How Partnerships Outside of HUD Address Homelessness
Partnerships to develop affordable housing often include HUD funding. Recently, however, institutions such as hospitals and local governments have been working outside of HUD and taking more active roles in addressing homelessness. Last February, the National Alliance to End Homelessness hosted the conference, Solutions for Individual Homeless Adults. One panel, “Innovations in Housing: Working Outside of HUD to Create New Opportunities,” explored alternative investment strategies to help alleviate issues connected with homelessness in Chicago, Portland, and the state of California. Stephen Brown, director of preventive emergency medicine at the University of Illinois Hospital and Health Sciences System (UI Health); Sean Hubert, chief housing and strategy officer at Central City Concern; and Lahela Mattox, local government liaison and acting grant manager at the Homeless Coordinating and Financing Council, joined moderator Kendall Stagg, director of community health at Kaiser Permanente, to discuss this emerging topic.
Health Care and Housing
Looking at emergency room visits in cities with large homeless populations, Brown reported that the small number of chronically homeless people account for a disproportionate share of healthcare costs due to their numerous emergency room visits and high readmission rates. In Chicago, the Center for Housing and Health partnered with UI Health, which committed $250,000, to launch Better Health Through Housing (BHTH), an initiative to reduce healthcare costs and provide stable housing for those experiencing chronic homelessness. Using a Housing First approach, BHTH transitions individuals directly from hospitals into supportive units with intensive care management. The initiative’s network of approximately 4,000 scattered-site units across Chicago also allows program participants to choose where they want to live. To date, BHTH has transitioned 47 individuals into permanent supportive housing. In addition, in the first cohort studied, Brown reported that between 2015 to 2017, the 26 participants cut their medical costs by 21 percent (67 percent if one terminally ill outlier is excluded) and reduced their emergency department visits by 67 percent.
Taking a similar Housing First approach in Portland, Oregon, the Housing Is Health initiative, launched by nonprofit Central City Concern, used a $21.5 million donation from six different health systems to create 380 units along with a new health center. Central City Concern conducted a study of the city to determine which neighborhoods had the greatest need. They then located three housing projects in the areas that struggled the most with homelessness, with specific goals designed for each neighborhood. According to Hubert, the program’s person-centered and population-driven design created services and housing options that target the varying needs of different populations. Hubert also argued that because of the recent decline in federal investment in low-income housing, local actors need to take more responsibility for addressing the issues of homelessness and the lack of affordable housing.
Public-Sector Programs Address Homelessness in California
The state of California is making strides in its efforts to help communities address the issue of homelessness. California is home to nearly a quarter of the nation’s population of individuals experiencing homelessness and the largest number of unaccompanied youths, veterans, and other individuals experiencing chronic homelessness. Because the problem is so acute, and because a lack of shelter is expensive for communities, Mattox argued that states need more than just federal funds to alleviate the crisis. In 2016, the state legislature passed Senate Bill (SB) 1380, which required the state to implement a Housing First policy for all programs that provide services to individuals experiencing homelessness. SB 1380 also established the Homeless Coordinating and Financing Council to supervise the Housing First elements of state programs. Furthermore, in 2018 voters approved the No Place Like Home Program, which provided $2 billion to fund permanent supportive housing for individuals with a mental illness who are experiencing chronic homelessness.
In 2017, homelessness in California increased by 14 percent from the previous year, which forced cities to use additional funds to fight homelessness. However, despite their best efforts, the crisis required more attention and funding. In 2018, the state legislature passed SB 850, establishing the Homeless Emergency Aid Program (HEAP) to provide localities with a one-time flexible block grant to address immediate homelessness challenges. Eligible HEAP applicants include the state’s 11 largest cities and the 43 Continuums of Care. Mattox reported that as of January 31, 2019, all 11 cities and 43 Continuums of Care were awarded HEAP funds. By February 19, more than $400 million of the $500 million total HEAP funds had been allocated.
For many cities and states, tackling the homelessness crisis requires the creation of new partnerships, investment strategies, and funding sources that go beyond federal funding. All three panelists reported that building strong partnerships is a critical step toward being able to successfully implement new programs. Brown suggested that the public sector and healthcare groups need more alignment and coordination. Hubert and Mattox added that after these groups form relationships, the involved parties must come to a shared understanding. Finding common ground is especially crucial when partners from different fields, such as the healthcare and housing industries, bring different professional competencies and assumptions to the table. Creating a common language can help streamline discussions and allow both sides to better understand one another. Finally, partnerships need to be taken seriously, and all partners must provide continued support and assistance to ensure that program performance is maintained.