Housing First: Longer-Term Benefits and Costs
Housing First is a homeless assistance approach that prioritizes providing permanent housing to people experiencing homelessness, thus ending their homelessness and serving as a platform from which they can pursue personal goals and improve their quality of life. This approach is guided by the belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or attending to substance use issues. Additionally, Housing First is based on the theory that client choice is valuable in housing selection and supportive service participation, and that exercising that choice is likely to make a client more successful in remaining housed and improving their life. (“Housing First,” National Alliance to End Homelessness, April 20, 2016, Housing First - National Alliance to End Homelessness).
To people who understand how Housing First works, the benefits are completely clear. The idea is to get people indoors, where it is safe and there is no impact from inclement weather. People can have their goods, clothes, wallet, purse, money, shoes, and other items around them without the fear they could all be stolen at any time. With a door that locks, and a place to eat, bathe, sleep, relax, cook, and plan, the newly-housed person is able to not only survive but also excel.
Many other models in use for housing the homeless demand they jump through a variety of difficult hoops—stay in a room for a few months, get a good job, save their money, develop references for housing, sign a lease, make a commitment, stay off booze or drugs for a year, etc. In some cases, the homeless are expected to do all these things while still sleep on a train, or living in a shelter, with limited or no access to showers, places to keep their clean clothes, being forced to eat food they do not want—and at strange times.
Imagine needing to go a job interview—but you have no alarm clock; no place to keep clean clothes or soap or shampoo or toothpaste; no normal breakfast or coffee in the morning in the same location where you are showering and dressing; no safe place to sleep the night before, all of this while you avoid being killed or robbed or injured. But you still have the job interview and you still have to leave all your belongings somewhere—if you are actually able to get your shower, get dressed, and get ready for the interview. Then in this same situation, you are supposed to get enough sleep (in a group shelter with dozens of strangers or in a dumpster or in an abandoned car) to go to work for weeks or months to get paychecks (you have no place to put so you must get to the bank, after work, but before the bank closes) and you have to find decent meals, people who will vouch for you, and friends who will keep your clean clothes hanging in their closet for weeks.
If these sound like difficult challenges, that is a good sign. The reader is beginning to see the reality of trying to work while homeless. It is a very rough situation. Few people are able to negotiate the agreements needed to get all of this together. Save your money. Save your clean clothes. Do your laundry and save your clean clothes at the house of a friend you have to impose on at least once a day to drop off/pick up clothing—perhaps in the evening or perhaps at 6:00 in the morning on your way to work. You also have to keep your dirty clothes at your friend’s house. And your shoes. And your boots. And your umbrella.
There are many protocols and rules to navigate while the homeless person is trying to obtain a place to live. They are the procedures most often used by agencies charged with helping the non-housed to get indoors to live. The success rate is low. The waiting and the struggle are both terribly frustrating to the non-housed person trying to survive them. This frustration is recorded thoroughly in the literature, in interviews, in anecdotal information on the street, and mentioned constantly even by counselors in social workers working in positions within agencies supposedly providing housing relief to the non-housed.
Housing First, in contrast, gives the non-sheltered person a place to house their clothing and shoes. Doing laundry becomes easier. Getting dressed can be done at the same place the shower occurs. Clothes can be kept there, near the shower. All these simple conveniences “kick in” and they are connections that the unhoused person has not had access to for a week, or a month, or 5 years. Your food is there too, and your utensils, and your skillet, and your eggs, and your bread. You have coffee, sugar, cream, and a cup. Or two. You can make your lunch. Take it with you to work.
As an unhoused person you are now rich! Perhaps you even got to help choose where you are going to live. You had the choice between two or three different apartments. You will be in a neighborhood you like, near a church or the train or friends. Maybe you will be near people from your culture. You can speak Polish with neighbors, or hear music you remember from your childhood.
Life is becoming normal.
As an unhoused person moving indoors, you are feeling normal. You are getting your dignity back. All kinds of other outcomes of living indoors because of Housing First suddenly kick in also. You will go to the emergency room a lot less for medical treatment. You will be getting into fewer arguments and fights because you are well-rested. You will now tend to stay out of jail. You will be able to attend job training and other classes and you will be able to concentrate on tasks at hand. You will have counselors (it is hoped as in many supportive programs) to help you set goals and reach them. You will be involved in fewer domestic violence situations, and wind up dealing with doctors, nurses, and police officers much less. You may be able to kick a habit or two, and life will be more normal (Housing First - National Alliance to End Homelessness).
There are two major versions of Housing First. 1. The more costly—but more effective—version includes provides longer-term housing funds, support in the way of counseling, advice about jobs and finances, and personal assistance with everything from helping the newly-housed person learn how to clean an apartment, how to cook meals, and how to organize bills—and keep them paid. You will be able to attend job-training sessions, lectures about retirement, finances, filing your taxes—and set longer-term goals. 2. The less costly—and less effective approach is immediate housing for a limited term (we will return to this example later).
Transitional Support Services (TSA), an agency in Saratoga Springs, New York, through its project RISE holds that “Housing First an approach to quickly and successfully connect individuals and families experiencing homelessness to permanent housing without preconditions and barriers to entry, such as sobriety, treatment or service participation requirements. This is why RISE Housing and Support Services says ‘Housing is Healthcare’ (https://www.riseservices.org/tsa-housing-first/). RISE is a special program for persons with certain illnesses and disabling conditions. The dignity of the non-housed person is respected, and counseling in a wide variety of areas is included in the move indoors. TSA further states that “Housing First is a philosophy that values flexibility, individualized supports, choice, and autonomy.”
Housing First with longer-term housing assistance (sometimes called permanent housing), it should be noted, is often the approach of choice when dealing with chronic homeless persons, persons on disability, and persons who are HIV-positive. Providing resources such as a refrigerator to keep medication in, a bathroom to bathe in and apply bandages, and a comfortable bed for proper rest are all essential elements for helping in the recovery and health care for persons at high risk of serious illness, infection, hospitalization, and death. Many studies have shown the benefits of Housing First with longer-term housing assistance for at-risk persons, such as the one conducted by Dr. David Buchanan and colleagues titled “The Health Impact of Supportive Housing for HIV-Positive Homeless Patients: A Randomized Controlled Trial” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774195/).
Housing First with longer-term housing assistance is not always successful. To be fair, we must consider some of the situations in which it does not work. Some studies remind us that this approach is not as effective with chronic homeless persons who suffer from extreme challenges of alcohol and drug addiction, for example (https://www.heritage.org/housing/report/the-housing-first-approach-has-failed-time-reform-federal-policy-and-make-it-work). Studies such as this one emphasize the need to deal with the addiction or other issues, such as mental illness, and worry less about the housing until good mental health—and rehab—have been achieved. The approach often suggested in these discussions—or implied—is that persons do not need, or cannot handle, or should not be stressed by, or cannot be trusted with housing. They must first deal with their other issues—wide variety of them, those studies suggest.
The less costly—and less effective—version of Housing First mentioned briefly above, includes shorter-term or limited-term housing and fewer supports. Mayor Lori Lightfoot of Chicago has established a program called the Expedited Housing Initiative (EHI) to support those who have been affected by COVID-19 (https://allchicago.org/ehi). The idea is to reduce the amount of time—and reduce the barriers—to getting unhoused persons into apartments. The goals are high, and the impact is advertised as one that is going to be very positive.
While the mayor has made a good start, there are a few problems so far with the implementation of this housing initiative:
1. The housing is short term, only one year leases;
2. The number of people targeted is very low, considering there are 10,000 homeless families in Chicago and there are thousands of single unhoused persons (that we know of);
3. Few agencies have clear access to or knowledge about how to enroll applicants; and
4. The gap between numbers served and the millions of dollars available is wide.
Housing First is the way to go, but in Chicago number 1 in the list is an issue. With so many non-housed persons in the city, one-year leases will be ending by the time a few more persons are actually being served.
Housing First is a very successful model, but like many things in Chicago, the problems shown in concerns # 2-4 above limit the usefulness of what could otherwise be a great initiative.
Like so many other things in Chicago, we know what works but what the reality is in our great city. Maybe a miracle will come along.