Moving the homeless out of shelters, into homes

A new approach is being heralded not only as more successful in fighting chronic homelessness, but more cost effective.

Two weeks ago, Moises and Jennifer Cedano expected to spend the next four to six months in a homeless shelter while they saved enough money for a deposit to rent an apartment.

Today they watch two of their three children, Timothy and Francisco, jump with joy on a new bed in a new apartment.

They rented the place with help from the city's Department of Homeless Services, which decided that in the long run, it will be less expensive to help the family get stabilized in their own apartment than to have them cycle into the shelter system.

The Cedanos' experience is a reflection of a fundamental transformation in thinking about homelessness and the new model's success in combating what was once thought to be an intractable social problem.

New focus for urban homelessness

From New York to Dallas to Seattle, cities across the country are focusing not just on emergency shelter, but on getting the homeless homes. As a result, they're seeing reductions in the numbers of chronically homeless people on their streets and in their shelters. The movement, known as Housing First, has had the most success in moving the chronically homeless, mentally ill, and drug addicted into housing complexes with social services, like counseling. That's proved to be more effective and less expensive than leaving people on the streets or in shelters. Now, the concept is being expanded and adapted to help the growing number of potentially homeless families like the Cedanos, giving them short-term help in getting back on their feet and, where possible, long-term help with rent subsidies.

"There's a paradigm shift occurring," says Dennis Culhane, a homelessness expert at the University of Pennsylvania. "The successes ... achieved among chronically homeless adults have led people to understand that that same paradigm shift can apply to all homeless families."

Chronic homelessness first gained widespread attention in the United States in the late 1970s and early 1980s. A major cause of its increased frequency was the de-institutionalization movement designed to get the mentally ill out of institutions and into community settings. For a variety of reasons, including lack of funding, many people ended up homeless instead. During the 1990s, a second wave of homeless people appeared in shelters: families who couldn't afford the skyrocketing cost of housing. And the homeless population ticked steadily upward.

Initially, shelters focused on helping people with psychiatric needs and drug addictions first, and worried about getting them homes afterward. With families, too, social service workers focused on job training and other help before placing them in homes.

Management vs. prevention

Homeless experts began to question that approach when they realized they were managing the homeless problem, not solving it. That's when they pioneered the Housing First concept, targeting the toughest homeless cases, the mentally ill and drug addicts who cycled through homeless shelters, emergency rooms, detox centers, and psychiatric hospitals. Professor Culhane's studies in the 1990s found this population accounted for about 10 percent of the people in shelters – but used more than 50 percent of the resources Moving these people into apartments with rent subsidies and support services was not only more humane, but more cost effective.

"It was a less expensive response than having these people being out on the street or in long-term shelter," says Philip Mangano, executive director of the Unites States Interagency Council on Homelessness. "That's because this is a population that randomly ricochets into very expensive primary and behavioral health systems costing between $30,000 and $150,000 per person per year."

Providing supportive housing, on the other hand, costs between $13,000 and $25,000 a year, says Mr. Mangano.

A study of one supportive-housing initiative in Boston released earlier this month by the Urban Institute found that the average client ended up in the hospital 102 times in the two years before getting into supportive housing. That dropped to seven days in the two years after getting into a home, saving the state $20,000 just in hospital costs. "Solving this problem turns out to be less expensive than managing it," says Mangano.

Almost 300 communities across the the country have now committed to 10-year plans to end homelessness. The federal government, under Mangano's leadership, is also asking for a record a $4.4 billion dollars in 2008 to spur the development of more supportive-housing complexes.

That success in dealing with the chronically homeless has prompted New York and other cities to experiment with similar philosophies for family homelessness. The city is taking a three-pronged approach: prevention, trying to help people with crises before they lose their homes, with an array of services from cash to pay-back rent to counseling and legal services to intervene with landlords; a short-term subsidy program to help families stabilize financially; and a diversion program that's designed to prevent families like the Cedanos from ending up in the homeless system in the first place.

The Cedanos' path to 'housing first'

The Cedanos had been living with Jennifer's mother. When she moved out of state, the family couldn't afford their own apartment, so they applied for shelter. Because Moises works – he's an electrician's assistant – social workers at the homeless intake center diverted him to the city's HomeBase program. The $12 million dollar program, founded in 2004, provides intensive case-work services and flexible financial assistance. The Cedanos' primary problem was that they couldn't afford a deposit on an apartment large enough for them with three children and a fourth on the way. So CAMBA, the nonprofit that provides HomeBase services for the city in Brooklyn's Bushwick neighborhood, found the family an apartment, paid their deposit, and is helping them get a Section 8 voucher, which will give them a long-term rent subsidy. It's also going to help pay for training so that Mr. Cedano can become certified as a licensed electrician – a step up from his current job.

"This is a community-based effort to help people remain in their homes," says Robert Hess, commissioner of New York's Department of Homeless Services. "That's some of the best 'housing first' you can do."

Currently, New York has HomeBase programs in the six communities that had the highest percentage of people coming into the shelter system. While the number of people entering shelters around the city dropped 7 percent overall since 2004, the HomeBase communities saw a drop of 12 percent. Next year, Mr. Hess hopes to expand the program citywide. The budget will jump to $20 million by 2010.

A difficult question of greatest need

While critics applaud efforts to reduce chronic homelessness, there's also concern the focus on prevention and diversion takes resources away from families that are already homeless. Patrick Markee, senior. policy analyst at the Coalition for the Homeless, notes that while homelessness of chronic adults is down as much as 13 percent in the city, the number of homeless families is at a record high, with as many as 9,000 families in shelters on a given night. He points out that as the Bush administration is spending more on some homeless services, it's cutting funds to develop more affordable housing. He also believes the city should focus on providing long-term rent subsidies.

"Families that leave shelter and have either Section 8 vouchers or move into public housing have the very lowest rates of return to shelter," he says.

While the Cedanos wait for an answer on their Section 8 application, HomeBase will help pay their rent.

"We have that kind of flexibility that a lot of other organizations don't," says Melissa Mowery, CAMBA's HomeBase director.

The Cedanos are still shocked they didn't end up in shelter. "But I had faith ... everything would work out," says Moises. He's hoping that all of his kids, including the one on the way, will grow up in this apartment.