As our understanding of homelessness has evolved, we have come to recognize chronic homelessness as a relatively small and “solvable” problem that affects, on average, about 10 to 15 percent of people who experience homelessness. This vulnerable population of people with disabilities is composed primarily of adults living on their own, who either experience homelessness for prolonged periods of time or have repeat episodes of homelessness. Chronic homelessness, in addition to being extremely debilitating to those who experience it, can be very expensive to homeless systems and public systems, including health care and criminal justice.
Between 2007 and 2017, the number of people experiencing chronic homelessness on a single night fell by 27.4 percent, compared with a 14.5 percent reduction in homelessness overall. This decline coincided with a national, bipartisan commitment to increase investment and capacity to serve people experiencing chronic homelessness. Since 2007, the number of permanent supportive housing (PSH) beds dedicated to people experiencing chronic homelessness nearly quadrupled, from 37,807 to 149,005. Efforts to target PSH to the most vulnerable people and to prioritize chronic homelessness in programmatic and policy responses also intensified, and randomized-controlled trials have demonstrated that PSH keeps people with behavioral health issues from returning to homelessness.
Providing permanent affordable housing to individuals with chronic patterns of homelessness has alsoproven to significantly reduce use of expensive acute care services such as emergency shelters, hospital emergency rooms, and detoxification and sobering centers. As a result, PSH can lead to substantial savingsand, among the heaviest service users, may even be a cost-neutral investment, with the cost of housing subsidies and services offset by reductions in other spending for public services.
What are the implications for policymakers and practitioners?
From the available evidence, we can draw some clear lessons for policy and practice:
- Coordinated entry and assessment can be used to differentiate the majority of people experiencing an acute housing crisis from the minority experiencing chronic homelessness, and to refer each group to the appropriate interventions. Accurate identification of those who are most likely to develop chronic patterns of homelessness in the future, in order to provide services to preempt this shift, is not feasible at this time.
- Treatment and care for people experiencing chronic homelessness should be the primary motivators for any intervention. However, communities that are also hoping to realize cost savings by addressing chronic homelessness will limit savings potential if they only focus on those who are already high-cost users of crisis response systems. Practitioners should consider referring all adults who are homeless with disabilities to rapid re-housing, with the option to transition to PSH as continuing need is revealed, consistent with a Progressive Engagement approach (i.e., initially providing a small amount of assistance to resolve a housing crisis, and then additional assistance as needed after individual assessment).
- Among the current population of people experiencing chronic homelessness, PSH is still the best fit, possibly with rapid re-housing as a bridge.
- As individuals with chronic patterns age, they will need more medical services and assistance with activities of daily living rather than behavioral health services. Symptoms of severe mental illness or substance abuse may become less acute, but people develop other severe chronic health conditions.
- Scalable interventions should be part of the solution, including aggressive enrollment in SSI and shallow rent subsidies when PSH is not available.