Chronic Homelessness In Focus

Chronic Homelessness In Focus

On April 5, 2012, Department of Health and Human Services Secretary Kathleen Sebelius convened her first meeting as Chair of the U.S. Interagency Council on Homelessness. The meeting was hosted at the Department of Housing and Urban Development and focused on the national effort to end chronic homelessness by 2015. Secretary Sebelius was joined by Department of Veterans Affairs Secretary and Vice Chair of USICH Eric Shinseki, Department of Housing and Urban Development Secretary Shaun Donovan, Department of Labor Secretary Hilda Solis, and representatives from all member agencies. The Council met to review progress and challenges towards the goal of ending chronic homelessness.

Based on HUD’s 2011 Point-in-Time estimates for chronic homelessness, there was a 2.4 percent decline in the number of individuals experiencing chronic homelessness (to 107,148 individuals). The count may not be the most accurate estimate of the incidence of chronic homelessness because of the methods used to determine chronicity. This is because determining whether someone meets the chronic definition requires an interview that is much more difficult to obtain among the unsheltered population during a count. Many, perhaps most, communities conduct their unsheltered counts late at night to better distinguish individuals living on the street from those who are in transit. The tradeoff is that many individuals are sleeping at the time the count is conducted, and volunteers in many communities are specifically instructed not to wake people out of respect so an interview cannot be conducted. As a result, many communities rely on sampling techniques and data extrapolation to get estimates of chronic homelessness.

The Council received a briefing from USICH staff that analyzed data from HUD, VA, and the field to understand factors influencing the slowed decline in chronic homelessness and determine strategies to bend the curve to achieve the 2015 goal. The Council also heard from three thought leaders in the field: President and CEO of the Corporation for Supportive Housing (CSH) Deborah De Santis, President of Community Solutions Rosanne Hagerty, and President and CEO of the Center for Health Care Strategies, Inc. Stephen Somers. They  presented recommendations about important steps that are needed, which included using a multi-sector approach to housing the most vulnerable, targeting resources for those most in need, and ensuring that communities are using front door solutions in the mental health and prison systems to prevent the cycle of chronic homelessness.

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 systems such as jails and emergency rooms.  This growing body of research has helped motivate significant federal and local investments in permanent supportive housing, increasing the national inventory by 40 percent—or approximately 57,000 units—over the last five years. 

To better understand the relationship between permanent supportive housing and chronic homelessness, changes in each community’s permanent supportive housing inventory were compared to changes in the number of people who experienced chronic homelessness in that community. There was a statistically insignificant relationship between increases in communities’ permanent supportive housing inventory and decreases in the number of people experiencing chronic homelessness. However, a significant association was found between increases in permanent supportive housing units for individuals and decreases in the number of sheltered individuals experiencing chronic homelessness.

Based on these findings, three key factors may be influencing the nation’s progress on chronic homelessness: targeting, geographic distribution of resources, and the changing dynamics of the chronic population.

1. Targeting

The first factor is the degree to which communities are effectively targeting their permanent supportive housing units to individuals and families experiencing chronic homelessness (as opposed to other homeless populations).  As of 2011, only one-third of the country’s permanent supportive housing units were occupied by persons experiencing chronic homelessness.  

2. The geographic distribution of resources

Just as homelessness itself is concentrated, so is chronic homelessness.  Six states (California, Texas, Florida, New York, Georgia, and Louisiana) are home to nearly 60 percent of the chronically homeless population, with approximately one-third in California alone.  However, the nation’s permanent supportive housing inventory is distributed fairly evenly across the United States.  Federal funding is distributed based on factors other than chronic homelessness.  In addition, many state and local governments in regions with the highest homeless prevalence appear to be underinvesting in housing and services, which further hinders progress on developing an adequate supply of permanent supportive housing.

3. The dynamics of chronic homelessness

The population experiencing chronic homelessness appears to be much more dynamic than previously assumed, and the current methodology for gathering data on this population presents challenges for obtaining an accurate count.  Recent research on chronic homelessness in Philadelphia suggests that between 60 and 70 percent of all persons experiencing chronic homelessness meet the definition via episodes (as opposed to being homeless continuously for one year or longer).  This means that the Point-in-Time count likely misses a sizable portion of the chronically homeless population that is between episodes on the night of the count.

In addition, there appears to be a significant inflow of new people experiencing chronic homelessness into the system each year. Though communities may actually be making progress on housing individuals experiencing chronic homelessness, the chronic homelessness population is not the static population it was once believed it to be— USICH examined state prison and mental health data to determine if state funding cuts may be contributing to an increase in individuals experiencing chronic homelessness.  Preliminary findings suggest there is cause for concern – especially when the largest cuts in mental health funding and largest release of prisoners in the next five years are in geographic areas already struggling with a concentration of chronic homelessness. The inflow problem points to the need for more interventions at the “front door” for individuals who are at a higher risk of falling into episodes of chronic homelessness, in addition to developing more units of permanent supportive housing.

USICH’s review of existing administrative data and the expert briefs provided several insights concerning the challenges and opportunities that lie before us in our pursuit to end chronic homelessness. One of the more pressing issues is the evidence of a cohort of individuals experiencing chronic homelessness born between 1954 – 1966. As this cohort ages, their health will continue to decline at a rate hastened by life on the streets. Without additional investment in permanent housing solutions for this population, it is likely that this group will incur large costs to the public health care system and they are at a high risk of dying on the streets. However, several questions remain that will require further study.  Because time is short and the situation urgent for the tens of thousands of Americans experiencing chronic homelessness each day, it will be imperative that all parties take immediate action where possible while also remaining focused on continuing to build our knowledge about the scope and dynamics of chronic homelessness.

The presentation of this analysis of chronic homelessness and statements from experts at the Council meeting resulted in a robust discussion of interagency work that can accelerate progress towards the goal of ending chronic homelessness by 2015. The Council charged itself with working within their own agencies and in partnership to determine areas for federal policy improvement and creation of resources for those in the field.

Read Issue Briefs from Four Thought Leaders on Chronic Homelessness

Program Profile, Integrated Housing and Health Care: Chicago Housing for Health Partnership 

Program Profile, Implementing a Supportive Housing Registry: UNITY of Greater New Orleans 

Read Research Briefs from HHS on Chronic Homelessness