People Experiencing Chronic Homelessness

Providing permanent supportive housing for people experiencing chronic homelessness is highly cost effective.   Permanent supportive housing leads to dramatic drops in utilization rates for hospitals, ERs, and other major services as well as drops in arrest rates.

In 2012, on a single night, there were 99,894 adults experiencing chronic homelessness in America; representing 15.8 percent of all people experiencing homelessness. Chronic homelessness declined by 7 percent between 2011 and 2012, and 19 percent since 2007. Three-quarters are men with the average age approaching 50. Almost one-third are Veterans.  Most go unsheltered and, despite disabling conditions, are not enrolled in Medicaid or other insurance programs.

The cost to individuals and society is high. The mortality rate for those experiencing chronic homelessness is four to nine times higher than for the general population. Rates of severe mental health disorders and substance abuse are high. In a wide range of communities, the extraordinarily high costs associated with the use of public services by those experiencing chronic homelessness have been documented. Health care is the major expense due to frequent and avoidable emergency room visits, inpatient hospitalizations, sobering centers, and nursing homes.  People experiencing chronic homelessness have high rates of incarceration often for offenses that are non-violent and are related to mental illness or the realities of living on the street. This adds an additional burden to a justice system that, in many communities, is already stretched to its limit. The physical and mental health needs of this population are prevalent and acute, and must be addressed if we are to end chronic homelessness.

Chronic Homelessness In Focus

In order to improve outcomes for individuals experiencing chronic homelessness, strategic action should be concentrated in three key areas:

  1. Provide Permanent Supportive Housing
  2. Reduce Financial Vulnerability
  3. Improve Health and Housing Stability

Research from many communities has shown that permanent supportive housing is a cost-effective solution for chronic homelessness. The cost of the housing subsidy and supportive services is more than offset by less frequent use of costly public services such as jails and emergency rooms. This growing body of research has helped to motivate significant federal and local investments in permanent supportive housing, increasing the national inventory by 40 percent -- or approximately 57,000 -- in the last five years. 

The Affordable Care Act will help many individuals, including people experiencing chronic homelessness, who were not eligible for Medicaid previously. Medicaid will be expanded to all individuals under the age of 65 with incomes currently up to about $15,000 for a single individual in FY 2010 in the continental United States (133 percent of the federal poverty level). Although many in this group will become Medicaid eligible due to the passage of Health Reform, a key to their enrollment will be providing them with transition assistance and permanent supportive housing solutions.

One of the four goals of Opening Doors is to finish the job of ending chronic homelessness by 2015.  Working together to implement proven solutions, we can continue to make progress towards our goal.

Below you will find information and resources focused specifically on improving outcomes for individuals experiencing chronic homelessness.

Additional Resources

Building Systems to End to Homelessness: HUD’s FY 2014 Continuum of Care Program Competition

A Sea Change in Fresno’s Homelessness Crisis Response

Creating a Medicaid Supportive Housing Services Benefit

Responding to the Crisis of Homelessness

DESC to Create More Supportive Housing to Serve Seattle’s Most Vulnerable

Inspired by People: New Report Offers Alternatives to Criminalization

Connect with USICH at the NAEH Conference

The Workforce Innovation and Opportunity Act Is Law

Supportive Services for Veteran Families: A Powerful Tool to Keep Veterans and Their Families Home

Successful Partnerships through Aligned Missions and Empathetic Relationships

Communities Come Together to Discuss Coordinated Entry

Your Input Is Essential to the Ongoing Success of Opening Doors

Four Clarifications about Housing First

How to Talk About Housing First

101,628 People Are Now in Safe and Stable Homes!

In One Year, New Orleans Reduced Veteran Homelessness by 43%, Chronic Homelessness by 30%

Houston and Phoenix are Proving that Ending Homelessness is Possible and Within Reach

Federal Partners Release Final 2014 HMIS Data Standards

The True Cost of Doing Nothing

Opening Doors Works: USICH Releases Annual Update to Congress

Creating Meaningful Alternatives to Criminalization in Our Communities

Criminalizing Homelessness is Costly, Ineffective, and Infringes on Human Rights

3 Reasons to Address Homelessness as a Human Rights Issue

The Power of Constituent Voice: The Rhode Island Homeless Bill of Rights

Starting Is the Starting Point for Coordinated Assessment

Wichita Police Department: Making a Difference for People Experiencing Homelessness

Houston Partners Dedicated to Ending Chronic Homelessness

Leveraging the Affordable Care Act to Solve Homelessness: A Message to CoCs and Ten-Year Plan Leaders

Why Permanent Supportive Housing and Managed Care Need Each Other

How Medicaid Expansion Will Benefit People Experiencing Homelessness

How Coordinated Entry is Working on Skid Row

Rapid Re-Housing is Working in DC

Peer Mentors and Navigators are What We Need

Atlanta Hosts Mobile Fair to Help Veterans Find Housing

The Power of Collaboration

HUD SNAPS Issues New NoFA Communications

Ending Chronic Homelessness: A Message to Continuum of Care & Ten-Year Plan Leaders from Barbara Poppe

In Order To Bend the Curve, We Must First Abandon the Line

Housing First: a movement goes mainstream

HUD Provides Additional Funds for nearly 900 Local Homeless Programs across the Country

WASHINGTON – U.S. Housing and Urban Development (HUD) Secretary Shaun Donovan today announced a...

Obama Administration Renews Critical Support for nearly 7,100 Local Homelessness Programs across U.S.

HUD Secretary Shaun Donovan today announced nearly $1.6 billion in grants to renew support for 7,100...

Second Chance Act Reentry Program for Adult Offenders FY 2013 Competitive Grant Announcement

Applications due May 16, 2013 WASHINGTON - The U.S. Department of Justice, (DOJ) Office of Justice...

Preventing and Addressing Tuberculosis among People Experiencing Homelessness

Tuberculosis is a serious health concern for people experiencing homelessness and those working with...

The Affordable Care Act’s Role in Preventing and Ending Homelessness

What is the Affordable Care Act?  On March 23, 2010, President Obama signed the Affordable Care...

Opening Doors: Chronic Homelessness

In 2009, on a single night, there were 110,917 adults experiencing chronic homelessness in America; three quarters...

Barriers to employment for people with schizophrenia

Robert A. Rosenheck 2006 There is growing interest in identifying and surmounting barriers to employment for...

Homes Not Handcuffs: The Criminalization of Homelessness in U.S. Cities

National Law Center on Homelessness and Poverty and The National Coalition for the Homeless July 2009 ...

Homelessness, substance misuse, and access to public entitlements in a soup kitchen population

Peter C. Nwakeze, Ph.D., Stephen Magura, Ph.D., C.S.W., Andrew Rosenblum, Ph...

Tenant Outcomes in Supported Housing and Community Residences in New York

Carole E. Siegel, Judith Samuels, Dei-In Tang, Ilyssa Berg, Kristine Jones and Kim Hopper July 2006 ...

A Narrative Approach to the Evaluation of Supportive Housing Stories of Homeless People Who Have Experienced Serious Mental Illness

Geoffrey Nelson , Juanne Clarke, Angela Febbraro, and Maria Hatzipantelis Fall 2005 In this study, researchers employ...

Taking Health Care Home: Baseline Report on PSH Tenants, Programs, Policies

Martha R. Burt July 2005 In 2003, the Robert Wood Johnson Foundation awarded CSH $6 million over two...

The Evidence on Supported Housing

Debra J. Rog May 2006 This study reviews the evidence base for supported housing that was...

Outcomes of Homeless Adults with Mental Illness in Housing

Colleen Clark and Alexander R. Rich January 2003 This study compares the effectiveness of two types...

An Evaluation of an Initiative to Improve Coordination and Service Delivery of Homeless Services Networks

Greg A. Greenberg and Robert A. Rosenheck Feburary 2007 In 2003, the Department of Housing and Urban...

An evaluation of an initiative to improve coordination and service delivery of homeless services networks. Preliminary Report: Draft 2.

Greg A. Greenberg 2007 In 2003, the Department of Housing and Urban Development, the Department of Health...

The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness.

Carol L. Pearson, Gretchen Locke,  Ann Elizabeth Montgomery, and Larry Buron July 2008 In recent...

Evaluability Assessment of Discharge Planning and the Prevention of Homelessness: Final Report

Garrett Moran, Rafael Semansky, Elizabeth Quinn, Rebecca Noftsinger and Teresa Koenig September 22, 2005 Past research has...

Medicaid-Financed Services in Supportive Housing for High-Need Homeless Beneficiaries: The Business Case

Michael Nardone, Richard Cho and Kathy Moses The Corporation for Supportive Housing and The Center...

Treating Homeless Clients with Severe Mental Illness, Substance Use Disorders

Gary A. Morse, Robert J. Calsyn, W. Dean Klinkenberg, Thomas W. Helminiak, Nancy Wolff, Robert...

Comparison of ACT and Standard Case Management For Delivering Integrated Treatment For Co-Occurring Disorders

Susan M. Essock, Kim T. Mueser, Robert E. Drake, Nancy H. Covell, Gregory J. McHugo,...

Long-Term Effectiveness of the ACCESS Program

Aileen B. Rothbard, So-Young Min, Eri Kuno and Yin-Ling Irene Wong October 2004 This study examined...

A Modified Therapeutic Community for Homeless Persons

Darren C. Skinner January 2005 This article, "A Modified Therapeutic Community for Homeless Persons with Co-Occurring...

Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults: A Randomized Trial

Laura S. Sadowski, Romina A. Kee, Tyler J. VanderWeele, and David Buchanan May 2009 The Chicago...

Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems

Mary E. Larimer, Daniel K. Malone, Michelle D. Garner, David C. Atkins, Bonnie Burlingham, Heather...

Frequent Users of Health Services Initiative:  Final Evaluation Report

Karen W. Linkins, Jennifer J. Brya, and Daniel W. Chandler, PhD August 2008 The Frequent Users...

Denver Housing First Collaborative Cost Benefit Analysis and Program Outcomes Report

Jennifer Perlman and John Parvensky December 11, 2006 The Colorado Coalition for the Homeless created the Denver...

Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults

Tia E. Martinez and Martha R. Burt July 2006 This analysis examined the impact of permanent...

Estimated Cost Savings Following Enrollment in the Community Engagement:  Program Findings from a Pilot Study of Homeless Dually Diagnosed Adults

Thomas L. Moore June 2006 This report discusses the estimated cost-benefits of providing community-based therapeutic care...

Impact of the San Diego Serial Inebriate Program

James V. Dunford, Edward M. Castillo, Theodore C. Chan, Gary M. Vilke, MD, Peter Jenson...

Capitated Assertive Community Treatment Program Savings: System Implications

Daniel Chandler and Gary Spicer September 2002 In a California county of one million people, 4% of...

Costs and Effectiveness of Substance Abuse Treatments For Homeless Persons

Joseph E. Schumacher, Stephen T. Mennemeyer, Jesse B. Milby, Dennis Wallace and Kim Nolan June 2002 ...

Public Service Reductions Associated with Placement of Homeless Persons with Severe Mental Illness

Dennis P. Culhane, Stephen Metraux, and Trevor Hadley January 2002 This article assesses the impact of...

Cost-Effectiveness of Services For Mentally Ill Homeless People

Robert Rosenheck October 2000 About one-quarter of homeless Americans have serious mental illnesses. This review synthesizes...

Characteristics of Individuals With Severe Mental Illness Who Use Emergency Services

Alexander S. Young, Matthew J. Chinman, Julie A. Cradock-O’Leary, Green Sullivan, Dennis Murata,...

An Empirical Investigation of the Determinants of Street Homelessness

Dirk W. Early March 2005 This study examines the determinants of street homelessness by developing and...

Prevalence and Risk Factors For Homelessness and Utilization of Mental Health Services Among 10,340 Patients With Serious Mental Illness in a Large Public Mental Health System

David P. Folsom, William Hawthorne, Laurie Lindamer,  Todd Gilmer, Anne Bailey, Shahrokh Golshan, Piedad...

Homelessness among persons with serious mental illness

Erik Kuno 2000 Homelessness and patterns of service use were examined among seriously mentally ill persons...

Homelessness Among Persons With Serious Mental Illness

Eri Kuno, Aileen B. Rothbard, June Avery and Dennis Culhane August 2000 Homelessness and patterns of...

Services in Supportive Housing

The Services in Supportive Housing (SSH) program was created to help prevent or reduce chronic...

Coordinated Assessment: Putting the Key Pieces in Place

Remarks by Eric Grumdahl at a gathering of community stakeholders focused on ending Veteran and...

“In Order to House Everyone, We Must Tear Down Some Walls…”

In this speech delivered at the Georgia Supportive Housing Association annual conference, USICH Policy Director...

Effective Community-Based Solutions to Encampments

Ending homelessness is about protecting and furthering human rights. Balancing health, safety, and community impact...

Chronic Survey 2012

Here's something on chronic homelessness.

HHS Releases 4 New Issue Briefs from Researchers on Chronic Homelessness

The Assistant Secretary for Policy and Evaluation (ASPE) at the Department of Health and Human...

Implementing a Community-Wide Supportive Housing Registry: UNITY of Greater New Orleans

After Hurricane Katrina, the City of New Orleans began to experience a large increase in...

The Chicago Housing for Health Partnership’s Approach to Housing and Health Care Integration

One of the challenges of serving individuals experiencing chronic homelessness is effectively integrating physical and...

Thought Leaders to USICH: How to Accelerate Progress on Chronic Homelessness

As a part of the April 2012 Council meeting on chronic homelessness, USICH sought input from...

Chronic Homelessness In Focus

On April 5, 2012, Department of Health and Human Services Secretary Kathleen Sebelius convened her first meeting...

People Experiencing Chronic Homelessness

Providing permanent supportive housing for people experiencing chronic homelessness is highly cost effective.  ...

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