Quickly moving homeless people with disabling medical illnesses into housing with supportive services helps them, and saves communities money, according to results of a rigorous study conducted in Chicago. The study results are consistent with the principal claim of the "Housing First" service model that the best way to end homelessness is to make housing the first priority, then to provide individualized services that address the problems that had resulted in the person becoming homeless. The more traditional approach to ending homelessness is to work on recovery and self-sufficiency first, then obtain housing.

The study was reported in a story by Joe Barrett in The Wall Street Journal of Thursday, 6 March 2008.

Called the Chicago Housing for Health Partnership, or CHHP, the study recruited homeless people who had been admitted to any of three hospitals in Chicago. All participants had a chronic medical illness, such as HIV/AIDS, hypertension, or heart or liver problems, and some also had alcohol- or drug-use disorders or mental illnesses. Participants were randomly assigned to the "housing-first" group, or the "usual-care" group. The housing-first group were immediately offered housing, and provided with intensive services coordinated by a case manager. The usual-care group were provided with a broad range of services (e.g., shelter, healthcare, case management) from a variety of community providers. There were 201 in the housing-first group, and 206 in the usual-care group. Researchers collected data on every service (e.g., case management, emergency room, hospital admission, nursing home admission) received by individuals in both groups for an 18-month period.

Housing-First services cost significantly less.

At the end of the 18 months, 60% of those assigned to the housing-first group were living in an apartment or other permanent housing, compared with only 15% of those in the usual-care group. As shown in the Wall Street Journal chart below, the total cost of all services (including housing) provided to those in the housing-first group during the 18-month study period was about $1.3 million less than the cost of services provided to those in the usual-care group. For example, housing-first individuals spent 5,500 days in nursing homes, compared with more than 10,000 days for usual-care individuals. The savings in nursing home costs for the housing-first group was nearly $500,000.

The average annual total cost of care for a person in the usual-care group ($22,330) was $4,088 more than the cost for a person in the housing-first group ($18,242). Philip Mangano, who was appointed in 2002 to lead the U.S. Interagency Council on Homelessness, concluded that "The old status quo responses of ad hoc crisis intervention are more expensive."

Two Seattle studies also find savings with housing-first services.

Similar results were found in two studies of the Housing First initiative in Seattle, Washington. These studies examined costs of healthcare services (including emergency room, inpatient, and detoxification) in addition to jail services in 117 chronically homeless persons with mental illnesses, addictions, and physical disabilities who were provided with housing-first services at two permanent housing sites: "Plymouth on Stewart," and "1811 Eastlake." Total service costs for the year following enrollment in housing-first services were $3.2 million less than costs for the year prior to enrollment, when participants had been homeless. The table below shows outcomes from the Plymouth on Stewart site.

A controversy about alcohol consumption.

The news advisory notes that "there was much controversy over the fact that residents were allowed to consume alcohol in their homes at 1811. However, since moving in, 1811 residents have reported a one-third reduction in days spent drinking to intoxication, and researchers found an almost total elimination of the use of the sobering center by the building’s residents, a decline of more than 5,000 visits per year."

Housing First in Cuyahoga County.

Locally, the Housing First Initiative was created in November 2001, when the Sisters of Charity Foundation of Cleveland, the Enterprise Foundation, and the Cleveland and Cuyahoga County Office of Homeless Services convened 17 housing and service providers to develop a strategy to end long-term homelessness in Cuyahoga County. This Initiative was instrumental in the creation of the County's Housing First projects, including Emerald Commons, Downtown Superior Apartments, and Liberty Commons at St. Clair. In the autumn of 2008, MHS will open another Housing First program, Southpointe Commons, with its 82 permanent housing units.

References

Barrett, Joe (2008, March 6). Homeless study looks at "Housing First." Shifting policies to get chronically ill in homes may save lives, money. The Wall Street Journal, p. A10. Retrieved 7 March 2008 from http://online.wsj.com/article/SB120477350786615859.html   View a preview of the article.

Nickels, Gregory J. (2008, January 9). "Housing First" approach to homelessness brings hope to hard lives. Two studies show once-controversial projects are helping save lives and money. News advisory, City of Seattle, Washington, USA. Retrieved 10 March 2008 from http://www.ci.seattle.wa.us/news/detail.asp?ID=8078&Dept=40   Read the news advisory.

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