By Tom Peterson
One day in 1967 John van Hengel saw a mother of 10 rummaging for food behind a Phoenix, Arizona, grocery store. Wanting to help people like her, he found a way to get to hungry people the food that could no longer be sold. In doing this, he started St. Mary’s, the world’s first food bank. The model he created worked and others copied it. A decade later food banks had spread to 18 cities. They proliferated in the 1980s in response to the need created by deep cuts in the social safety net. Today the largest network, Feeding America, serves 46 million people a year through food banks in more than 200 cities.
Like food banks (or libraries, dog parks, or hospitals) many community institutions we now take for granted started somewhere as an idea — a response to a need — that became a physical reality. And because they solved a need in one community they soon spread.
Now, a new model called Housing First or Permanent Supportive Housing is spreading from city to city. Like the food banks, this model has its pioneers, beginning in the late eighties and early nineties by people like Tanya Tull in Los Angeles and Sam Tsemberis in New York City. And like the food banks, because the model is proving in city after city to work, it’s rapidly growing.
The basic idea is that by getting the chronically homeless people into permanent housing first and providing them with basic services, their outcomes are dramatically improved and the model saves the community funds. Housing approaches are not all the same. In some communities the housing units are scattered throughout the community while in others units in one building.
Permanent supportive housing
In dozens of cities — such as Orlando, Charlotte, Denver, Chicago and San Francisco — hospitals are joining with others to develop permanent supportive homes. This approach appears to have the greatest impact. It usually means placing individuals in efficiency apartments and connecting them with wrap-around supportive services. The National Alliance to End Homelessness calls this a proven effective alternative “in reducing chronic homelessness, as well as public health care costs.”
Here’s a small sampling:
√ Augusta, Georgia
The VA hospital and nonprofits in Augusta are currently retrofitting three historic buildings to create 98 units for homeless veterans and their families. The center is on a bus route, within walking distance of a grocery store and the hospital. Homeless veterans coordinator Mary Cunningham told the Augusta Chronicle “A lot of low-income veterans don’t have transportation so anywhere in a city like Augusta where you can step outside your door and be able to catch the bus is an asset.” She anticipates that the program will also create “a good sense of community.”
Community First Village has the feel of an upscale KOA campground in the Texas Hill Country. Eight miles east of downtown (and just outside the city limits, avoiding NIMBY issues) it’s a 27-acre master-planned community. The Village expects by year’s end to place around 200 chronic homeless people in 120 micro-homes, 20 “canvas-sided cottages” and 100 RVs. To get the right people at the right growth rate the group is intentionally going slow. The Village also bought the property next door where they hope to house an additional 350 people. While the homes don’t have running water, they have microwaves and small refrigerators and all are near community kitchens, restrooms and showers.
Besides the houses, the Village has many amenities: a city bus stop, WiFi, places to worship and gather. An artistically decorated coop is a nicer shelter for chickens than many of the residents have known in recent years. There are walking trails, a small market sells food and crafts made by residents and free weekly movies at an outdoor theatre. Go out on a Saturday and you’ll see dozens of volunteers — from church groups to Eagle Scouts — working alongside residents on a new house or in community gardens.
Recognizing that seven of its top 10 recurring patients were chronically homeless people the University of Illinois Hospital in Chicago is testing a Housing First program for 20 individuals. The hospital’s Stephen Brown told SJNN Chicago that these patients were “very, very expensive. Their health care costs are five to 15 times what the average patient costs… They’re both sick and they’re also accessing the ER for what we call secondary gain — it’s warm, they can get a sandwich, they’re there to sleep during the night.”
Lloyd Pendleton, director of Utah’s Homeless Task Force, learned about Housing First when he heard Sam Tsembiris at a conference in 2003. A conservative, Pendleton was impressed by reports of cost savings from the approach. So he left the conference and decided to try it back home. “As I flew out and we flew through the clouds, I can remember looking out at the clouds and saying, Lloyd, if there’s any state in the Union that can accomplish this, it’s the state of Utah,” Pendleton told NPR.
They started with a pilot, housing 17 chronically homeless people. After 22 months they were all still in their homes. “So political people became believers because it worked in Salt Lake City,” Pendleton said in the report. “That then gave us the courage, the moral impetus, the political will to go forth and build that hundred units, the next year, 84 units, the next year, 201 units, the next year, 110 units and then another 59 units.”
Today men and women who may have spent decades on the streets may live their own apartment in a former Holiday Inn. They pay either one-third of their monthly income or $50, whichever is more. In 2005 the state of Utah set a goal to house all of its chronically homeless people by 2015. By 2015 they had reduced that population by 91 percent, from 2,000 to 200. (There are still 14,000 non-chronic homeless in the state.)
The HousingWorks program in Charlotte offers several home options chronically homeless: “at Moore Place, an 85-unit apartment building…, in Scattered Site apartments (90 units), and in MeckFUSE, a partnership with Mecklenburg County providing an additional 45 community-based apartments.” Its partners include Novant Health and Salisbury VA Medical Center.
Hospitals engaging in housing first initiatives are no longer stabbing in the dark. The spread of health system/permanent supportive housing programs follows mounting evidence of their success. A recent article in Hospitals & Health Networks:
A growing body of research, in fact, suggests that the benefits of housing programs for the health care system might be substantial. Researchers at Yale University’s Global Health Leadership Institute evaluated and summarized the results of several studies in the area in their report “Leveraging the Social Determinants of Health: What Works?”
• A “housing first” program in Seattle found that the median per person, per month cost of incarceration, emergency medical services, hospital-based medical services, detoxification and other publicly funded programs fell from $4,066 to $958 after 12 months in housing. This added up to annual net savings — after accounting for housing costs — of $29,388 per person compared with a control group.
• A Massachusetts initiative that targeted homeless people with serious mental illness reduced the average number of hospital days per client from 102 to seven within two years after housing placement. That reduced hospital costs by about $18 million per year overall.
• A Los Angeles program that serves homeless patients with the highest public services and hospital costs documented that every $1 invested in housing and support reduced public and hospital costs by $2 the following year and $6 in subsequent years.
Hospitals Housing First Combo: A wheel that may not need to be reinvented
Health systems run the data from their electronic medical records. They notice the disproportionate number of visits from people whose addresses are homeless shelters and services. The frequent visits indicate that health needs may not be met. The costs raise the question of effectiveness.
Sometimes the wheel you need has already been invented. Sometimes what’s needed in your town is what’s working in a town down the road. Just borrow the proven idea and adjust it to fit your particular needs.
Photos: Austin, T. Peterson; Charlotte, Urban Ministry Center.