** 0.188 -0.090 0.164 0.070

(0.125) (0.117) (0.281) (0.269) (0.331) (0.129) (0.185)

Ages 25 – 30 0.088 0.093 0.226 0.443 -0.536* 0.160 -0.059

(0.111) (0.107) (0.28) (0.279) (0.309) (0.120) (0.169)

Ages 41 – 50 0.076 -0.036 0.349 0.183 -0.104 -0.047 -0.163

(0.079) (0.075) (0.246) (0.202) (0.207) (0.084) (0.119)

Age 51 and Above 0.102 0.166* 0.260 0.207 -0.050 0.221** -0.244

(0.095) (0.094) (0.266) (0.256) (0.265) (0.103) (0.160)

0.423*** 0.587*** -0.015 0.012 0.468** 0.240 Received Food Stamps or **

TANF (0.068) (0.068) (0.211) (0.174) (0.185) (0.103)

0.285*** 1.413*** 0.749*** -0.501** 0.614*** -0.269 Received Medicaid Services *

(0.093) (0.078) (0.174) (0.214) (0.082) (0.14)

-0.145* 0.831*** 0.299* 0.441** Received Mental Healthcare 0.029 0.150

(0.079) (0.067) (0.176) (0.176) (0.075) (0.116)

0.372*** 0.637*** 0.254 0.137 0.018 0.361 Received Substance Abuse ***

(0.078) (0.066) (0.184) (0.158) (0.074) (0.108)

0.160** 1.094*** 0.031 0.045 0.304* Involved with Criminal Justice 0.071

(0.067) (0.063) (0.177) (0.162) (0.17) (0.067)

Missing Gender 0.433 0.108 0.960 -0.411 0.147 -0.015 -0.812

(0.468) (0.425) (1.125) (0.954) (1.289) (0.454) (0.957)

Missing Race 0.830*** 0.035 -1.107 0.321 0.630 0.190 -0.435

(0.227) (0.219) (1.015) (0.513) (0.749) (0.226) (0.363)

Missing Age -0.479** 0.246 0.573 -0.658 0.954 0.206 -2.011

(0.240) (0.24) (0.591) (0.524) (0.679) (0.256) (1.371)

Constant 3.619*** 6.172*** 7.432*** 6.917*** 6.389*** 6.435*** 7.374***

(0.080) (0.096) (0.328) (0.229) (0.248) (0.094) (0.127)

Observations 1901 1465 390 492 437 1024 755

R-squared 0.64 0.47 0.04 0.07 0.11 0.2 0.09

Reference categories are: Males, Whites, Ages 31 – 40

Standard errors in parentheses. * Significant at 10%; ** Significant at 5%; *** Significant at 1%
Abt Associates Inc. Appendix B: Jacksonville Tables B-9

B.5. Multivariate Analysis of Costs by Domain, with Path Groups as

Covariates

B.5.1 Models Excluding Usage of Each Domain as Covariates

Outcome variables: The outcome variable for these models is total costs associated with each domain in

their original metric (dollar amounts).

Description: All models control for homeless path groups, gender, race, and age homeless utilization.

These models do not include utilization of each particular mainstream domain as covariates.

Model (1) Model (2) Model (3) Model (4) Model (5)

Criminal Justice

Income

Supports

Physical

Healthcare Mental Health

Substance

Abuse

Single ES Long Stayers+ 47.142 2,326.988*** 1,629.965 -1,238.011 -12.359

(656.299) (306.924) (1,118.827) (1,158.049) (448.596)

Multiple ES Long Gappers 1,677.589*** -93.135 -540.835 -163.468 349.426

(338.415) (158.263) (576.914) (597.138) (231.315)

Street/ES Short Stayers 541.743** -4.741 -134.925 -2.881 312.461*

(234.931) (109.867) (400.498) (414.539) (160.581)

PSH Long Stayers 839.736 439.888 7,562.911*** -177.606 1,174.122***

(589.556) (275.711) (1,005.047) (1,040.280) (402.976)

Sequential Short Stayers 43.786 -247.596 910.630 1,306.901** 883.603***

(338.613) (158.355) (577.251) (597.487) (231.450)

Sequential Long Stayers 42.512 43.305 -634.893 -716.680 1,345.077***

(723.410) (338.309) (1,233.235) (1,276.468) (494.468)

Circling/ Relapsers 1,099.228*** 325.064* -342.969 -501.256 491.023*

(386.022) (180.526) (658.072) (681.141) (263.855)

Female+ -920.635*** 1,793.028*** 2,252.018*** 1,590.685*** 264.270

(249.170) (116.526) (424.773) (439.664) (170.314)

African American+ 356.920* 254.646*** 524.382 -901.187*** -346.331***

(196.010) (91.666) (334.149) (345.863) (133.978)

Other Race 839.945 -215.937 176.758 659.964 -681.944*

(537.436) (251.336) (916.195) (948.314) (367.350)

Age: 18-24+ 90.056 455.442** 715.421 1,209.422* -211.340

(381.693) (178.502) (650.692) (673.503) (260.896)

Age: 25-30 -82.979 231.148 63.796 684.489 -179.945

(342.779) (160.303) (584.352) (604.838) (234.297)

Age: 41-50 -692.992*** -135.882 -19.914 236.254 -14.492

(242.255) (113.293) (412.985) (427.463) (165.587)

Age: 51 or above -1,132.213*** -52.109 748.102 1,013.491** -74.962

(292.185) (136.643) (498.102) (515.564) (199.715)

Gender missing -895.875 495.061 1,427.608 -1,309.097 426.853

(1,398.425) (653.985) (2,383.968) (2,467.542) (955.857)

Race missing -508.396 290.689 -426.163 1,139.488 -484.723

(700.858) (327.762) (1,194.788) (1,236.674) (479.053)

Age missing -1,967.192*** 28.630 1,998.803 176.788 550.893

(718.321) (335.929) (1,224.558) (1,267.487) (490.989)

Constant 1,682.568*** 467.889*** 476.466 978.383** 587.542***

(241.042) (112.726) (410.918) (425.323) (164.758)

Observations 1972 1972 1972 1972 1972

R-squared 0.04 0.18 0.06 0.02 0.02

Notes: + Reference categories are: Single ES Short Stayers, Men, Whites, Age 31 to 40.

Standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%.
B-10 Appendix B: Jacksonville Tables Abt Associates Inc.

B.5.2 Model Including Usage of Each Domain as Covariates

Outcome variables: The outcome variable for these models is total costs associated with each domain in

log scale.

Description: All models control for homeless path groups, gender, race, and age homeless utilization.

These models include utilization of each particular mainstream domain as covariates.

Total Costs (log

scale)

Homeless

Costs

Mainstream

Costs

Medicaid

Costs

Mental

Health Costs

Substance

Abuse Costs

Entitlement

Costs

Criminal

Justice

Costs

3.905*** 0.450** 1.011** -1.088** -0.356 0.784*** Single ES Long -0.084

Stayers (0.251) (0.184) (0.416) (0.535) (0.562) (0.179) (0.356)

1.532*** 0.067 -0.302 -0.13 0.245 -0.254** 0.256 Multiple ES Long *

Gappers (0.131) (0.104) (0.37) (0.309) (0.288) (0.12) (0.151)

0.801*** 0.038 0.119 -0.320* Street/ES Short 0.096 -0.015 0.143

Stayers (0.094) (0.076) (0.216) (0.194) (0.216) (0.086) (0.128)

3.727*** 0.247 0.789* -0.247 1.155** PSH Long Stayers 0.228 -0.403

(0.227) (0.17) (0.421) (0.475) (0.45) (0.167) (0.271)

1.753*** 0.177* 0.841*** -0.233 0.772*** Sequential Short -0.087 -0.192

Stayers (0.13) (0.106) (0.275) (0.263) (0.268) (0.115) (0.184)

4.296*** 0.353 -0.73 -0.537 1.437*** Sequential Long -0.009 -0.407

Stayers (0.276) (0.216) (0.604) (0.562) (0.536) (0.225) (0.38)

2.878*** 0.142 0.421 -0.926*** Circling/Relapsers 0.198 0.089 0.181

(0.149) (0.117) (0.379) (0.303) (0.326) (0.121) (0.195)

Females 1.117*** 0.044 0.134 0.08 -0.256 0.478*** -0.564***

(0.11) (0.081) (0.184) (0.197) (0.223) (0.082) (0.141)

African-Americans 0.424*** -0.011 -0.031 -0.352** -0.203 0.096 0.144

(0.077) (0.062) (0.176) (0.166) (0.176) (0.069) (0.101)

Other Races 0.390* 0.06 -0.334 0.296 -1.276*** -0.12 0.506*

(0.211) (0.171) (0.511) (0.388) (0.452) (0.196) (0.299)

Ages 18 – 24 0.034 0.238** 0.563** 0.197 -0.151 0.201 0.08

(0.149) (0.118) (0.275) (0.267) (0.328) (0.129) (0.186)

Ages 25 – 30 0.037 0.105 0.226 0.42 -0.498 0.161 -0.066

(0.132) (0.107) (0.276) (0.277) (0.305) (0.119) (0.17)

Ages 41 – 50 0.027 -0.045 0.339 0.219 -0.095 -0.037 -0.174

(0.094) (0.076) (0.244) (0.201) (0.207) (0.084) (0.121)

Age 51 and Above 0.211* 0.158* 0.307 0.197 0.015 0.249** -0.281*

(0.114) (0.094) (0.265) (0.256) (0.261) (0.103) (0.16)

0.541*** 0.577*** 0.096 0.065 0.438** 0.222 Received Food **

Stamps or TANF (0.08) (0.068) (0.209) (0.173) (0.184) (0.105)

0.458*** 1.433*** 0.714*** -0.484** 0.626*** -0.264 Received Medicaid *

Services (0.111) (0.078) (0.173) (0.212) (0.083) (0.141)

-0.213** 0.832*** 0.267 0.416** Received Mental 0.033 0.137

Healthcare (0.094) (0.068) (0.175) (0.175) (0.075) (0.117)

0.419*** 0.644*** 0.255 0.116 0.034 0.363 Received Substance ***

Abuse (0.093) (0.066) (0.182) (0.158) (0.074) (0.109)

0.248*** 1.104*** 0.055 0.04 0.317* Involved with 0.072

Criminal Justice (0.079) (0.063) (0.176) (0.163) (0.169) (0.067)
Abt Associates Inc. Appendix B: Jacksonville Tables B-11

Total Costs (log

scale)

Homeless

Costs

Mainstream

Costs

Medicaid

Costs

Mental

Health Costs

Substance

Abuse Costs

Entitlement

Costs

Criminal

Justice

Costs

Missing Gender 0.921* 0.11 0.754 -0.501 -0.227 0.171 -1.016

(0.557) (0.427) (1.117) (0.955) (1.274) (0.455) (0.973)

Missing Race 0.622** 0.006 -0.846 0.44 0.758 0.144 -0.452

(0.271) (0.22) (0.998) (0.511) (0.742) (0.226) (0.366)

Missing Age -0.624** 0.235 0.791 -0.598 1.07 0.254 -2.226

(0.287) (0.242) (0.583) (0.523) (0.672) (0.257) (1.384)

Constant 3.468*** 6.117*** 7.144*** 7.012*** 6.272*** 6.420*** 7.329***

(0.1) (0.101) (0.327) (-0.237) (0.27) (-0.101) (-0.139)

Observations 1901 1465 390 492 437 1024 755

R-squared 0.49 0.47 0.09 0.09 0.14 0.21 0.09

Reference categories are: Males, Whites, Ages 31 – 40

Standard errors in parentheses. * Significant at 10%; ** Significant at 5%; *** Significant at 1%
B-12 Appendix B: Jacksonville Tables Abt Associates Inc.

B.6. Multivariate Analysis of Costs by Domain, with Total Homeless

Costs as a Covariate

Outcome variables: The outcome variable for these models is total costs associated with each domain in

log scale.

Description: All models control for homeless costs, gender, race, and age homeless utilization. These

models include utilization of each particular mainstream domain as covariates.

Total Costs By Domain

(log scale)

Medicaid

Costs

Mental Health

Costs

Substance Abuse

Costs

Entitlement

Costs

Criminal Justice

Costs

Total Homeless System

Costs

0.102** -0.077* 0.058 0.029* -0.005

(0.046) (0.041) (0.042) (0.017) (0.026)

Females 0.107 0.101 -0.309 0.510*** -0.649***

(0.199) (0.209) (0.233) (0.087) (0.15)

African-Americans -0.103 -0.341** -0.275 0.141** 0.137

(0.183) (0.168) (0.176) (0.07) (0.1030

Other Races -0.155 0.42 -1.268*** -0.104 0.426

(0.541) (0.424) (0.473) (0.199) (0.314)

Ages 18 – 24 0.494* 0.278 -0.118 0.151 0.117

(0.295) (0.273) (0.34) (0.132) (0.19)

Ages 25 – 30 0.134 0.383 -0.577* 0.163 -0.065

(0.288) (0.277) (0.31) (0.121) (0.172)

Ages 41 – 50 0.271 0.15 -0.086 -0.059 -0.171

(0.256) (0.205) (0.209) (0.086) (0.123)

Age 51 and Above 0.135 0.126 -0.066 0.258** -0.327**

(0.273) (0.258) (0.268) (0.104) (0.162)

Received Food Stamps or

TANF

-0.032 0.019 0.514*** 0.242**

(0.222) (0.181) (0.189) (0.109)

Received Medicaid

Services

0.850*** -0.510** 0.645*** -0.329**

(0.176) (0.216) (0.084) (0.146)

Received Mental

Healthcare

0.403** 0.449** 0.032 0.168

(0.181) (0.18) (0.077) (0.12)

Received Substance

Abuse

0.238 0.134 0.004 0.339***

(0.19) (0.16) (0.076) (0.111)

Involved with Criminal

Justice

0.036 0.145 0.332* 0.052

(0.182) (0.163) (0.171) (0.069)

Missing Gender 0.92 0.098 0.364 0.769 -1.493

(1.184) (1.054) (1.277) (0.485) (0.946)

Missing Race -1.467 0.755 0.583 0.231 -0.486

(1.043) (0.525) (0.748) (0.227) (0.379)

Missing Age 0.813 -0.609 0.943 0.13 -2.059

(0.686) (0.569) (0.681) (-0.271) (1.381)

Constant 6.878*** 7.144*** 6.169*** 6.233*** 7.422***

(0.424) (0.275) (0.324) (0.127) (0.169)

Observations 369 465 429 980 719

R-squared 0.05 0.09 0.1 0.2 0.08

Reference categories are: Males, Whites, Ages 31 – 40

Standard errors in parentheses. * Significant at 10%; ** Significant at 5%; *** Significant at 1%
Abt Associates Inc. Appendix B: Jacksonville Tables B-13

B.7. Mainstream Involvement and Per Person Mainstream Costs by

Homeless Path Group and Time Period

Path Groups

ES

Short

Stayers

Street/ES

Short

Stayers

ES Long

Stayers

ES Long

Gappers

Sequential

Short

Stayers

Sequential

Long

Stayers Circlers

PSH

Long

Stayers

Number of Individuals 746 556 44 197 196 36 142 55

% of Cohort 38% 28% 2% 10% 10% 2% 7% 3%

Criminal Justice

Percent Involved 31% 38% 34% 62% 35% 36% 44% 55%

Average Costs Pre $461 $573 $376 $527 $356 $488 $454 $539

Average Costs During $12 $307 $57 $1,636 $215 $178 $1,400 $561

Average Costs Post $777 $902 $612 $885 $529 $14 $366 $628

Average Costs Total $1,251 $1,783 $1,045 $3,048 $1,100 $680 $2,219 $1,728

Income Supports (TANF and food stamps)

Percent Involved 42% 51% 86% 53% 57% 67% 71% 84%

Average Costs Pre $298 $194 $706 $182 $227 $432 $328 $332

Average Costs During $57 $84 $1,777 $45 $57 $366 $243 $667

Average Costs Post $598 $561 $1,458 $367 $670 $321 $697 $528

Average Costs Total $953 $839 $3,941 $593 $955 $1,119 $1,267 $1,527

Physical Healthcare

Percent Involved 22% 17% 39% 12% 25% 22% 15% 31%

Average Costs Pre $499 $319 $1,865 $213 $957 $167 $375 $3,197

Average Costs During $86 $56 $808 $19 $302 $528 $201 $3,452

Average Costs Post $804 $733 $1,218 $303 $1,367 $451 $489 $2,651

Average Costs Total $1,389 $1,108 $3,892 $535 $2,626 $1,146 $1,064 $9,300

Mental Healthcare

Percent Involved 21% 28% 25% 21% 30% 28% 30% 27%

Average Costs Pre $474 $427 $131 $267 $1,230 $470 $147 $429

Average Costs During $59 $117 $147 $50 $116 $336 $121 $568

Average Costs Post $839 $746 $92 $498 $1,545 $53 $483 $284

Average Costs Total $1,372 $1,290 $371 $816 $2,891 $859 $750 $1,281

Substance Abuse

Percent Involved 17% 22% 23% 26% 32% 31% 26% 33%

Average Costs Pre $90 $57 $235 $71 $542 $881 $321 $310

Average Costs During $45 $147 $164 $91 $365 $977 $93 $950

Average Costs Post $269 $514 $4 $511 $422 $7 $465 $341

Average Costs Total $404 $718 $403 $673 $1,329 $1,865 $879 $1,601

All Mainstream Domains

Average Costs Pre $1,822 $1,571 $3,314 $1,260 $3,313 $2,439 $1,624 $4,808

Average Costs During $259 $711 $2,953 $1,841 $1,054 $2,385 $2,057 $6,198

Average Costs Post $3,288 $3,456 $3,384 $2,563 $4,533 $846 $2,499 $4,432

Average Costs Total $5,369 $5,737 $9,651 $5,664 $8,901 $5,670 $6,180 $15,438

Note: Jacksonville’s ES Short Stayers and Street/ES Short Stayers are combined in the ES Short Stayers common path group. Sequential

Short Stayers and Sequential Long Stayers are combined in the Sequential Program Users common path group.
B-14 Appendix B: Jacksonville Tables Abt Associates Inc.
Abt Associates Inc. Appendix C: Individual Data C-1

Appendix C: Individual Data

C.1. Cohort Summaries

C.1.1 Jacksonville, Florida Study Cohort

Path Groups

ES

Short

Stayers

Street/ES

Short

Stayers

ES

Long

Stayers

ES Long

Gappers

Sequential

Short

Stayers

Sequential

Long

Stayers Circlers

PSH

Long

Stayers

Total

Cohort

Number of

Individuals 746 556 44 197 196 36 142 55 1,972

% of Cohort 38% 28% 2% 10% 10% 2% 7% 3% 100%

Demographicsa

Male 80% 85% 45% 95% 66% 71% 79% 70% 81%

African-American 45% 43% 73% 59% 47% 44% 57% 54% 48%

51 and older 17% 16% 20% 17% 21% 31% 17% 33% 18%

Average Age at First

Entry 40 yrs 41 yrs 41 yrs 42 yrs 41 yrs 47 yrs 43 yrs 46 yrs 41 yrs

Homeless Experience

Average Number of

Stays 1 stay 3 stays 1 stay 11 stays 2 stays 6 stays 8 stays 3 stays 3 stays

Average Total

Length of Stay 18 days 29 days 304

days 40 days 54 days 364 days 135 days 338 days 57 days

Average Total Gap 0 days 58 days 0 days 358 days 71 days 49 days 182 days 68 days 75 days

Median Total Length

of Stay 2 days 6 days 269

days 24 days 33 days 371 days 83 days 384 days 10 days

Mainstream System Involvement (% of study cohort with involvement at any point during the study)

Medicaid Managed

Care and Primary

Health Claims

22% 17% 39% 12% 24% 22% 15% 31% 20%

Mental Health -

Medicaid and State 21% 28% 25% 21% 30% 28% 30% 27% 25%

Substance Abuse

Treatment -

Medicaid and State

17% 22% 23% 26% 32% 31% 26% 33% 22%

Criminal Justice -

Arrests and Jail 31% 38% 34% 62% 35% 36% 44% 55% 38%

TANF 5% 2% 18% 1% 3% 0% 1% 2% 3%

Food Stamps 42% 51% 86% 53% 57% 67% 71% 84% 52%

Costs During Homelessness (Average Cost Per Person in Path Group)

Homeless System $563 $853 $9,756 $910 $1,585 $10,416 $3,987 $8,493 $1,634

Medicaid Managed

Care and Primary

Health Care Claims

$86 $56 $808 $19 $302 $528 $201 $3,452 $219

Medicaid and Statefunded Mental

Health Treatment

$58 $117 $147 $50 $116 $336 $121 $568 $106

Medicaid and Statefunded Substance

Abuse Treatment

$45 $147 $164 $91 $365 $977 $93 $950 $158

Jail and Arrests $12 $307 $57 $1,636 $214 $178 $1,400 $561 $397

TANF $4 - $227 $1 $2 - $1 $3 $7

Food Stamps $54 $84 $1,551 $44 $55 $366 $241 $664 $131

Mainstream Costs $259 $711 $2,954 $1,841 $1,054 $2,385 $2,057 $6,198 $1,002

Total Costs $822 $1,564 $12,710 $2,751 $2,639 $12,801 $6,044 $14,691 $2,636

Note: Jacksonville’s ES Short Stayers and Street/ES Short Stayers are combined in the ES Short Stayers common path group. Sequential Short

Stayers and Sequential Long Stayers are combined in the Sequential Program Users common path group.

a

Null demographic values are excluded from percentage calculations and thus may differ from findings presented elsewhere.
C-2 Appendix C: Individual Data Abt Associates Inc.

C.1.2 Houston, Texas Individuals Study Cohort

Street

Only

ES Short

Stayers

Extended

ES

Stayers

ES Long

Gappers

Frequent

ES Long

Gappers

Sequential

Program

Users Circlers

TH Only

or PSH

Only

Total

Cohort

Number of

Individuals 871 2,306 115 263 101 89 85 576 4,406

% of Cohort 20% 52% 3% 6% 2% 2% 2% 13% 100%

% of Cohort

excluding Street

Only Path Group

- 65% 3% 7% 3% 3% 2% 16% 100%

Demographicsa

Male 78% 88% 43% 88% 100% 51% 31% 23% 74%

African-American 63% 52% 72% 66% 63% 65% 68% 52% 57%

51 and older 17% 17% 9% 19% 30% 19% 8% 12% 16%

Average Age at First

Entry 42 yrs 40 yrs 37 yrs 42 yrs 46 yrs 43 yrs 40 yrs 40 yrs 41 yrs

Homeless Experience

Average Number of

Stays 1 stay 2 stays 1 stay 7 stays 40 stays 3 stays 3 stays 1 stay 3 stays

Average Total

Length of Stay 1 day 8 days 158 days 23 days 124 days 182 days 174 days 150 days 39 days

Average Total Gap 0 days 16 days 6 days 376 days 245 days 149 days 150 days 10 days 44 days

Median Total Length

of Stay 1 day 2 days 112 days 14 days 95 days 254 days 269 days 205 days 22 days

Mainstream System Involvement (% of study cohort with involvement at any point during the study)

Mental Health Care 2% 17% 30% 36% 28% 35% 48% 28% 18%

State MH Inpatient 0% <1% 0% 3% 0% 0% 2% <1% <1%

Criminal Justice 1% 14% 14% 26% 23% 19% 27% 19% 13%

Costs During Homelessness (Average Cost Per Person in Path Group)

Residential

Homeless $199 $353 $10,540 $880 $2,494 $14,418 $10,705 $8,799 $2,257

Mental Health Care $2 $149 $1,050 $1,669 $1,491 $2,052 $1,847 $489 $380

State MH Inpatient $170 $10

Criminal Justice - $45 $222 $1,049 $782 $900 $749 $109 $157

Mainstream Costs $2 $194 $1,272 $2,888 $2,274 $2,952 $2,596 $598 $547

Total Costs $201 $547 $11,812 $3,768 $4,768 $17,370 $13,301 $9,397 $2,804

Note: ES Long Gappers and Frequent ES Long Gappers are combined in the ES Long Gapper common path group.

a

Null demographic values are excluded from percentage calculations and thus may differ from findings presented elsewhere.
Abt Associates Inc. Appendix C: Individual Data C-3

C.1.3 Des Moines, Iowa Study Cohort

ES

Short

Stayers

ES Long

Gappers

Sequential

Program

Users Circlers

TH Only

(Shared

Room

Model)

TH Only (Ind

Room Model) Total Cohort

Number of

Individuals 641 154 42 48 147 92 1,124

% of Cohort 57% 14% 4% 4% 13% 8% 100%

Demographicsa

Male 73% 72% 88% 90% 58% 85% 73%

African-American 21% 29% 27% 26% 12% 18% 21%

51 and older 16% 14% 31% 19% 3% 13% 15%

Average Age at

First Entry 39 yrs 40 yrs 44 yrs 40 yrs 34 yrs 37 yrs 39 yrs

Homeless Experience

Average Number

of Stays 2 stays 8 stays 4 stays 7 stays 1 stay 1 stay 3 stays

Average Total

Length of Stay 17 days 63 days 259 days 203 days 133 days 237 days 73 days

Average Total

Gap 10 days 308 days 110 days 171 days 9 days 26 days 63 days

Median Total

Length of Stay 4 days 44 days 181 days 157 days 92 days 198 days 24 days

Average Per

Person

Residential

Homeless

System Costs

$321 $1,224 $8,539 $6,374 $3,103 $11,731 $2,308

a

Null demographic values are excluded from percentage calculations and thus may differ from findings presented elsewhere.
C-4 Appendix C: Individual Data Abt Associates Inc.

C.2. Cross-Site Individuals Multivariate Analyses

C.2.1 Analysis of Homeless Costs and Homeless Service Utilization, with Homeless Program

Type as Covariates

Outcome variables: The outcome variables for these models are total homeless costs in log scale and

total length of stay (in days) in log scale

Description: Both models control for the program types used, site, gender, race and age. The homeless

costs model also controls for homeless utilization data.

Model 1: Total

Homeless Costs

(log scale)

Model 2: Length of Stay

(log scale)

Homeless Programs Used+

Persons who only Used TH Housing 1.299*** 2.029***

(0.049) (0.063)

Only Used ES and TH Programs 1.114*** 2.294***

(0.067) (0.088)

Used Other Program Types or Combinations 0.793*** 1.261***

(0.051) (0.067)

Site+

Des Moines, IA 0.068 0.227***

(0.045) (0.061)

Houston, TX 0.012 -0.465***

(0.033) (0.046)

Homeless System Utilization+

Number of stays 0.037***

(0.003)

Total length of stay (in days), divided by 30 0.351***

(0.005)

Total gaps between stays (in days), divided by 30 0.073***

(0.004)

Demographics+

Female 0.974*** 0.735***

(0.035) (0.047)

Black 0.192*** 0.300***

(0.030) (0.040)

Other Race 0.051 0.100

(0.059) (0.080)

Age 18 – 24 0.074 -0.232***

(0.055) (0.075)

Age 25 – 30 0.105** -0.043

(0.051) (0.070)

Age 41 – 50 0.098*** 0.190***

(0.037) (0.051)

Age 18 – 24 0.098** 0.261***

(0.046) (0.062)

Gender missing -0.452*** 0.439***

(0.091) (0.123)

Race missing 0.241*** 0.930***

(0.087) (0.119)
Abt Associates Inc. Appendix C: Individual Data C-5

Model 1: Total

Homeless Costs

(log scale)

Model 2: Length of Stay

(log scale)

Age missing 0.134** -2.345***

(0.063) (0.084)

Constant 3.953*** 1.685***

(0.041) (0.054)

Observations 7502 7502

R-squared 0.68 0.36

Notes: + Reference categories are: Used ES Only, Jacksonville, Age 31 – 40, Male, White.

Standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%
C-6 Appendix C: Individual Data Abt Associates Inc.

C.2.2 Analysis of Homeless Costs and Homeless Service Utilization, without Homeless Program

Type as Covariates

Outcome variables: The outcome variables for these models are (1) total homeless cost in log scale, (2)

total number of stays in log scale, (3) total length of stay in log scale, and (4) total number of gap days in

log scale.

Description: All four models control for site, gender, race and age. The model for homeless costs

controls for homeless system utilization data.

Outcome variable

Model 1: Total

Homeless Costs

(log scale)

Model 2: Number

of Stays (log scale)

Model 3: Length of

Stay (log scale)

Model 4: Total

gap days (log

scale)

Site+

Des Moines, IA 0.180*** 0.023 0.293*** -0.179*

(0.049) (0.030) (0.067) (0.103)

Houston, TX 0.095*** -0.084*** -0.534*** -0.119

(0.037) (0.023) (0.050) (0.078)

Homeless System Utilization

Number of stays 0.030***

(0.003)

Total length of stay

(in days), divided by

30

0.385***

(0.004)

Total gaps between

stays (in days),

divided by 30

0.076***

(0.004)

Demographics+

Female 1.268*** -0.376*** 1.307*** 0.335***

(0.037) (0.022) (0.049) (0.099)

Black 0.188*** 0.137*** 0.276*** 0.403***

(0.033) (0.020) (0.045) (0.075)

Other Race -0.032 0.098** -0.060 -0.015

(0.065) (0.040) (0.089) (0.143)

Age 18 – 24 0.061 -0.092** -0.310*** -0.030

(0.061) (0.038) (0.083) (0.141)

Age 25 – 30 0.087 -0.098*** -0.116 -0.237*

(0.057) (0.035) (0.078) (0.128)

Age 41 – 50 0.116*** 0.098*** 0.228*** 0.222**

(0.041) (0.025) (0.056) (0.088)

Age 18 – 24 0.094* 0.153*** 0.260*** 0.074

(0.051) (0.031) (0.069) (0.106)

Gender missing -0.655*** -0.241*** 0.136 -0.596**

(0.098) (0.061) (0.134) (0.272)

Race missing 0.129 0.246*** 0.707*** 0.256

(0.095) (0.059) (0.130) (0.229)

Age missing 0.582*** -0.501*** -1.645*** 0.180

(0.055) (0.034) (0.074) (0.304)

Constant 4.059*** 0.657*** 2.096*** 3.630***

(0.044) (0.027) (0.059) (0.092)

Observations 7502 7502 7502 2870

R-squared 0.62 0.11 0.22 0.03

Notes: + Reference categories are: Used ES Only, Jacksonville, Age 31 – 40, Male, White

Standard errors in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%
Abt Associates Inc. Appendix C: Individual Data C-7

C.3. Multivariate Analysis of Costs by Domain in Houston Individuals

Outcome variables: The outcome variable for these models is total costs associated with each domain in

their original metric (dollar amounts).

Description: Models 1, 2, and 3 model Mental Health System Costs. Models 4, 5, and 6 model criminal

justice costs. All models control for gender, race, and age. Models 1 and 4 control based on path groups.

Models 2 and 5 control for underlying homeless utilization data. Models 3 and 6 control for homeless

system costs.

Model 1 Model 2 Model 3 Model 4 Model 5 Model 6

Outcome

Mental Health

System Costs

(Homeless

Path Group

Model)

Mental Health

System Costs

(Homeless

Utilization

Model)

Mental Health

System Costs

(Homeless

Cost Model)

Criminal

Justice

Costs

(Homeless

Path Group

Model)

Criminal

Justice

Costs

(Homeless

Utilization

Model)

Criminal

Justice Costs

(Homeless

Cost Model)

Path Group+

Street-Only

Short Stayers

-648.743 -497.902

(472.107) (389.487)

Emergency

Shelter Long

Gappers

2,351.606*** 1,179.294***

(401.362) (331.123)

Emergency

Shelter MultipleStay Long

Gappers

2,317.959*** 761.055

(627.240) (517.472)

Emergency

Shelter

Extended

Stayers

767.744 709.349

(598.898) (494.089)

Progressive

Long Stayers

2,084.817*** 604.719

(672.278) (554.628)

Circling Long

Stayers

2,966.777*** 1,943.164***

(695.542) (573.821)

TH-Only and

PSH-Only

-94.020 790.651***

(331.763) (273.704)

Homeless System Utilization

Number of stays 2.035 -23.043*

(15.330) (12.658)

Total length of

stay (in days),

divided by 30

135.568*** -33.204

(31.638) (26.123)

Total gaps

between stays

(in days),

divided by 30

207.498*** 136.029***

Homeless System Costs

Total Homeless

Costs

244.533*** -25.776

(54.671) (44.988)
C-8 Appendix C: Individual Data Abt Associates Inc.

Model 1 Model 2 Model 3 Model 4 Model 5 Model 6

Outcome

Mental Health

System Costs

(Homeless

Path Group

Model)

Mental Health

System Costs

(Homeless

Utilization

Model)

Mental Health

System Costs

(Homeless

Cost Model)

Criminal

Justice

Costs

(Homeless

Path Group

Model)

Criminal

Justice

Costs

(Homeless

Utilization

Model)

Criminal

Justice Costs

(Homeless

Cost Model)

Demographics+

Female 568.855** 408.504* 6.249 -635.795*** -174.216 -227.191

(257.202) (233.006) (254.764) (212.191) (192.393) (209.644)

Black -249.602 -281.174 -170.798 81.006 62.298 125.816

(217.731) (216.820) (218.043) (179.627) (179.028) (179.427)

Other Race -668.275** -671.700** -589.103* -752.921*** -813.770*** -777.166***

(309.769) (308.407) (310.447) (255.559) (254.652) (255.465)

Age 18 – 24 -653.342 -625.156 -664.094 -338.548 -388.749 -384.910

(416.243) (414.834) (417.714) (343.400) (342.528) (343.734)

Age 25 – 30 -94.633 -28.563 -149.842 -290.677 -321.642 -365.413

(370.515) (369.645) (371.953) (305.674) (305.216) (306.077)

Age 41 – 50 -729.987*** -797.297*** -739.953*** -1,242.844*** -1,250.060*** -1,210.904***

(269.043) (268.755) (270.714) (221.960) (221.911) (222.769)

Age 51 or

greater

-1,454.007*** -1,498.154*** -1,453.801*** -1,634.459*** -1,635.552*** -1,624.431***

(334.955) (334.779) (336.496) (276.337) (276.428) (276.901)

Gender missing 174.329 -27.085 -211.924 -227.348 184.237 137.760

(1,121.838) (1,117.312) (1,127.713) (925.514) (922.565) (927.988)

Race missing -1,015.764* -692.421 -330.123 -749.294* -376.993 -341.467

(551.384) (448.306) (452.561) (454.890) (370.166) (372.410)

Age missing -1,393.196*** -1,772.292*** -2,305.343*** -1,745.497*** -2,333.122*** -2,470.592***

(498.065) (299.000) (294.904) (410.902) (246.884) (242.675)

Constant 2,161.168*** 1,990.985*** 1,278.324*** 2,420.949*** 2,520.263*** 2,741.075***

(265.168) (262.855) (362.525) (218.763) (217.039) (298.320)

Observations 4404 4404 4404 4404 4404 4404

R-squared 0.04 0.04 0.03 0.04 0.04 0.03

Notes: + Reference categories are ES Short Stayers, Age 31 – 40, Male, White

Standard errors in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%
Abt Associates Inc. Appendix D: Family Data D-1

Appendix D: Family Data

D.1. Family Cohort Summaries

D.1.1 Houston, Texas Families Study Cohort

Path Groupsa

ES Short

Stayers

ES Repeat

Users

ES Long

Gappers

MultiProgram

Users

Housing

Program

Users

Total

Cohort

Number of Families 262 54 22 44 95 477

% of Cohort 55% 11% 5% 9% 20% 100%

Number of Adults 290 65 29 47 103 534

Number of Children 553 125 50 80 187 995

Avg. Household Size 3.2 3.5 3.6 2.9 3.1 3.2

Household Characteristics

One Adult 89% 83% 68% 93% 91% 88%

Membership changed during

homeless period 7% 52% 68% 70% 26% 25%

Children six and under 53% 35% 45% 56% 49% 50%

Demographicsb

Male Adults 14% 25% 28% 9% 3% 13%

African-American 65% 67% 78% 62% 61% 65%

Adults 41 and older 15% 16% 28% 21% 15% 16%

Average Age at First Entry 30.4 33.4 34.9 32.5 31.8 31.5

Homeless Experience

Average Number of Stays 1 stay 2.1 stays 3.4 stays 2.5 stays 1.2 stays 1.4 stays

Average Total Length of Stay 37.1 days 100.6 days 63.0 days 236.3 days 283.6 days 113.0 days

Median Total Length of Stay 24 days 49 days 45 days 191 days 45 days 49 days

Average Total Gap 0.0 days 41.3 days 346.0 days 81.1 days 12.2 days 30.5 days

Mainstream System Involvement (% of study cohort with involvement at any point during the study)

Criminal Justice 5% 7% 23% 14% 13% 8%

Mental Health 11% 19% 23% 23% 21% 16%

State Hospitals - - - - 1% 0.2%

Costs During Homelessness (Average Cost Per Person in Path Group

Homeless System $2,321 $5,748 $3,885 $26,913 $35,344 $11,626.77

Criminal Justice - - $163 - - $7.52

Mental Health $48.92 $210.29 $72.68 $331.27 $364.72 $157.22

State Hospitals - - - - - -

Mainstream Costs $49 $210 $236 $331 $365 $164.74

Total Costs $2,370 $5,959 $4,121 $27,244 $35,709 $11,792 a

The ES Short Stayers and ES Repeat Users are combined to form the Brief Users of Emergency Shelter path in the Family Chapter, MultiProgram Users and Housing Program Users are considered Heavy Users of Transitional Housing, and the Emergency Shelter Long Gappers

path is considered Repeat Users with Long Gaps.

b

Null demographic values are excluded from percentage calculations and thus may differ from findings presented elsewhere
D-2 Appendix D: Family Data Abt Associates Inc.

D.1.2 Kalamazoo, Michigan Study Cohort

Path Groupsa

ES Single

Use Short

Stayers

ES Repeat

Users

ES Long

Gappers

MultiProgram

Long

Gappers

Long

Stayers Total Cohort

Number of Families 161 47 33 19 82 342

% of Cohort 47% 14% 10% 6% 24% 100%

Number of Adults 172 51 38 21 98 380

Number of Children 307 94 92 42 171 706

Avg. Household Size 3.0 3.1 3.9 3.3 3.3 3.2

Household Characteristics

One Adult 93% 92% 85% 90% 81% 89%

Membership changed during

homeless period

1% 17% 61% 53% 5% 13%

Children six and under 48% 54% 56% 51% 44% 49%

Demographicsb

Male Adults 12% 8% 16% 10% 24% 15%

African-American 59% 53% 71% 67% 60% 60%

Adults 41 and older 11% 10% 11% 19% 15% 12%

Average Age at First Entry 29.6 28.8 29.1 32.7 31.1 30.0

Homeless Experience

Average Number of Stays 1 stay 2.1 stays 3.1 stays 3.3 stays 1.2 stays 1.5 stays

Average Total Length of Stay 14.6 days 48.1 days 37.8 days 144.1 days 289 days 94 days

Median Total Length of Stay 8 days 31 days 31 days 135 days 308 days 30 days

Average Total Gap 0 days 50.0 days 377.5 days 275.4 days 8.7 days 60.5 days

Mainstream System Involvement (% of study cohort with involvement at any point during the study)

Criminal Justice 39% 45% 61% 63% 34% 42%

Medicaid 92% 98% 100% 100% 94% 94%

Financial Assistance*** >=32% >=36% >=58% >=79% >=40% >=39%

Costs During Homelessness (Average Cost Per Person in Path Group)

Homeless System $1,172 $2,977 $3,295 $5,925 $6,574 $3,184

Criminal Justice $1.09 $45.34 $125.61 $383.00 $112.31 $67.08

Medicaid $340.35 $1,951.99 $13,184.15 $10,283.72 $10,555.85 $4,802.88

Financial Assistance $3.04 $51.15 $204.29 $268.76 $295.47 $113.95

Mainstream Costs $344 $2,048 $13,514 $10,935 $10,964 $4,984

Total Costs $1,516 $5,026 $16,809 $16,860 $17,537 $8,168 a ES Single Use Short Stayers and ES Repeat Users are combined to form the Brief Users of Emergency Shelter path in the Family Chapter, the Long

Stayers path is considered Heavy Users of Transitional Housing, and ES Long Gappers and Multi-Program Long Gappers are considered Repeat Users

with Long Gaps.

b Null demographic values are excluded from percentage calculations and thus may differ from findings presented elsewhere

c De-duplicated data across programs within this domain was not provided. Values in this row represent the maximum value received by the path group

in any one type of sub-domain. The total de-duplicated value across types is most likely higher assuming that at least some families receiving each type

of assistance were different.
Abt Associates Inc. Appendix D: Family Data D-3

D.1.3 Upstate South Carolina Study Cohort

Path Groupsa

One Week

Single

Stayers

One

Month

Returners

ThreeMonth

Single

Stayers

Six

Month

Returners

Long Stay

Progressers

TH Only

Long

Stayers

Total

Cohort

Number of Families 35 11 24 14 25 36 145

% of Cohort 24% 8% 17% 10% 17% 25% 100%

Number of Adults 38 12 26 17 28 41 162

Number of Children 57 16 48 26 48 77 272

Avg. Household Size 2.7 2.6 3.1 3.1 3.0 3.3 3.0

Household Characteristics

One Adult 91% 91% 92% 79% 88% 86% 88%

Membership changed

during homeless period 0% 36% 4% 64% 36% 6% 17%

Children six and under 50% 69% 27% 46% 30% 43% 41%

Demographicsb

Male Adults 3% 17% 8% 18% 11% 15% 10%

African-American 56% 25% 46% 41% 63% 54% 49%

Adults 41 and older 5% 8% 23% 0% 18% 12% 12%

Average Age at First Entry 30.1 29.1 34.6 28.3 32.4 31.3 31.2

Homeless Experience

Average Number of Stays 1 stay 2.1 stays 1 stay 2.3 stays 2.2 stays 1 stays 1.4 stays

Average Total Length of

Stay 9.3 days 31.6 days 87.6 days 176.2 days 328.5 days 375.3days 186.0 days

Median Total Length of

Stay 6 days 33 days 87 days 117 days 298 days 409 days 103 days

Average Total Gap 0 days 92.7 days 0 days 133.8 days 24.9 days 3.4 days 24.9 days

Mainstream System Involvement (% of study cohort with involvement at any point during the study)

Criminal Justice 31% 45% 38% 71% 32% 19% 34%

Food Stamps 80% 100% 92% 100% 100% 94% 92%

Medicaidc >=69% 100% >=96% >=93% 100% >=94% >90%***

Costs During Homelessness (Average Cost Per Person in Path Group)

Homeless System $784 $2,508 $8,890 $12,475 $16,036 $15,478 $9,663.12

Criminal Justice - $18.18 $41.67 $57.14 $64.00 $33.33 $33.10

Food Stamps $64.00 $866.00 $630.58 $2,140.57 $2,725.92 $3,030.44 $1,614.57

Medicaid $48.17 $2,730.73 $1,712.75 $4,071.43 $4,436.76 $5,608.89 $3,052.89

Mainstream Costs $112 $3,615 $2,385 $6,269 $7,227 $8,673 $4,700.56

Total Costs $896 $6,123 $11,275 $18,744 $23,262 $24,151 $14,363.68 a One-Week Single Stayers, One-Month Returners and Three-Month Returners are combined to form the Brief Users of Emergency

Shelter path in the Family Chapter, Long Stay Progressers and TH Only Long Stayers are considered Heavy Users of Transitional

Housing, and the Six-Month Returners are considered Repeat Users with Long Gaps.

b Null demographic values are excluded from percentage calculations and thus may differ from findings presented elsewhere

c De-duplicated data across programs within this domain were not provided. Values in this row represent the maximum value received

by the path group in any one type of sub-domain.
D-4 Appendix D: Family Data Abt Associates Inc.

D.1.4 Washington, DC Study Cohort

Path Groupsa

Congregate

ES, Short

Stayers

Congregate

and

Apartment

ES

Progressing

Long

Stayers

Transitional

Housing

Only

Direct to

Permanent

Housing

Long

Gappers

Total

Cohort

Number of Families 135 36 52 45 91 51 410

% of Cohort 33% 9% 13% 11% 22% 12% 100%

Number of Adults 157 47 70 47 108 171 500

Number of Children 303 112 135 90 199 107 946

Avg. Household Size 3.4 4.4 3.9 3.0 3.4 3.5 3.5

Household Characteristics

One Adult 84% 72% 69% 96% 81% 69% 80%

Membership changed during

homeless period 11% 64% 75% 22% 5% 92% 34%

Children six and under 43% 53% 43% 64% 44% 53% 48%

Demographicsb

Male Adults 15% 25% 16% 4% 21% 25% 18%

African-American 97% 100% 100% 94% 96% 98% 97%

Adults 41 and older 21% 15% 29% 21% 16% 21% 20%

Average Age at First Entry 32.0 30.6 30.8 30.5 30.6 32.4 31.6

Homeless Experience

Average Number of Stays 1.2 stays 2.6 stays 2.8 stays 1.2 stays 1 stays 7.2 stays 2.2 stays

Average Total Length of Stay 67.2 days 513.2 days 550.5 days 447.1 days 384.4 days 272.6

days

308.6

days

Median Total Length of Stay 39 days 474 days 543 days 472 days 381 days 207 days 258 days

Average Total Gap 5.8 days 20.4 days 42.6 days 0.1 days 0.0 days 514.7

days

73.2 days

Mainstream System Involvement (% of study cohort with involvement between 7/1/2003 and 7/31/2008)

Medicaid 92% 100% 100% 98% 93% 98% 95%

Substance Abuse 7% 8% 6% 13% 1% 29% 9%

Child Welfare 46% 56% 37% 49% 29% 55% 43%

Mental Health 30% 47% 46% 58% 14% 55% 36% a

Congregate ES Short Stayers are considered Brief Users of Emergency Shelter in the Family Chapter, Progressing Long Stayers and

Transitional Housing Only are combined to form Heavy Users of Transitional Housing and the Long Gappers are considered Repeat Users

with Long Gaps.

b

Null demographic values are excluded from percentage calculations and thus may differ from findings presented elsewhere
Abt Associates Inc. Appendix D: Family Data D-5

D.2. Cross-Site Family Multivariate Analysis

D.2.1 Analysis of Total Homeless Costs: Approach 1

Description: This series of regressions starts with the basic building blocks of costs per family, first

adding length of stay (Model 1) to dummy variables controlling for site differences. Model 2 adds

program type to site dummy variables and length of stay. Models 3 and 4 add other variables that

reflect program use patterns, number of stays, number of “gap days,” and whether the family changed

composition during the period of homelessness. The final models (5 and 6) add basic family

demographic characteristics: age of adults, age of children, household size, and race.

Outcome Variable: Total Homeless Costs in Log Scale

Model 1 Model 2 Model 3 Model 4 Model 5 Model 6

Total Homeless

Cost (log scale)

(Length of

Stay only)

(Model 1

variables

plus

Program

Type)

(Model 2

variables

plus Number

of stays and

number of

“gap days”)

(Model 3

variables plus

Change in

composition

during

homeless

period)

(All

variables

except

household

change)

(All

variables)

Washington, DCa 0.734*** 0.828*** 0.769*** 0.727*** 0.864*** 0.836***

(0.097) (0.098) (0.098) (0.098) (0.103) (0.103)

Upstate South

Carolina

0.733*** 0.700*** 0.748*** 0.732*** 0.719*** 0.693***

(0.121) (0.120) (0.119) (0.118) (0.119) (0.119)

Houston, TX 0.843*** 0.862*** 0.903*** 0.854*** 0.916*** 0.862***

(0.086) (0.085) (0.084) (0.085) (0.085) (0.086)

Length of stay (in

days) divided by 30

0.239*** 0.218*** 0.223*** 0.219*** 0.222*** 0.219***

(0.006) (0.008) (0.008) (0.008) (0.008) (0.008)

Transitional Housingonly program type0.422*** 0.442*** 0.459*** 0.464*** 0.475***

(0.112) (0.111) (0.111) (0.112) (0.111)

Emergency Shelter

and Transitional

Housing-only

program type

0.633*** 0.443*** 0.394*** 0.489*** 0.437***

(0.131) (0.133) (0.133) (0.133) (0.133)

Other program type -0.066 -0.222 -0.330** -0.303* -0.427***

(0.153) (0.154) (0.157) (0.155) (0.158)

Total number of stays 0.051** 0.037 0.044* 0.031

(0.024) (0.024) (0.024) (0.024)

Total gaps between

stays (in days),

divided by 30

0.036*** 0.025*** 0.038*** 0.028***

(0.008) (0.009) (0.008) (0.009)

Any change in

household

composition during

the study period

0.326*** 0.350***

(0.096) (0.099)

Total number of

adults in household

0.025 -0.024

(0.160) (0.160)

Total number of

children in household

0.067** 0.055**

(0.028) (0.028)

Male adult-only

household type

-0.218 -0.230

(0.237) (0.236)
D-6 Appendix D: Family Data Abt Associates Inc.

Model 1 Model 2 Model 3 Model 4 Model 5 Model 6

Total Homeless

Cost (log scale)

(Length of

Stay only)

(Model 1

variables

plus

Program

Type)

(Model 2

variables

plus Number

of stays and

number of

“gap days”)

(Model 3

variables plus

Change in

composition

during

homeless

period)

(All

variables

except

household

change)

(All

variables)

Female adult-only

household type

-0.243 -0.245

(0.184) (0.183)

African American

household head

-0.273*** -0.290***

(0.084) (0.084)

Household head of

other race

-0.038 -0.042

(0.167) (0.166)

Household head

ages 18-24

-0.037 -0.038

(0.099) (0.099)

Household head

ages 25-30

0.023 0.020

(0.092) (0.091)

Household head

ages 41-50

0.084 0.086

(0.108) (0.107)

Household head

ages 51 or above

0.159 0.156

(0.246) (0.245)

Household with

youngest child born

after study entry

-0.338 -0.465**

(0.207) (0.209)

Household youngest

child ages 6-12

0.198** 0.205**

(0.088) (0.088)

Household youngest

child ages 13-17

0.184 0.195

(0.142) (0.141)

Household head race

missing

-0.232 -0.191

(0.214) (0.213)

Household head age

missing

-0.763 -0.802

(0.553) (0.551)

Youngest child age

missing

-0.064 -0.061

(0.261) (0.260)

Constant 6.221*** 6.163*** 6.012*** 6.031*** 6.179*** 6.283***

(0.068) (0.068) (0.074) (0.074) (0.356) (0.355)

Observations 1287 1287 1287 1287 1285 1285

R-squared 0.60 0.61 0.63 0.63 0.64 0.64

Reference categories are: Kalamazoo, MI, Emergency Shelter-only program type, mixed-adult household type, white household head,

household head ages 31 - 40, household youngest child ages 0-5.

Standard errors in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%

a Excluded CCG/SAFAH-only families in DC
Abt Associates Inc. Appendix D: Family Data D-7

D.2.2 Analysis of Total Homeless Costs: Approach 2

Description: This approach starts with site dummies and basic family demographics (Model 1) and

then adds program type (Model 3), length of stay (Model 4), and then numbers of stays and gap days

(Model 5). Models 2 and 6 also add the variable that reflects whether the household changed

composition. Model 1 does not control either for length of stay or for program type.

Outcome Variable: Total Homeless Costs in Log Scale

Total

homeless cost

(log scale)

Model 1

(Basic family

demographics)

Model 2

(Model 1

variables

plus

Household

Change)

Model 3

(Model 2

variables

plus

Program

Type)

Model 4

(Model 3

variables

plus

Length of

Stay)

Model 5

(Model 4

plus

Number of

stays and

gap days)

Model 6

(All

variables)

Washington, DCa 1.630*** 1.453*** 1.483*** 0.898*** 0.864*** 0.836***

(0.149) (0.148) (0.126) (0.104) (0.103) (0.103)

Upstate South

Carolina

1.442*** 1.377*** 1.121*** 0.682*** 0.719*** 0.693***

(0.177) (0.174) (0.148) (0.121) (0.119) (0.119)

Houston, TX 1.016*** 0.890*** 1.007*** 0.881*** 0.916*** 0.862***

(0.128) (0.127) (0.106) (0.086) (0.085) (0.086)

Total number of

adults in

household

0.181 -0.023 0.048 0.067 0.025 -0.024

(0.241) (0.238) (0.200) (0.161) (0.160) (0.160)

Total number of

children in

household

0.085** 0.052 0.095*** 0.065** 0.067** 0.055**

(0.042) (0.042) (0.035) (0.028) (0.028) (0.028)

Male adult-only

household type

-0.176 -0.253 -0.226 -0.203 -0.218 -0.230

(0.358) (0.350) (0.296) (0.239) (0.237) (0.236)

Female adult-only

household type

-0.219 -0.239 -0.368 -0.254 -0.243 -0.245

(0.278) (0.272) (0.230) (0.186) (0.184) (0.183)

African American

household head

-0.249* -0.277** -0.194* -0.270*** -0.273*** -0.290***

(0.127) (0.125) (0.105) (0.085) (0.084) (0.084)

Household head

of other race

-0.369 -0.320 -0.046 -0.032 -0.038 -0.042

(0.252) (0.247) (0.209) (0.169) (0.167) (0.166)

Household head

ages 18-24

-0.387*** -0.349** -0.251** -0.065 -0.037 -0.038

(0.150) (0.147) (0.124) (0.100) (0.099) (0.099)

Household head

ages 25-30

-0.070 -0.060 -0.088 -0.005 0.023 0.020

(0.139) (0.136) (0.115) (0.093) (0.092) (0.091)

Household head

ages 41-50

0.293* 0.267* 0.185 0.092 0.084 0.086

(0.163) (0.160) (0.135) (0.109) (0.108) (0.107)

Household head

ages 51 or above

0.575 0.518 0.631** 0.227 0.159 0.156

(0.372) (0.365) (0.308) (0.249) (0.246) (0.245)

Household with

youngest child

born after study

entry

0.988*** 0.380 0.481* -0.054 -0.338 -0.465**

(0.299) (0.304) (0.251) (0.204) (0.207) (0.209)
D-8 Appendix D: Family Data Abt Associates Inc.

Total

homeless cost

(log scale)

Model 1

(Basic family

demographics)

Model 2

(Model 1

variables

plus

Household

Change)

Model 3

(Model 2

variables

plus

Program

Type)

Model 4

(Model 3

variables

plus

Length of

Stay)

Model 5

(Model 4

plus

Number of

stays and

gap days)

Model 6

(All

variables)

Household

youngest child

ages 6-12

0.092 0.124 0.165 0.177** 0.198** 0.205**

(0.134) (0.131) (0.111) (0.089) (0.088) (0.088)

Household

youngest child

ages 13-17

0.120 0.155 0.049 0.170 0.184 0.195

(0.215) (0.211) (0.178) (0.144) (0.142) (0.141)

Household head

race missing

-0.778** -0.602* -0.398 -0.273 -0.232 -0.191

(0.324) (0.318) (0.268) (0.216) (0.214) (0.213)

Household head

age missing

-0.940 -0.994 -0.641 -0.822 -0.763 -0.802

(0.839) (0.822) (0.693) (0.560) (0.553) (0.551)

Youngest child

age missing

0.180 0.168 -0.297 -0.034 -0.064 -0.061

(0.395) (0.387) (0.327) (0.264) (0.261) (0.260)

Any change in

household

composition

during the study

period

0.926*** 0.350***

(0.125) (0.099)

Transitional

Housing-only

program type

2.274*** 0.459*** 0.464*** 0.475***

(0.109) (0.113) (0.112) (0.111)

Emergency

Shelter and

Transitional

Housing-only

program type

2.119*** 0.659*** 0.489*** 0.437***

(0.146) (0.131) (0.133) (0.133)

Other program

type

1.668*** -0.143 -0.303* -0.427***

(0.170) (0.154) (0.155) (0.158)

Length of stay (in

days) divided by

30

0.215*** 0.222*** 0.219***

(0.008) (0.008) (0.008)

Total number of

stays

0.044* 0.031

(0.024) (0.024)

Total gaps

between stays (in

days), divided by

30

0.038*** 0.028***

(0.008) (0.009)

Constant 7.025*** 7.227*** 6.555*** 6.307*** 6.179*** 6.283***

(0.537) (0.527) (0.444) (0.359) (0.356) (0.355)

Observations 1285 1285 1285 1285 1285 1285

R-squared 0.16 0.20 0.43 0.63 0.64 0.64

Reference categories are: clients in Kalamazoo, Emergency Shelter-only program type, mixed-adult household type, white household head,

household head ages 31-40, household youngest child ages 0-5

Standard errors in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%

1Excluded CCG/SAFAH-only families in DC
Abt Associates Inc. Appendix D: Family Data D-9

D.2.3 Analysis of the Selection of Program Type, With Household Change as a Covariate

Description: The coefficients for this Multinomial Logit model are expressed as odds ratios, with

values greater than one showing that, compared to the reference category, a particular type of

household is more likely to use a program type. This model is used to identify the factors associated

with the type of program use by first-time homeless families.

Program type Category (ES only;

TH only; ES and TH only; Other)

Multinomial Logit Model

Base category = Emergency Shelter Only

Outcome

Transitional Housing

Only

Emergency Shelter

and Transitional

Housing Only Other

Washington, D.C>a 0.866 0.966 5.776***

(0.205) (0.311) (2.591)

Upstate South Carolina 1.630* 2.865** 0.151

(0.406) (0.940) (0.163)

Houston, TX 1.002 0.656 0.799

(0.190) (0.200) (0.342)

Total number of adults in household 1.112 0.827 1.255

(0.471) (0.399) (0.516)

Total number of children in household 0.972 0.830* 0.998

(0.065) (0.076) (0.091)

Any change in household composition

during the study period

0.894 6.057*** 15.410***

(0.200) (1.446) (4.673)

Male adult-only household type 0.975 0.829 1.849

(0.597) (0.593) (1.346)

Female adult-only household type 1.493 0.897 1.438

(0.720) (0.484) (0.757)

African American household head 0.939 1.083 0.212***

(0.174) (0.296) (0.081)

Household head of other race 0.714 0.177 0.000

(0.269) (0.185) (0.000)

Household head ages 18-24 0.749 1.062 0.277**

(0.169) (0.343) (0.129)

Household head ages 25-30 0.965 1.387 0.988

(0.200) (0.415) (0.337)

Household head ages 41-50 1.037 1.831 1.206

(0.263) (0.602) (0.428)

Household head ages 51 or above 0.767 1.234 0.390

(0.457) (0.863) (0.346)

Household with youngest child born after

study entry

1.525 2.729* 0.327

(0.870) (1.216) (0.205)

Household youngest child ages 6-12 0.761 1.121 1.258

(0.158) (0.313) (0.408)

Household youngest child ages 13-17 1.160 1.186 1.626

(0.365) (0.517) (0.794)

Household head race missing 0.427 0.456 0.421

(0.245) (0.485) (0.469)

Household head age missing 0.576 0.000 0.000

(0.767) (0.000) (0.000)

Youngest child age missing 3.273* 0.802 2.961

(1.667) (0.894) (2.792)

Constant 0.223 0.115* 0.035***

(0.205) (0.124) (0.036)

Observations 1285

Log likelihood -1109.4261

Reference categories are: clients in Kalamazoo, mixed-adult household type, white household head, household head ages 31-40, household

youngest child ages 0-5

Coefficients in relative risk ratio format

Standard errors in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%

a

Excluded CCG/SAFAH-only families in DC
D-10 Appendix D: Family Data Abt Associates Inc.

D.2.4 Analysis of the Selection of Program Type, Without Household Change as a Covariate

Description: coefficients for this Multinomial Logit model are expressed as odds ratios, with values

greater than one showing that, compared to the reference category, a particular type of household is

more likely to use a program type. This model is used to identify the factors associated with the type

of program used by first-time homeless families. This analysis is identical to the one shown

previously, except that the household change variable is excluded from the model.

Program type Category (ES only;

TH only; ES and TH only; Other)

Multinomial Logit Model

Base category = Emergency Shelter Only

Transitional

Housing Only

Emergency Shelter and

Transitional Housing

Only Other

Washington, DCa 0.852 1.346 9.246***

(0.201) (0.414) (3.822)

Upstate, South Carolina 1.622 3.433*** 0.224

(0.404) (1.080) (0.237)

Houston, TX 0.990 0.984 1.433

(0.186) (0.283) (0.562)

Total number of adults in household 1.102 1.220 2.156

(0.445) (0.603) (0.849)

Total number of children in household 0.972 0.890 1.127

(0.064) (0.080) (0.096)

Male adult-only household type 0.965 0.899 1.732

(0.579) (0.643) (1.190)

Female adult-only household type 1.512 0.925 1.369

(0.705) (0.509) (0.688)

African American household head 0.934 1.155 0.286***

(0.173) (0.302) (0.101)

Household head of other race 0.713 0.164 0.000

(0.268) (0.171) (0.000)

Household head ages 18-24 0.747 1.009 0.265**

(0.168) (0.316) (0.118)

Household head ages 25-30 0.961 1.370 0.925

(0.199) (0.395) (0.290)

Household head ages 41-50 1.034 1.829 1.319

(0.261) (0.585) (0.424)

Household head ages 51 or above 0.780 1.391 0.553

(0.465) (0.948) (0.451)

Household with youngest child born

after study entry

1.376 7.974*** 1.124

(0.745) (3.403) (0.703)

Household youngest child ages 6-12 0.763 1.013 1.016

(0.158) (0.274) (0.303)

Household youngest child ages 13-17 1.164 1.035 1.454

(0.365) (0.440) (0.640)

Household head race missing 0.432 0.290 0.198

(0.247) (0.306) (0.215)

Household head age missing 0.575 0.000 0.000

(0.757) (0.000) (0.000)

Youngest child age missing 3.324* 0.912 3.284

(1.685) (0.987) (2.813)

Constant 0.222 0.086* 0.029***

(0.197) (0.094) (0.028)

Observations 1285

Log likelihood -1109.4261

Reference categories are: clients in Kalamazoo, mixed-adult household type, white household head, household head ages 31-40,

household youngest child ages 0-5

Coefficients in relative risk ratio format

Standard errors in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%

a

Excluded CCG/SAFAH-only families in DC
Abt Associates Inc. Appendix D: Family Data D-11

D.2.5 Analysis of the Length of Stay

Description: This series of regressions predicts length of stay, based on study site and household

characteristics, and the types of programs used. Model 1 includes all variables. Model 2 excludes the

program type variables. Model 3 excludes the household change variable.

Outcome variable: Length of Stay in Log Scale

Total length of stay (log scale)

Model 1

All Variables

Model 2

All Variables except

Program Type

Model 3

All Variables except

Household Change

Washington, DCa 0.913*** 1.003*** 0.964***

(0.115) (0.144) (0.116)

Upstae South Carolina 0.714*** 0.991*** 0.737***

(0.135) (0.170) (0.136)

Houston, TX 0.449*** 0.400*** 0.507***

(0.098) (0.123) (0.097)

Total number of adults in household -0.045 0.014 0.032

(0.183) (0.232) (0.184)

Total number of children in household 0.077** 0.056 0.091***

(0.032) (0.040) (0.032)

Any change in household composition

during the study period

0.443*** 0.879***

(0.104) (0.121)

Transitional Housing-only program type 2.436*** 2.431***

(0.100) (0.100)

Emergency Shelter and Transitional

Housing-only program type

1.988*** 2.123***

(0.137) (0.134)

Other program type 1.921*** 2.145***

(0.164) (0.156)

Male adult-only household type -0.127 -0.093 -0.105

(0.271) (0.342) (0.272)

Female adult-only household type -0.361* -0.195 -0.362*

(0.210) (0.265) (0.211)

African American household head -0.132 -0.214* -0.110

(0.097) (0.122) (0.097)

Household head of other race -0.182 -0.500** -0.175

(0.191) (0.240) (0.192)

Household head ages 18-24 -0.269** -0.406*** -0.278**

(0.113) (0.143) (0.114)

Household head ages 25-30 -0.057 -0.041 -0.063

(0.105) (0.133) (0.106)

Household head ages 41-50 0.145 0.238 0.146

(0.123) (0.156) (0.124)

Household head ages 51 or above 0.538* 0.437 0.567**

(0.281) (0.356) (0.283)

Household with youngest child born after

study entry

0.224 0.390 0.487**

(0.238) (0.297) (0.231)

Household youngest child ages 6-12 0.103 0.038 0.087

(0.101) (0.128) (0.102)

Household youngest child ages 13-17 0.176 0.273 0.156

(0.162) (0.205) (0.164)

Household head race missing -0.312 -0.630** -0.378

(0.245) (0.310) (0.247)

Household head age missing -0.522 -0.860 -0.492

(0.634) (0.801) (0.638)
D-12 Appendix D: Family Data Abt Associates Inc.

Total length of stay (log scale)

Model 1

All Variables

Model 2

All Variables except

Program Type

Model 3

All Variables except

Household Change

Youngest child age missing -0.183 0.337 -0.179

(0.299) (0.377) (0.301)

Constant 2.812*** 3.372*** 2.726***

(0.407) (0.513) (0.409)

Observations 1285 1285 1285

R-squared 0.48 0.16 0.47

Reference categories are: clients in Kalamazoo, Emergency Shelter-only program type, mixed-adult household type, white household

head, household head ages 31-40, household youngest child ages 0-5

Standard errors in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%

a

Excluded CCG/SAFAH-only families in DC
Abt Associates Inc. Appendix D: Family Data D-13

D.2.6 Summary Statistics of Variables Used in the Family Cross-site Regression Models

Variable Obs Mean Std. Dev. Min Max

Cost 1287 10,310.99 15,820.13 31.65 97,242.60

Costs in Log scale 1287 7.95 1.92 3.45 11.48

DC 1287 0.25 0.43 0 1

South Carolina 1287 0.11 0.32 0 1

Houston 1287 0.37 0.48 0 1

Total length of stay 1287 144.37 175.48 1 550

Total length of stay (in days), divided by 30 1287 4.81 5.85 0.03 18.33

Number of stays 1287 1.62 1.61 1 25

Total gap days 1287 53.11 139.45 0 867

Total gaps between stays (in days) divided

by 30

1287 1.77 4.65 0 28.90

Transitional Housing-only program type 1287 0.18 0.39 0 1

Emergency Shelter and Transitional

Housing-only program type

1287 0.09 0.29 0 1

Other program type 1287 0.07 0.26 0 1

Any change in household composition

during study period

1287 0.25 0.43 0 1

Total number of adults in household 1286 1.14 0.38 1 4

Total number of children in household 1285 2.12 1.28 1 9

Male adult-only household type 1287 0.05 0.21 0 1

Female adult-only household type 1287 0.83 0.38 0 1

African American household head 1287 0.70 0.46 0 1

Household head of other race 1287 0.05 0.21 0 1

Household head ages 18-24 1287 0.27 0.44 0 1

Household head ages 25-40 1287 0.24 0.43 0 1

Household head ages 41-50 1287 0.14 0.35 0 1

Household head ages 51 or above 1287 0.02 0.14 0 1

Household with youngest child born after

study entry

1287 0.03 0.17 0 1

Household youngest child ages 6-12 1287 0.25 0.43 0 1

Household youngest child ages 13-17 1287 0.08 0.27 0 1

Household head race missing 1287 0.03 0.16 0 1

Household head age missing 1287 0.01 0.07 0 1

Youngest child age missing 1287 0.02 0.14 0 1
D-14 Appendix D: Family Data Abt Associates Inc.
Abt Associates Inc. Bibliography/References R-1

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