People Experiencing Chronic Homelessness

What is Chronic Homelessness?

Among people experiencing homelessness, there is a subset of individuals with disabling health and behavioral health conditions who experience homelessness for long periods and/or in repeated episodes over many years—people experiencing chronic homelessness.  The combination of challenges faced by individuals and families experiencing chronic homelessness includes complex health conditions, poor access to coordinated care services, prolonged time living on the streets, in shelters, and in and out of institutional settings, leads to worsening health conditions, premature mortality, and represents costs to the public that do not result in a decrease in homelessness.  Studies have found that people experiencing chronic homelessness cost the public between $30,000 and $50,000 per person per year through their repeated use of emergency rooms, hospitals, jails, psychiatric centers, detox and other crisis services – the  use of which make little improvements to their health and well-being. Given the cost it bears in human lives and public dollars, ending chronic homelessness is a moral and fiscal imperative.  

Permanent Supportive Housing: The Cost Effective Solution

The solution to chronic homelessness is an intervention known as permanent supportive housing, which combines affordable housing and a tailored package of supportive services that help people achieve housing stability, connection to care, and improved health and social outcomes.  Study after study has shown that permanent supportive housing not only ends homelessness for people with the most severe challenges, but also results in reduced use of emergency services and lowered public costs.  Some studies have even found that permanent supportive housing pays for itself or results in cost savings by breaking the cycle of hospital and jail use.  

Achieving an End to Chronic Homelessness

Since the launch of Opening Doors in 2010, the number of people experiencing chronic homelessness has declined by 21 percent. The Obama administration has set the goal to end chronic homelessness before the end of 2016. 

To achieve this goal, the Administration has been working to bring the supply of permanent supportive housing to scale. This permanent supportive housing supply is necessary to help every person currently experiencing chronic homelessness quickly exit homelessness and to ensure that no person with disabling chronic conditions has to experience chronic homelessness.  

The President made annual requests to Congress for the resources needed to achieve this goal, but Congress has not funded these requests.  As a result, we are not on track to achieve this goal by 2015. An interagency working group on ending chronic homelessness led by HUD and USICH and represented by eleven Federal agencies has developed a strategy that would make it possible to end chronic homelessness in 2016, just one year later than originally planned.  This strategy involves five components:

  1. Direct existing targeted homeless programs (e.g. Continuum of Care Programs) and leverage mainstream resources (e.g. Housing Choice Vouchers, Medicaid, and mental health and substance abuse block grants) to expand permanent supportive housing.
  2. Ensure that communities are targeting their new and existing permanent supportive housing to people experiencing chronic homelessness, prioritizing those with the most severe challenges for assistance.
  3. Connect permanent supportive housing to street outreach, shelter, and institutional "in-reach" that can identify and engage people experiencing chronic homelessness.
  4. Lower barriers to housing entry through community-wide adoption of Housing First.
  5. Request $301 million in additional resources from Congress in FY 2015 to create 37,000 new units of permanent supportive housing.

Use existing targeted and mainstream resources to create permanent supportive housing 

Through incentives in its Continuum of Care (CoC) Program competition, HUD encourages CoCs to reallocate existing funds towards new permanent supportive housing.  HUD and USICH have also been engaging public housing authorities to leverage project-base Housing Choice Vouchers and implement admissions preferences to create permanent supportive housing.  In addition, through its Cooperative Agreement for the Benefit of Homeless Individuals (CABHI)-States grant program and its Policy Academy on Chronic Homelessness, SAMHSA has been encouraging States to use Medicaid and behavioral health grants to finance services in supportive housing.  Forthcoming guidance from HHS will provide useful information to States on how to cover permanent supportive housing services under Medicaid.

Ensure targeting and prioritization of people experiencing chronic homelessness 

Incentives in HUD's CoC Program competition encourage communities to prioritize people experiencing chronic homelessness using 85 percent of their existing permanent supportive housing, starting with those with the most severe service needs.  HUD issued guidance to communities on how to implement prioritization.  Coordinated entry systems are also enabling communities to make the process for connecting people experiencing chronic homelessness to permanent supportive housing easier and more person-centered.

Connect permanent supportive housing to collaborative outreach and in-reach 

People experiencing chronic homelessness have some of the most severe service needs, but are often the least able or likely to seek help.  The success of permanent supportive housing is fully realized when it is connected to a systematic approach for identifying, engaging, and facilitating housing placement for people experiencing chronic homelessness.  This includes street outreach and shelter "in-reach" efforts that proactively engage and identify people experiencing chronic homelessness.  Outreach efforts including those funded through SAMHSA's PATH program and HUD's Emergency Solutions Grants must be coordinated, reducing duplication of efforts, and ensuring full community coverage.  "In reach" into shelters and collaboration with institutional settings like hospitals and jails can maximize the chances of identifying and engaging people experiencing chronic homelessness.  Innovative data-driven strategies like data matching between HMIS and health care or jail data can help ensure that the people with the highest needs are reached.  

Lower barriers to entry through Housing First adoption 

Chronic homelessness cannot be ended if people with the highest needs are excluded from or screened out of housing.  Research shows that people can achieve housing stability regardless of their time spent experiencing homelessness, experience with mental health or substance abuse, past income and credit history, or prior housing or criminal history, especially when supportive services are in place to help people with these barriers.  Communities can adopt a Housing First approach in their permanent supportive housing, as well as at a community-wide level.  USICH's Housing First Checklist can help communities identify what steps are needed to adopt Housing First.  HUD's brief on Housing First provides more information on how to implement Housing First in permanent supportive housing.

Expand permanent supportive housing through $301 million in new Congressional appropriations 

Improved targeting and use of existing resources will help bend the curve on chronic homelessness. However, even the most efficient use of existing resources will not create permanent supportive housing at a scale needed to achieve an end to chronic homelessness. Careful evaluation identified that there is a gap of 37,000 permanent supportive units nationally.  Additional resources are needed to create this additional permanent supportive housing.  The President's FY 2015 Budget requests an increase of $301 million in HUD's Homeless Assistance Grants to create these units.  If funded, HUD would deploy these resources through a special competition for permanent supportive housing, awarding resources to communities that have unmet needs and who are targeting and maximizing existing resources.  With these resources, we will be able to achieve an end to chronic homelessness in 2016.  However, if Congress does not provide these resources, there is a strong likelihood that the goal of ending chronic homelessness will need to be delayed yet again.  

Additional Resources

Partnerships for Opening Doors – Ending Homelessness through Meaningful and Sustainable Employment

Building Momentum to Abolish Criminalization of Homelessness

Your Reallocation Questions Answered, USICH Releases Reallocation Tool

Partnering with Landlords to End Homelessness

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

What is Chronic Homelessness? Among people experiencing homelessness, there is a subset of individuals with...

// Crazy Egg // MouseFlow // Google Analytics // HEAP DEMO