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This blog was originally published on the Bill and Melinda Gates Foundation blog, Impatient Optimists.
By David Wertheimer
Twenty-five years ago, in the earlier years of the AIDS epidemic, health care and housing providers figured out that without housing, the health of people living with AIDS deteriorated far more rapidly than for those who had stable homes. AIDS Housing of Washington, now Building Changes, helped coin a critically important phrase that became a game changer in the fight against AIDS: “Housing is healthcare.”
A quarter century later the phrase still rings true, and has expanded meaning in the challenging work of ending homelessness for all people, including families, single adults, youth, and veterans.
The Bill & Melinda Gates Foundation recently hosted more than 100 state and local leaders in ending family homelessness together with health care leaders responsible for implementing the Affordable Care Act (ACA) and Medicaid expansion here in Washington State. As the health care system changes, the opportunities to integrate and improve the delivery of both housing and health services to families recovering from homelessness have the potential to be transformational.
What might this look like in practice? We can now envision and realize the possibilities, thanks to a 5-year, $65 million competitive federal grant for State Innovations in Medicaid secured by the Washington State Health Care Authority. In part, this grant offers the opportunity to think in new and innovative ways about “social determinants of health,” the broad set of conditions in which we live and work, at home and with our families, including the air we breathe and the water we drink, that play a more important role in promoting long-term health than medical interventions.
Health starts where we live, learn, work and play.
By Mayor Carolyn Goodman, Las Vegas
On June 2, I gathered with Councilman Ricki Barlow, the Executive Director of the U.S. Interagency Council on Homelessness, local mayors, non-profit and faith leaders, and three Federal Cabinet Secretaries from the Departments of Veterans Affairs, Housing and Urban Development, and Labor for the Mayors Challenge Forum at the World Market Center. It was an unprecedented showing of the power of the “we” that Las Vegas does so well. True grit, determination, and hard-held collaboration make the successes in Las Vegas something that, we hope, will change the coined phrase, “what happens in Vegas, stays in Vegas.” As Veterans Affairs Secretary Robert McDonald said in his speech, “we do not want what we have learned and what we have achieved in Las Vegas ‘to stay in Vegas.’ We want to share it with the nation.”
By USICH Executive Director Matthew Doherty, Labor Secretary Thomas Perez, VA Secretary Robert McDonald, and HUD Secretary Julián Castro
Five years ago, the Obama Administration set an ambitious goal: to end homelessness among Veterans by the end of 2015. Many scoffed; many continue to scoff. In the face of such skepticism, we remain optimistic and focused, and know this is an historic opportunity we must seize. Veteran homelessness is not a reality we have to accept.
On Monday, the four of us took this message on the road in a three-city swing to connect with communities committed to ending Veteran homelessness. In Houston, we joined Mayor Annise Parker at a rally celebrating the creation of a system in her community which ensures that all Veterans who need assistance will be quickly linked to the supportive services and permanent housing. The progress made in places like Houston, New Orleans, and Salt Lake City inspires us and provides models and strategies – like “Housing First” – for every community in the nation.
What we have been able to achieve in partnership with each other— joining forces with state and local governments, the business community and non-profits—is nothing short of amazing. In fact, between the 2010 rollout of Opening Doors – the first-ever federal strategic plan to prevent and end homelessness – and the January 2014 point-in-time homeless count, homelessness among Veterans nationwide has been slashed by one-third. This progress is a testament to what our nation can do when we set the bar high, invest resources and effort, and refuse to scale back our vision. It’s unacceptable that men and women who wore the uniform are returning without a safe, stable place to call home.
Now, it’s important to understand this doesn’t mean that no Veteran will ever face a housing crisis in the future. But it does mean that communities like Houston, New Orleans, and Salt Lake City are leading the way in building systems that will prevent and address homelessness whenever possible.
By Peter Nicewicz
The HUD-VASH program has been a vital tool in our national efforts to end Veteran homelessness and since 2008, has assisted over 90,000 Veterans experiencing homelessness by providing rental assistance with case management and clinical services. In order to help communities achieve the goal of ending homelessness by the end of this year, HUD and VA have worked to ensure the timely deployment of HUD-VASH vouchers. In April, HUD and VA announced over 9,300 new tenant-based HUD-VASH vouchers, for a total of 79,000 HUD-VASH vouchers now allocated to VA Medical Centers and Public Housing Agencies (PHAs) across the country.
Now it is up to partners at the community level, with Federal support, to put them to full use. Doing so requires communities to identify all eligible Veterans with high service needs, especially those experiencing chronic homelessness, and refer them to the HUD-VASH program. It entails engaging Veterans and helping HUD-VASH applicants through the voucher application and approval process. It entails PHAs quickly processing and issuing vouchers. It entails community partners assisting Veterans to find apartments that can be rented with the HUD-VASH voucher. And, it entails case managers providing ongoing service support so that Veterans receiving assistance through HUD-VASH can remain stably housed.
HUD’s Office of Public & Indian Housing recently published a letter highlighting strategies that PHAs can pursue to improve HUD-VASH voucher utilization. Although aimed at PHAs, all partners engaged in the community efforts to end Veteran homelessness, including Continuums of Care, VA Medical Centers, and other community partners, should understand these strategies and collaborate with their PHAs to advance their efforts of ending Veteran homelessness.
06/04/2015 - The Connecticut Head Start-Family Shelter Partnership: Working Together to Meet the Needs of Families and Children
By Grace Whitney, Jamie Peterson, and Susan Compton Agamy
Surprisingly, we are more likely to find ourselves in a homeless shelter at age one that at any other age in our lives. [2012 AHAR (HUD, 2012) and Census Data] This remains true through age five. Half of all children in family shelters are age five or younger. In order to address this, Head Start and family shelters in Connecticut have come together to combine resources so that they can better meet the particular needs of pregnant women, infants, toddlers, preschoolers, and their families.
Through a partnership that has included the Head Start State Collaboration Office (HSSCO), the state’s HUD agency, which was formerly the Department of Social Services and is now the Department of Housing, and the state’s networks of local Head Start and shelter agencies, ongoing discussions are taking place to identify opportunities to align policies and practices that can overcome the shared challenge of serving this population of families.
The goals of the effort have been simple:
- increase enrollment in Head Start,
- make family shelters more child-friendly, and
- penetrate one another’s local networks and councils to bring the children’s voice to the housing community and the housing voice to the early childhood community.
On any given night, we know that nearly 85,000 Americans with disabling health conditions who have experienced homelessness for long periods of time—some for years or decades—can be found sleeping on our streets, in shelters, or other places not meant for human habitation. These men and women experiencing chronic homelessness commonly have a combination of mental health problems, substance use disorders, and medical conditions that worsen over time and too often lead to an early death.
Without connections to the right types of care, people who are experiencing chronic homelessness cycle in and out of hospital emergency departments and inpatient beds, detox programs, jails, prisons, and psychiatric institutions—all at high public expense. Some studies have found that leaving a person to remain chronically homeless costs taxpayers as much as $30,000 to $50,000 per year.
By Coco Auerswald
On Wednesday, April 29, I had the honor of representing our We Count, California! team at two historic events in Washington, DC—a Senate hearing and a White House briefing—both focused on the Administration’s goal of ending youth homelessness by 2020. Across the board, I heard a clear message that youth counts matter.
This day of unprecedented attention to the need to end youth homelessness was inspiring but came with a sober recognition that we have a good way to go to meet our goal. The importance of better data regarding youth—upon which an adequate plan is to be built—was a recurring theme throughout the day. From Senator Dianne Feinstein's remarks to statements by Jennifer Ho of HUD and USICH Executive Director Matthew Doherty, there was a consistent recognition during both events that current counts underestimate the actual scope of youth homelessness.
05/13/2015 - Public Housing Authorities and Continuums of Care: Establishing and Maintaining Powerful Teams in the Effort to End Homelessness
By Kiley Gosselin
Although they have long been assisting families and individuals experiencing homelessness, more and more public housing authorities (PHAs) are emerging as heroes in the fight to end homelessness –making housing those experiencing homelessness a formal focus of their efforts, often overcoming regulatory hurdles and limited resources. In many communities from Houston to Asheville, contributions from PHAs are helping to reduce the number of individuals and families experiencing homelessness. Given the scale of PHA resources, even smaller and incremental contributions of vouchers and housing units by PHAs, especially when combined with the resources of Continuums of Care (CoCs), can have a big impact on homelessness.
While some PHAs already have strong partnerships with local CoCs, others are just beginning. HUD and USICH have long promoted the idea that strong CoC and PHA relationships are critical to our efforts to end homelessness across populations. In an effort to assist communities in building these relationships, HUD, in concert with USICH, recently produced a set of two documents. The first, CoC and PHA Collaboration: Strategies for CoCs to Start the Partnership Conversation provides some preliminary strategies and tips for starting or improving the conversation between CoCs and their local PHAs. The second, entitled, The Business Case for Partnering with Public Housing Agencies to Serve People Who Are Homeless is designed to help PHAs and CoCs understand the ways their partnerships can benefit a community’s overall efforts to end homelessness from a business perspective.
By Luke Tate
No young person should lack a stable and safe home, or be without a caring adult they can count on. Too many of America’s youth have been robbed of that essential foundation — and thanks to the extraordinary work of practitioners and volunteers across the country, we are learning what it takes to reestablish that footing and end youth homelessness nationwide.
In 2012, the U.S. Interagency Council on Homelessness (USICH) issued the Framework to End Youth Homelessness detailing the steps necessary to achieve the goal of ending youth homelessness by 2020, and strategies to improve outcomes for children and youth experiencing homelessness. This framework articulates the need for government, non-profit, civic, and faith community partners to focus together on the overall well-being of youth experiencing homelessness — addressing not just their need for stable housing, but also their educational and employment goals, and the importance of permanent adult connections in their lives.
By Richard Cho
Five years since the passage of the Affordable Care Act, many of the major objectives of the law are being met; more than 16 million Americans have gained health coverage, bringing the number of people without insurance down to historic lows. Included in the newly insured are approximately six million of the lowest income Americans, who have gained access to public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). And while the data is limited on the specific number of people experiencing homelessness who have gained coverage, we have numerous reports that enrollment in Medicaid and other types of health insurance among people experiencing homelessness has grown significantly. With so many people now able to access health care coverage, the results are in: the Affordable Care Act is working.
Of course, increasing access to health coverage is only one objective of the law. The other major objective is to shift the focus of health care away from procedures and treatments and towards the overall quality of care and people’s health outcomes. For people who experience homelessness, we know that having stable housing is essential to health. Stable housing not only has direct benefits on health—reducing exposure to high-risk behaviors and the negative effects of life on the streets—but it also creates a platform for better care. Thus, for people experiencing homelessness, the ultimate measure of whether or not the Affordable Care Act is working may be the degree to which it can incentivize the health care system to address housing needs as a foundation for better health.