Seeking a Home Remedy

Grant makers, federal agencies focus on ‘chronic homelessness’

The one-bedroom apartment in an unassuming housing complex outside Columbus, Ohio, is modest, but to its

43-year-old occupant, the space marks his entry into a brave new world.

“I’ve never lived on my own before,” says Daston, who asked to be identified by his first name only. “This is all new to me.”

Before moving in a year ago, Daston’s address has often been a state prison, where drug charges have sent him several times. Other times he had no address at all.

“I was what you call a front-porch homeless person,” says Daston, who has a mental disability that brings on depression and paranoia — both made worse by drug and alcohol abuse. “I would sleep on my family’s front porch, or in a car, coming and going before they’d wake up.”

Years of Drifting

Housing advocates and the federal government have another name for Daston’s way of life: chronic homelessness. At any given time, 150,000 people nationwide are on the streets after years of drifting from shelters to hospitals and sometimes, like Daston, to prison.

The chronically homeless are a tough group to help, and an expensive group to ignore. Research shows that they use a disproportionate amount of social services, such as beds at shelters and soup-kitchen meals, and heavily burden public health-care systems. Such studies, combined with promising results from some innovative programs, have prompted many advocates for the homeless to zero in on this population.

Last fall, nine foundations — including the Rockefeller and Robert Wood Johnson Foundations — contributed $37-million toward ending long-term homelessness by 2014. The Bush administration has also been steering a growing share of housing dollars to help such people and has pledged to end chronic homelessness as well. It created the Collaborative Initiative on Chronic Homelessness in 2003, which has distributed $35-million pooled from three agencies (Housing and Urban Development, Health and Human Services, and the Veterans Administration).

Supporters of the focus on the chronically homeless say that unless such people get help, homelessness will never disappear. They say that while people have always been homeless, it has only been in the last 20 years or so that it has become a burgeoning social problem.

Some housing advocates, however, worry that the move dangerously divides the homeless population, as by design it only focuses on adult singles and ignores the swelling ranks of homeless families and children. Social-service organizations in rural and suburban areas say it also puts too much emphasis on urban problems. The endgame, they say, should be ending homelessness for everyone.

Services on the Side

Most of the efforts to help the chronically homeless center on so-called supportive housing, which gives the homeless not just low-cost apartments, but also health care and social services.

Daston’s rent, for example, is paid largely by the Community Shelter Board, a Columbus nonprofit organization that coordinates the city’s homelessness programs. The charity received a $3.3-million federal grant last year. In addition to getting a roof over his head, Daston receives medication and weekly therapy. And he is now taking computer classes, reconnecting with his children, and looking for a job.

“I’m rebuilding my life,” Daston says. “My five-year plan now is go to school so I can learn to help others.”

While recovery from extended homelessness makes for heartwarming stories, housing advocates say that cost savings, not just concern for the welfare of others, is behind the push to end chronic homelessness.

“What is being discovered across the country is that the costs associated with a homeless population randomly ricocheting across systems may be more expensive than providing them with housing and all the support services that they need to end their homelessness,” says Philip Mangano, executive director of the Interagency Council on Homelessness, in Washington, which coordinates homelessness efforts of 20 federal agencies. “The cost-benefit analysis is driving political will in our country now.”

Pivotal to this conclusion is a 1998 study by a professor at the University of Pennsylvania School of Social Policy and Practice. Dennis Culhane analyzed shelter usage over two years by adults in New York and Philadelphia. The data showed that while the bulk of the shelter residents came and went rather quickly, about 10 percent of them — which Mr. Culhane called the “chronic homeless” — made extended use of shelter space, to the point of using 50 percent of the shelter’s resources over time.

“Half of the shelter system was inappropriately functioning as permanent housing,” Mr. Culhane says.

Mr. Culhane and other researchers next studied the expenses that governments incur when helping 10,000 mentally ill New Yorkers, half of whom where in supportive housing programs that cost, on average, slightly more than $17,000 a year. The other half were homeless and on their own.

After tallying costs for such things as shelters, hospitals, jails, inpatient psychiatric services, and Medicaid assistance, the researchers found that those in supportive housing required an average of $16,282 a year less in other charity and government services than did the homeless group. The savings were all but enough to offset the cost of the supportive housing.

Lobbying Efforts

Armed with such research, housing advocates have been lobbying for increased spending on supportive housing. Mr. Mangano, for example, spends much of his time traveling the country encouraging states, counties, and cities to develop their own 10-year plans to end chronic homelessness. The U.S. Conference of Mayors endorsed the idea in 2003, and nearly 200 local plans have been created.

“The chronic-homeless initiative refocuses us on that original population that we were responding to at the beginning of the contemporary response to homelessness,” Mr. Mangano says, noting that some of the first homeless people to emerge in numbers were mentally ill people who had been ejected from psychiatric hospitals in the 1960s and ‘70s. When homelessness swelled in the 1980s, he says, those “hardest to serve got passed over by the homelessness bureaucracy.”

The U.S. Department of Housing and Urban Development defines chronic homelessness as a single adult with a disabling condition who has either been continuously homeless for a year or more or has had at least four episodes of homelessness in the past three years. (A “disabling condition” can be a substance-use disorder, a mental illness, or a physical illness or disability.)

Through its Collaborative Initiative on Chronic Homelessness, the federal government is paying for supportive housing for 544 chronically homeless men and women in 11 cities. Mr. Mangano says this group cumulatively represents some 3,500 years of homelessness.

Divisions

Opponents of the federal efforts to end chronic homelessness don’t complain about who is being helped. The problem, they say, is who is not: families and children, excluded by definition from being considered chronically homeless. Families represent as much as 40 percent of the homeless population, and some do struggle with disability and experience long periods of homelessness.

“We don’t support the chronic-homelessness initiatives mainly because we don’t support placing certain individuals over others,” says Michael Stoops, acting executive director of the Coalition for the Homeless, a Washington group that represents 200 advocacy groups nationwide. “We want to end homelessness for all people, not just a targeted group.”

Adds Brad Paul, executive director of the National Policy and Advocacy Council on Homelessness, in Washington: “It pits desperate populations against each other in that some groups have been deemed more worthy of needing resources than others.”

Advocates have had trouble getting policy makers to focus on families, in part because little comprehensive data are available to show what they need. Mr. Culhane and others are currently studying homeless families, but it will take time until their conclusions are ready.

“Perhaps we haven’t articulated the solutions for other homeless people as clearly and consistently as we have for chronically homeless people,” says Nan Roman, president of the National Alliance to End Homelessness, in Washington, which is one of the beneficiaries of the grants made by the nine foundations last year. “We don’t yet have a cost study on homeless families, we don’t have a topology of how homeless families use the system.”

Another concern is that the main studies used to justify the focus on chronic homelessness have been conducted in big cities. They say the experiences of suburban, rural, and smaller metropolitan areas have not been as widely considered.

Since chronic homelessness does appear to be more prevalent in large cities, some advocates for the homeless worry that social-services groups that work outside metropolitan areas are forced to ignore local needs to fall in line with the national agenda.

“As a system we need to be focusing on a broad range of populations and approaches and can’t rely on one approach as a silver bullet,” says John Parvensky, president of the Colorado Coalition for the Homeless, a nonprofit group that coordinates the state’s homelessness services.

Mr. Parvensky’s group sees both sides of the issue. His organization was awarded a $3.4-million grant through the federal Collaborative Initiative to provide housing for 100 chronically homeless people in Denver, an effort now 80 percent complete. On the other hand, the coalition also oversees grants for Colorado social-service groups in rural areas that don’t have sizable chronic populations.

“There are homeless people in need in these areas and the providers fear they will not be able to respond under the current rules,” Mr. Parvensky says. “They are doing tremendous work and risk being defunded for this new shift to the chronic population.”

Proposed Changes

The Department of Housing and Urban Development is considering policy changes that could make things even harder on groups that work in small cities and towns. The agency wants to give higher priority to efforts to help the chronically homeless as part of the Samaritan Housing Initiative, formerly called the Permanent Housing Bonus program, which provides supplemental grants specifically for the development of new housing. And the agency recently changed the maximum amounts of Samaritan Housing Initiative funds that social-service groups can seek by instituting a new supplemental-grant calculation process that favors providers in large urban areas.

Such changes could mean the potential loss of hundreds of thousands of grant dollars, says Susan Johnson, housing coordinator at Clackamas County, Oregon’s Division of Mental Health, which serves a largely suburban and rural county south of Portland. Of the 2,320 homeless people counted there earlier this year during a countywide census, only 32 — or 1.4 percent of the total — fit the federal definition of chronic homelessness. The count did find 900 homeless children under 18, some who are on their own, and others who are seeking housing along with the rest of their family.

The proposed changes in federal guidelines presents a major problem, says Ms. Johnson. “It puts us at a tremendous funding disadvantage when we don’t have an urban core that attracts chronic homeless,” she says.

Mr. Mangano, however, says some homeless groups are overreacting to the attention now given to the chronically homeless. He notes that half of homelessness dollars awarded by the Department of Housing and Urban Development already go toward helping homeless families. And he believes the new strategies will carry broad benefits.

“Ending chronic homelessness is the portal through which we must pass to end all homelessness,” he says. “It’s the most visible expression of the problem, and a disproportionate amount of resources are being consumed there. It’s a strategy. It’s not pitting anyone against each other.”