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The Shockingly Simple, Surprisingly Cost-Effective Way to End Homelessness

The following text contains transcriptions, quotations, excerpts from an original source linked below.

In the past nine years, Utah has decreased the number of homeless by 72 percent—largely by finding and building apartments where they can live, permanently, with no strings attached. It’s a program, or more accurately a philosophy, called Housing First.
 
We could, as a country, look at the root causes of homelessness and try to fix them. One of the main causes is that a lot of people can’t afford a place to live.  They don’t have enough money to pay rent, even for the cheapest dives available. Prices are rising, inventory is extremely tight, and the upshot is, as a new report by the Urban Institute finds, that there’s only 29 affordable units available for every 100 extremely low-income households. So we could create more jobs, redistribute the wealth, improve education, socialize health care basically redesign our political and economic systems to make sure everybody can afford a roof over their heads.
 
To understand how the state did that it helps to know that homeless-service advocates roughly divide their clients into two groups: those who will be homeless for only a few weeks or a couple of months, and those who are “chronically homeless,” meaning they have been without a place to live for more than a year, and have other problems—mental illness or substance abuse or other debilitating damage. The vast majority, 85 percent, of the nation’s estimated 580,000 homeless are of the temporary variety, mainly men but also women and whole families who spend relatively short periods of time sleeping in shelters or cars, then get their lives together and, despite an economy increasingly stacked against them, find a place to live, somehow.
 
However, the remaining 15 percent, the chronically homeless, fill up the shelters night after night and spend a lot of time in emergency rooms and jails. This is expensive—costing between $30,000 and $50,000 per person per year according to the Interagency Council on Homelessness. And there are a few people in every city, like Reno’s infamous “Million-Dollar Murray,” who really bust the bank. So in recent years, both local and federal efforts to solve the homelessness epidemic have concentrated on the chronic population, currently about 84,000 nationwide.
 
The model for dealing with the chronically homeless at that time, both here and in most places across the nation, was to get them “ready” for housing by guiding them through drug rehabilitation programs or mental-health counseling, or both. If and when they stopped drinking or doing drugs or acting crazy, they were given heavily subsidized housing on the condition that they stay clean and relatively sane. This model, sometimes called “linear residential treatment” or “continuum of care,” seemed to be a good idea, but it didn’t work very well because relatively few chronically homeless people ever completed the work required to become “ready,” and those who did often could not stay clean or stop having mental episodes, so they lost their apartments and became homeless again.
 
In 1992, a psychologist at NYU named Sam Tsemberis decided to test a new model. His idea was to just give the chronically homeless a place to live, on a permanent basis, without making them pass any tests or attend any programs or fill out any forms.
 
“Okay,” Tsemberis recalls thinking, “they’re schizophrenic, alcoholic, traumatized, brain damaged. What if we don’t make them pass any tests or fill out any forms? They aren’t any good at that stuff. Inability to pass tests and fill out forms was a large part of how they ended up homeless in the first place.  Why not just give them a place to live and offer them free counseling and therapy, health care, and let them decide if they want to participate? Why not treat chronically homeless people as human beings and members of our community who have a basic right to housing and health care?”
Tsemberis and his associates, a group called Pathways to Housing, ran a large test in which they provided apartments to 242 chronically homeless individuals, no questions asked. In their apartments they could drink, take drugs, and suffer mental breakdowns, as long as they didn’t hurt anyone or bother their neighbors. If they needed and wanted to go to rehab or detox, these services were provided. If they needed and wanted medical care, it was also provided. But it was up to the client to decide what services and care to participate in.
 
The results were remarkable.After five years, 88 percent of the clients were still in their apartments, and the cost of caring for them in their own homes was less than what it would have cost to take care of them on the street. 
A subsequent study of 4,670+ New York City homeless with severe mental illness found that each cost an average of $40,449 a year in emergency room, shelter, and other expenses to the system, and that getting those individuals in supportive housing saved an average of $16,282. 
Soon other cities such as Seattle and Portland, Maine, as well as states like Rhode Island and Illinois, ran their own tests with similar results. 
Denver found that emergency-service costs alone went down 73 percent for people put in Housing First, for a savings of $31,545 per person; detox visits went down 82 percent, for an additional savings of $8,732. By 2003, Housing First had been embraced by the Bush administration.
 
Still, the new paradigm was slow to catch on. Old practices are sometimes hard to give up, even when they don’t work. When Housing First was initially proposed in Salt Lake City, some homeless advocates thought the new model would be a disaster. Also, it would be hard to sell the ultra-conservative Utah Legislature on giving free homes to drug addicts and alcoholics. And the Legislature would have to back the idea because even though most of the funding for new construction would come from the federal government, the state would have to pick up the balance and find ways to plan, build, and manage the new units. And where are you going to put them? Not in my backyard.
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“The old model was well-intentioned but misinformed. You actually need housing to achieve sobriety and stability, not the other way around.”
 
“Going from homelessness into a home changes a person’s psychological identity from outcast to member of the community,” Tsemberis says. 
The old model “was well-intentioned but misinformed. It is a long stairway that required sobriety and required stability in order to get into housing. So many people could never achieve that while on the street. You actually need housing to achieve sobriety and stability, not the other way around. But that was the system that was there. Some people called it a housing readiness industry, because all these programs were in business to improve people to get them ready for housing. Improve their character, improve their behavior, improve their moral standing. You actually need housing to achieve sobriety and stability, not the other way around. By contrast, he adds, “Housing First provides a new sense of belonging that is reinforced in every interaction with new neighbors and other community members. We operate with the belief that housing is a basic right. Everyone on the streets deserves a home. He or she should not have to earn it, or prove they are ready or worthy.”
 
Utah found that giving people supportive housing cost the system about half as much as leaving the homeless to live on the street.
 
Can Housing First scale to areas where land and services are expensive […], and where data about the benefits of offering the homeless a permanent residence might not withstand the whims of politicians?
 
In New York City, former Mayor Michael Bloomberg rolled out a well-regarded Housing First program focusing on mentally ill individuals. But he then gutted housing subsidies for the general homeless population, including families, after saying he thought they promoted passivity instead of “client responsibility.”
Former Mayor Michael Bloomberg slashed housing subsidies after saying he thought they promoted passivity instead of “client responsibility.” Today, 60,000 New Yorkers are homeless.
 
Today, homelessness is the highest since the Great Depression, with 60,000 New Yorkers—including 26,000 children—on the streets, in the subway tunnels, and in the city’s sprawling network of 255 shelters, conveniently located far from the playgrounds of the 1 percent. 
Every month I get a paper from Welfare saying how much they just paid for me and my two kids to stay in our one room in this shelter. $3,444! Every month!” one exasperated mom told The New Yorker. “Give me $900 and I’ll find me and my kids an apartment, I promise you.” 
The new mayor, Bill de Blasio, has pledged to reinvest in supportive and affordable housing, but 1 in 5 residents now live below the poverty line, and demand is high.
 
But the real test case might be California, where 20 percent of the nation’s homeless live. 
•••Los Angeles has 34,393 homeless people, more than a quarter of whom are chronically so. 
•••San Francisco has 6,408 homeless,
•••Santa Clara County—home to San Jose and the greater Silicon Valley—has 7,567, and housing costs are among the highest in the nation. 
It takes three minimum-wage jobs to pay for an average one-bedroom apartment there. Tax credits for construction and Section 8 vouchers for rent don’t come close to the actual costs.
 
New housing needs to be found, or built, but with the market so tight, finding housing—any housing—is a huge challenge, one made worse when Gov. Jerry Brown slashed all $1.7 billion of the state’s redevelopment funds during the 2011 budget crisis. (Those funds have not rematerialized now that California has a huge budget surplus.) So they’re getting creative—”tiny homes, pod housing, stackable—we’re looking at it all,” Loving says. 
And they’re employing creative financing efforts, like “pay-for-success” bonds, in which investors (mostly foundations) would stake the construction funds and get a small return if the savings materialize for the county.
 
Advocates estimate it could take up to a billion dollars, half from grants and philanthropy, the other half in the form of county land and services (for the state of California). “The work we’re going to be doing in the next year,” Loving says, “is determining where and how to create new units and how much they are going to cost and where we can get the resources from—whether it’s private or public money. The money is all here. 
We have eBay, Adobe, Applied Materials, Google.” 
The hope is that the emphasis on quantified efficiency will persuade tech firms and billionaires obsessed with metrics that Housing First is a solid civic investment. “It’s fascinating because we have this problem we could totally solve if we wanted to,” Loving says. “We solve complicated problems all the time, right? Silicon Valley is an example of solving complicated problems all the time.”
 
If places as different—economically, demographically, politically—as Salt Lake City and Santa Clara County can make Housing First work, is there any place that can’t? To be sure, the return on investment will vary, depending on how you count the various benefits of fewer people living in the streets, clogging emergency rooms, and crowding jails. 
But the overall equation is clear: “Ironically, ending homelessness is actually cheaper than continuing to treat the problem. This would not only benefit the people who are homeless; it would be healing for the rest of us to live in a more compassionate and just nation,” Tsemberis says. “It’s not a matter of whether we know how to fix the problem. Homelessness is not a disease like cancer or Alzheimer’s where we don’t yet have a cure. We have the cure for homelessness—it’s housing. What we lack is political will.”

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