By Lyndia Downie,
President and Executive Director, Pine Street Inn
There was a time when most of society assumed that someone like “Walter,” a chronically homeless man struggling with depression and addiction, had few alternatives to (or perhaps even preferred) life on the street. Walter would stay at a shelter like Pine Street Inn on the coldest of nights, required frequent trips to the emergency room with ailments that started small and ended big, and often needed costly inpatient hospital stays.
The costs of this approach — both for Walter personally, and in hard dollars spent on emergency room visits and hospital stays — were high. There seemed to be few options for people like Walter, other than a revolving door in and out of shelters, hospitals and prisons.
Groundbreaking research done by Professor Dennis Culhane at the University of Pennsylvania tracked how long people stayed in shelters. His research showed that most people used shelters for less than a month and quickly moved on. However, a small group — less than 20 percent of those in shelter — used 80 percent of the bed nights over the course of a year. These “chronically” homeless people suffered from alcoholism or persistent serious mental illness, often combined with other serious health problems.
How do you create a strategy that targets these people for housing and services when many people view their problems as intractable? Housing First, pioneered by Sam Tsemberis at Pathways to Housing in New York, does what its name implies. People get housing and support services first, greatly contributing to the person’s stability. The permanence of a home and the consistent and reliable follow-up from case managers changes the game.
Emergency room and inpatient stays are reduced by over 50 percent when we look at data before and after people were housed. Pine Street placed a group of long-term shelter and street dwellers in this type of housing four years ago with a retention rate of 84 percent. Not bad for a group of people that many deemed “unhouseable.”
This strategy of targeting the longest-term shelter occupants and creating barrier-free housing has contributed to a six-year, 30 percent decrease in the number of homeless individuals on the streets and in shelters in Boston. There is no question that this innovation has been successful; we at Pine Street are committed to this approach so that we can truly meet our mission of ending homelessness.
Although best known as a shelter, Pine Street has embarked on a strategy to create greater numbers of permanent housing units and decrease emergency beds. While both are needed, the shift towards permanent housing with support services is a critical step forward.
There is a growing realization that individuals who may never be able to live without a range of support services can be better served in permanent, stable housing. Permanent housing provides an improved platform from which to treat mental illness and address addiction, or learn to live with a disability.
Truth be told, when communities hear that a supported housing program may be in their neighborhood, they often raise concerns about safety, quality of life and property values. But with 34 residences in and around greater Boston, we can attest to the fact that our programs typically integrate seamlessly into neighborhoods.
Today, Walter lives in one of Pine Street’s housing locations, where he has a room and shared common space with several other individuals. A case worker has helped him access services for his depression and addiction. He has a part-time job, using skills he learned in one of our job training programs. Breaking the cycle of inevitability gave Walter the freedom to try a new approach that transformed his life.
We have clearly found a better way to address the issue of homelessness that is also more cost-effective. In fact, there is documented evidence that shows a $10,000 per person annual savings in emergency care and public safety systems with this approach. In this time of tight budgets, we must think carefully about how we spend funds to help homeless individuals. The investment in a long-term solution pays off in a big way, both from a financial perspective and a societal one.
LYNDIA DOWNIE is president and executive director of the Pine Street Inn. This op-ed is reprinted with permission from The Provider.