HUD Report on the 2014 AHAR: Homelessness in U.S. Continues to Decline

U.S. Housing and Urban Development (HUD) Secretary Julián Castro today announced HUD’s latest estimate of homelessness in the U.S., noting a continued general decline and specifically among veterans and persons living on the street. HUD’s 2014 Annual Homeless Assessment Report to Congress finds that there were 578,424 persons experiencing homelessness on a single night in 2014. This represents an overall 10 percent reduction and 25 percent drop in the unsheltered population since 2010, the year the Obama Administration launched Opening Doors, the nation’s first comprehensive strategy to prevent and end homelessness.

HUD’s annual ‘point-in-time’ estimates seek to measure the scope of homelessness on a single night in January. Based on data reported by state and local planning agencies, last January’s one-night estimate reveals a 33 percent drop in homelessness among veterans, including a 43 percent reduction in unsheltered homelessness among veterans, since 2010 and a 10.5 percent decline since last year. State and local communities also reported a 15 percent decline in the number of families with children experiencing homelessness since 2010, as well as a 53 percent reduction among these families who were found be to unsheltered.

“Even during challenging economic times, it’s clear that we’re changing the trajectory of homelessness in this country, especially when it comes to finding housing solutions for those who have been living on our streets as a way of life,” said Castro. “There is still a tremendous amount of work ahead of us but the strategy is working to end homelessness as we’ve come to know it.”

“The federal government, in partnership with states, communities, and the private and not-for-profit sectors, is focused on widespread implementation of what works to end homelessness,” said Laura Green Zeilinger, executive director of the U.S. Interagency Council on Homelessness. “Continued investments in solutions like permanent supportive housing and rapid re-housing using a Housing First approach is critical to the effort of every community to one day ensure homelessness is a rare, brief, and non-recurring experience.”

During one night in late January of 2014, volunteers across the nation conducted a count of their local sheltered and unsheltered homeless populations. These one-night ‘snapshot’ counts are then reported to HUD as part of state and local grant applications. While the data reported to HUD does not directly determine the level of a community’s grant funding, these estimates, as well as full-year counts, are crucial in understanding the scope of homelessness and measuring progress in reducing it.

The Obama Administration’s strategic plan to end homelessness is called Opening Doors – a roadmap for joint action by the 19 federal member agencies of the U.S. Interagency Council on Homelessness along with local and state partners in the public and private sectors. The Plan puts the country on a path to end homelessness among veterans by 2015; chronic homelessness by 2016; and to ending homelessness among children, family, and youth by 2020. The Plan presents strategies building upon the lesson that mainstream housing, health, education, and human service programs must be fully engaged and coordinated to prevent and end homelessness.

The decline in veteran homelessness is largely attributed to the close collaboration between HUD and the U.S. Department of Veterans Affairs on a joint program called HUD-VA Supportive Housing (HUD-VASH). Since 2008, more than 59,000 rental vouchers have been awarded and approximately 45,000 formerly homeless veterans are currently in homes of their own because of HUD-VASH.

Long-term or chronic homelessness among individuals is declining quite substantially since 2010. This decline is partially attributable to a concerted effort to make available more permanent supportive housing opportunities for people with disabling health conditions who otherwise continually remain in shelters or on the streets. Research demonstrates that for persons experiencing chronic homelessness, providing permanent housing coupled with appropriate supportive services without treatment preconditions, is the most effective solution for ending homelessness. This ‘housing first’ approach also saves the taxpayer considerable money by interrupting a costly cycle of emergency room and hospital, detox, and even jail visits.

Many communities are also making a special effort to identify youth experiencing homelessness on the night of their counts. Great strides have been made connecting young people to youth service providers, with particularly strong efforts focused on youth experiencing homelessness who are unsheltered. In addition, communities are finding creative ways to identify and engage these unsheltered youth, through efforts like youth-targeted events to more intentional use of social media outlets.

Key Findings

On a single night in January 2014, state and local planning agencies reported:

  • 578,424 people were homeless representing an overall 10 percent reduction from January 2010. Most homeless persons (401,051 or 70 percent) were located in emergency shelters or transitional housing programs while 177,373 persons were unsheltered.
  • Veteran homelessness fell by 33 percent (or 24,837 persons) since January 2010. On a single night in January 2013, 49,993 veterans were homeless.
  • Chronic or long-term homelessness among individuals declined by 21 percent (or 22,937 persons) since 2010.
  • The number of families with children experiencing homelessness declined 15 percent (or 11,833 households) since 2010. The number of unsheltered families fell 53 percent during that same time period.
  • The number of unaccompanied homeless youth and children was relatively unchanged overall, at 45,205. There was a 3 percent decrease in those who were unsheltered.

USICH’s Richard Cho about Housing First

Four Clarifications on Housing First, by Richard Cho, USICH Senior Policy Director

I must make a confession. When I first came to Washington to work for USICH, I was a bit skeptical about how sold the Federal government was on Housing First. I knew that Housing First was mentioned in Opening Doors, but did the Federal government truly embrace it? After all, it was not so long ago that terms like “harm reduction” were considered four-letter words by the Federal government.

So imagine my happy surprise when I discovered that I was flat-out wrong. In the first of what I learned would be many interagency meetings on chronic homelessness, Housing First adoption was discussed as a primary strategy for accelerating progress. And one of the very first tasks I was given was to help provide a clear, operational definition of Housing First. The result of that work is USICH’s Housing First Checklist, a tool that communities can use to adopt Housing First across their programs and overall community response. Not only does this Administration fully believe in Housing First, but it is working to make Housing First the underlying approach behind every community’s response to homelessness.

Ironically, while Housing First is at the forefront of the Federal government’s response to homelessness, I’ve learned that many communities are still engaged in the so-called “Housing First debate.” Communities continue to examine whether Housing First is the right way to address homelessness, saying things like, “We already have a Housing First program, we don’t need any more.” Or “One size doesn’t fit all. Housing First isn’t for everyone.” Or even, “It’s immoral and harmful to put people who drink into housing.”

But does anyone really think homelessness is safer than housing?

What I take from these “debates” is that Housing First is still misunderstood. So, as a representative of USICH I offer this attempt to provide some clarifications on Housing First.

1. Housing First is not a “program.” It is a whole-system orientation and response.

I often hear Housing First referred a program or a particular model, as in, “We just started a Housing First program.” Or “We don’t have a Housing First program in our community yet, just transitional housing.” In these instances, the term ‘Housing First’ is most often used to mean a permanent supportive housing program that uses a Housing First approach. Although I see it as a sign of progress that permanent supportive housing and Housing First are being conflated—it wasn’t long ago that Housing First was a new and radical concept in supportive housing circles—I think it’s incorrect to think of Housing First as a permanent supportive housing model, or as a program at all for that matter.

When we think of Housing First as a program, it creates the illusion that Housing First is just one among many choices for responding to homelessness. This sets up a dynamic in which individual programs are pitted against one another. The discussion ends up being about whether we should choose this program or that program, and whether one program is right and another one wrong. It leads to an absurd debate about whether permanent housing or emergency shelters are the solution to homelessness, when both play important but completely different roles. Thinking about Housing First as a program leads to divisions, factions, and conflicts—none of which are helpful in the effort to end homelessness.

Instead, Housing First is a whole-system orientation, and in some cases, a whole-system re-orientation. To borrow a phrase, it is about “changing the DNA” of how a community responds to homelessness. This change enables the community as a whole to:

  • make occurrences of homelessness rare and brief
  • help people who experience homelessness obtain permanent housing quickly
  • help people access the care and support needed to maintain their housing and achieve a better quality of life.

Some of you may have heard about the Triple Aim of health reform. Consider these the “Triple Aim” of ending homelessness.

Achieving these aims is impossible for one program alone. Rather, it requires a variety of programs and services including homeless outreach, emergency shelter, permanent supportive housing, affordable housing, rapid re-housing, along with case management supports, health care, income supports, employment services, and more. But it’s also not enough for these programs to simply exist; they need to work as part of a whole system to help people achieve these aims. That means that the focus of all programs must be to help people obtain permanent housing quickly and without conditions and contingencies. Programs should empower people to overcome barriers to obtaining permanent housing, access the right kinds of supports and care to keep their housing, and improve their quality of life.

Housing First also requires that communities constantly examine their overall set of programs to determine if they have the capacity to achieve the three aims above. Again, this is not about choosing this program or that program, but looking at whether the system as a whole is effective.

Consider the following thought experiment.

Let’s imagine for a moment that we could hit a magic “Housing First reset button” and start all over in building our community responses to homelessness. Would you wind up with the same set of programs and models that you have now? Would you even create discrete program models?

Now let’s imagine that we had enough resources to create the system we really need to achieve the three aims of ending homelessness. Let’s imagine we had a way to accurately assess housing and service needs at any point in time. What if we could provide different levels of housing assistance and different levels of services to people based on their needs? And what if we could actually adjust the level of assistance to people as their needs change in real-time without forcing people to move around?

That’s the system of response I would build. Unfortunately, we don’t have a Housing First reset button. Rather than adjustable and flexible levels of assistance, we have distinct programs and models that are often unconnected, preventing people from receiving personalized levels of assistance. The funding systems that support our programs don’t always allow for this level of flexibility. Even in the face of these issues, I still believe we can pursue a more flexible and dynamic system of response. Getting there starts with the adoption of a Housing First system orientation. Meanwhile, USICH and HUD have been encouraging communities to ensure that their inventory of programs includes the types of assistance at different levels of intensity—permanent supportive housing, affordable housing, rapid re-housing, etc.—targeted through a coordinated assessment process.

2. Housing First is a recognition that everyone can achieve stability in (real) housing. Some people simply need services to help them do so.

There is confusion about whether Housing First means providing housing with services or housing alone. I hear comments like, “We want to do Housing First, but don’t have a way to pay for supportive services,” or “It’s not responsible to do Housing First when people have chronic health challenges.” Some people believe Housing First is always service intensive. Others believe Housing First is not service intensive enough. So who’s right?

The short answer is both and neither. The problem goes back to thinking about Housing First as a program model. When we instead think of Housing First as an approach and a whole system orientation, it allows us to get away from “one-size-fits-all” solutions, and focus on matching the right level of housing assistance and services to people’s needs and strengths. There are some who might just need a bit of a financial boost and help with finding housing. Others may need a long-term rental assistance subsidy and support with their housing search, but not ongoing case management. And some people need permanent supportive housing, including long-term rental assistance or affordable housing coupled with case management supports.

It’s a basic equation where the constant is the goal of helping people obtain and maintain permanent housing. The variables are what level and duration of housing assistance and supportive services people need to stay in housing. So yes, if a community doesn’t have a way to pay for supportive services, they won’t be able to provide the right help to people who need ongoing case management. They should look to efforts across the country to increase Medicaid’s role in paying for case management supports in housing. And it’s also true that providing permanent housing without services to people who have chronic health challenges may be irresponsible. Let’s just remember that not everyone needs ongoing case management to maintain housing stability.

3. Housing First is about health, recovery, and well-being. Housing itself is the foundation and platform for achieving these goals.

The idea that programs within a Housing First approach sometimes require “intensive” services should not be taken to mean that the focus of services is on therapeutic or treatment goals. In fact, the Housing First approach emphasizes services that focus on housing stability, then using that housing as a platform for connecting people to the types of services and care that they seek and want. It’s based on the basic premise that if people have a stable home, they are in a better position to achieve other goals, including health, recovery and well-being than when they are homeless.

This is true for many reasons. It’s hard to comply with any kind of health care or treatment regimen when you have no certainty about where you are going to sleep. A person infected with TB will have a hard time completing a course of antibiotic treatment when they are bouncing from one shelter to another. It’s also hard to focus on recovery from addiction when you don’t have the certainty that you have a permanent place where you can stay each day, surrounded by supportive people. And for people who’ve experienced trauma, it can be impossible to shift away from a “fight-or-flight” mindset that comes with PTSD when they continue to live a rough life on the streets.

Let it be known, once and for all, that Housing First is about health and well-being. Housing First is about recovery. And connecting people to substance abuse or mental health treatment is entirely consistent with Housing First. The difference is that Housing First recognizes that health and recovery are so much more attainable when people have a safe and stable home. A Housing First approach recognizes that there are many paths to recovery and well-being—some of which are direct and some of which are long and indirect. But all of those paths start with a home.

4. Housing First is about changing mainstream systems.

Housing First is, and always has been, about changing mainstream systems. The approach emerged as a reaction to traditional mental health treatment modality, which thought that the way to address the needs of people with psychiatric symptoms on the street was to get them into psychiatric treatment, typically at an inpatient facility. Housing First was about changing the mental health system’s paradigm to recognize that housing is foundational to mental health recovery.

Housing First’s role in changing mainstream systems should not stop with the mental health system. Housing is just as foundational to addiction recovery and psychical well-being as it is to mental health. The new frontiers of systems change are to engage the substance abuse treatment system and the mainstream health care system around housing. Substance abuse treatment systems are integrating housing priorities alongside states like New York and New Jersey by adopting supportive housing as part of their own systems responses. Meanwhile, there are enormous opportunities to engage the mainstream health care system (Medicaid, managed care, and hospital systems) around housing, given the systems transformations underway through the Affordable Care Act.

There is a hunger to achieve health reform’s Triple Aim of improved health outcomes, improved healthcare experiences, and lower costs. Those of us who’ve been working to end homelessness know that affordable and supportive housing are part of that solution. It’s going to take engagement and persistence to make the health system aware of this. Luckily, this is precisely the kind of engagement and persistence that Housing First does so well.

DHCD seeks public comment on emergency regulations; comments due by close of business Friday, Oct. 31

To implement relevant provisions of Section 2 of Chapter 129 of the Acts of 2013 (An Act Financing the Production and Preservation of Housing for Low and Moderate Income Residents), the Department of Housing and Community Development has promulgated emergency amendments to the following Regulations, effective September 15, 2014:

The versions posted above show the emergency amendments.

DHCD is accepting public comments through the close of business on Friday, October 31, 2014.  Written comments should be sent to DHCD by directing the same to DHCD, 100 Cambridge Street, Suite 300, Boston, MA  02114, ATT: Shelagh Ellman-Pearl, or sent electronically to shelagh.ellman-pearl@ state.ma.us .

The public notice is posted on DHCD’s website at http://www.mass.gov/hed/economic/eohed/dhcd/open-meeting-notices.html