HOMELESSNESS AND HOUSING FIRST
A TINY WINDOW INTO THE AMERICAN HISTORY OF HOMELESSNESS
by John Bauters
by John Bauters
Homelessness, and its history in the United States, is a largely untold story. To understand
the origins of homelessness, one need not look much farther than the high school civic
book. Colonial expansion was wrought with land skirmishes that disenfranchised settlers
of land and home. The end of the Civil War and the subsequent institutionalization of
Americans from being locked out of home ownership opportunities. Broken promises
with Native American tribes spurned the creation of reservations that offered no housing
or resources. The economic fallout of the Great Depression, followed by the subsequent
and insufficient regulation of the market has inequitably punished lower income and
working families for a century. Perverse regulations in the early administration of Social
Security and other institutionalized welfare programs – even if unintentionally racist –
Security and other institutionalized welfare programs – even if unintentionally racist –
disproportionately and adversely affected women and non-white families, blocking
millions of families from building wealth and transferring assets between generations
– a key predictor of housing stability. The obliteration of HUD funding and rescission
of America’s modest safety net programs in the 1980’s removed some of the last
protections that kept poor, working families from the streets. Today, the ever-growing
gap in wage earnings, the lost bargaining power of workers for things like health
coverage and daycare, and the lack of investment in affordable housing exacerbate
America’s ever-growing homelessness problem.
CRUNCHING NUMBERS
The point-in-time, or “PIT” count, which takes places annually during the last week
of January, is an attempt to estimate the number of people who experience
homelessness on a given night in the United States. According to HUD's most
recent report on homelessness, there are nearly 600,000 people in the United States
who fit the federal definition of homelessness. The federal definition of
homelessness, encoded in the McKinney-Vento Homeless Assistance Act, is rather
prescriptive. Advocates have long complained that PIT counts undercount children
and youth, fail to include people who are marginally housed (i.e. living on a friend’s
couch or in a relative’s basement because they lack the resources to house
themselves) and that the process of collecting the data is inconsistently administered
across jurisdictions. Although admittedly imperfect, PIT counts offer us a general
sense of what homelessness looks like in the United States and is one of the few
tools policy experts and advocates have for identifying gaps in existing policy
and practices that would help reduce the number of people living without access
to housing.
THE CALIFORNIAN REALITY
California holds several dubious distinctions related to homelessness. Not only
do more than 20% of the people who experience homelessness in the United States
reside here (by contrast, California is home to 12% of the general population, which
means our homelessness rate exceeds our residential rate when compared with
the national average), but we also have the largest number of unsheltered people
experiencing homelessness as well. According to the most recent Annual
Homelessness Assessment Report (AHAR) issued by HUD in October 2014, 62.7%
of those experiencing homelessness in California have no access to shelter of any
kind. Even worse, on a local level, nearby San Jose and Santa Clara County have
the highest rates of people living without shelter nationally. California is also home
to the highest number of veterans who experience homelessness, with
approximately 24% of all homeless veterans living here in California. And perhaps
worst, 13,709 unaccompanied homeless children and youth live in California. These
children are often victims of sex trafficking and other abuses, which helps explain
why California also has the dubious distinction of being a leader in that category as well.
THE BIG PICTURE: A STEP TOWARD SOLUTIONS
For years, advocates, elected officials and communities have fought over how to address
the problem of homelessness and the ancillary problems that come from having large
numbers of unsheltered people in a community. The Bay Area and Emeryville are not
immune to these challenges. Developing solutions for the complex problem that
homelessness presents is as much a quest to solve for the social and fiscal problems
affecting individuals and families in our society as it is a quest to create communities
that are more livable, affordable, hospitable and humane.
It might surprise some that the solution to homelessness, in its most basic conceptual
form, is quite simple: house people.
Yes, house them.
For decades, the federal government, local communities, funders and even homeless
service providers have utilized a carrot and stick approach to solving homelessness:
“If you get treatment for your mental illness, we will be able to provide you with
housing assistance.” “In order for us to offer you a bed in our shelter, you must be
clean and sober for 30 days.” “We can only offer housing subsidies to people who
have already obtained some form of employment.”
This approach is significantly flawed. The chances that a person with a serious
mental illness can be compliant with medication or treatment in the absence of
intensive care or therapy while trying to survive on the street is infinitesimally
small. People who suffer from addiction and substance use disorders have
psychological and physiological cravings that are abetted by being left among
the social environment that enables their addiction to persist, making self-induced
sobriety on the streets as unlikely as winning the lottery for most. And the ability to
apply for work, be rested for work, prepare for work and physically get to work is
minimal when you lack a warm, safe and stable place to sleep each night.
HOUSING FIRST
The proper approach and the only successful solution to homelessness require
embracing a "housing first” model. Studies show that people who are offered
housing assistance find employment faster, have fewer health issues, respond
better to mental health and substance use treatment and experience fewer
encounters with law enforcement. If the thought of government financing
housing for the homeless bothers you, let’s examine how much it really costs us:
A study on the cost of chronic homelessness by the Massachusetts Home
and Healthy for Good Program found that the average cost for measured
and Healthy for Good Program found that the average cost for measured
services (Medicaid costs, emergency shelter, law enforcement/incarceration)
per person annually was $33,190. After employing a Housing First approach
by housing the chronically homeless individual and providing wrap around
supports, the same cost for those measured services fell to an average of $8,603.
When you add back in the affirmative cost of providing comprehensive housing
and supportive services to help make the program work, at a cost of $15,468 per
tenant, the total return on investment to the state and local governments was an
average of $9,118 per person.
What is missing from this analysis is something that doesn’t get crunched in
numbers: social outcomes. Fewer people rely on hospitals and emergency services,
scarce shelter beds become accessible to others when people in them become
housed, the number of people living unsheltered drops, and the reduced demand for
law enforcement and correctional services all make communities more livable.
In fact, if you want any more simple proof about how the lives of people who
experience chronic homelessness are improved by housing them, look no further
than Project 25. San Diego decided to house 35 chronically homeless individuals
who were among the highest consumers of state and local emergency services
and provide them with supportive services under a Housing First approach. The
results were dramatic, to say the least. In the 12 months prior to the project, those
35 individuals alone spent a whopping total of 1,505 days in hospital care.
Comparatively, two years into the program, that rate is down to 568, a reduction
of 64%. Other communities like Charlotte, North Carolina and Salt Lake City, Utah
have already paved the path with success.
HOUSING AS HEALTH
Housing is a social determinant for public health and healthy communities. I had
the pleasure of being a panelist at a recent convening held by the Alameda County
Department of Senior Services on how housing improves health outcomes, which
in turn makes communities not only more healthy, but safer. Aging and senior
age in place as opposed to receive institutionalized or nursing home care, which
are far more expensive and lower the social health of seniors by removing them
from their homes. Health officials and senior advocates already see that improving
the quality, affordability and accessibility of housing improves health outcomes.
So why stop there?
People who experience chronic homelessness have some of the greatest unmet
needs and are subject to the most dangerous of health risks. Their lack of shelter
and services decreases the affordability of general services we all share in as
residents of the community and the lack of resources designed to meet their
basic human needs decreases the livability of our community. If you want to learn
more about how housing is a social determinant for health, read this white paper by
the Corporation for Supportive Housing, one of the leading advocacy groups for
supportive housing and a partner of mine in advocating for a “Housing First” approach
to homelessness.
THE BOTTOM LINE
Funding the development of affordable, permanent, supportive housing is the single-
best long term solution to homelessness. Federal cuts to HUD due to sequestration,
uninspiring leadership from Governor Brown on this issue at the state level and a
lack of political will to fund housing solutions by a handful of legislators to address
this issue leaves some of the problem-solving to local and regional groups. The problem
cannot be resolved by a single local government alone. However, we can do our part.
I ascribe to a simple philosophy: “Think globally, act locally.” Promoting affordable
development and recognizing that solutions for people living in deep poverty or
experiencing homelessness are not going to be solved by naïve notions of achieving
affordability through simple “supply and demand” economics are major steps. We
must model local solutions for homelessness in such a way that breaks us from our
untenable trajectory. Good social policy and good fiscal policy are not mutually
exclusive. Providing a place for the housing first approach in the way we develop
going forward, investing in permanent supportive housing and meeting the needs of
everyone who calls Emeryville “home” are all steps toward creating a more livable,
just community.
Thank you John for this informative article.
ReplyDeleteRuth Major