If You Build It, Will They Come?
How a tiered approach to Housing First can get the U.S. closer to eliminating homelessness
All too often, national media coverage of the homelessness crisis in this country leaves an impression of an epidemic that is spiraling out of control. The mistakes and failures of major cities like Los Angeles, San Francisco and New York are magnified. And the success stories—if covered at all—are few and far between.
The reality is far more complicated. Overall, the U.S. currently has about 582,000 people who are homeless on any given day, according to the most recent statistics from the Department of Housing and Urban Development (HUD).
That figure is roughly equal to what it was three years ago. Yet cities such as Houston, Milwaukee and Salt Lake City, Utah, are among the growing numbers of municipalities that have significantly reduced their homeless populations in recent years by adopting a version of Finland’s Housing First policy.
Finland’s model, widely lauded across the globe for coming closer to eradicating homelessness in the Nordic nation than anywhere else, guarantees housing to all citizens as a constitutional right. It also fills the entire housing supply through various entities and programs that are funded by the national government. The policy reverses conventional homeless aid in that it does not require homeless people to meet certain criteria (a sustained period of sobriety, for example) before being granted housing. Homes are provided to those without them, literally first, before addressing any of their social service or healthcare needs.
Housing First Is a Good Start—But It Must Go Further
The political and economic realities in a country with 330 million people presumably make a federal Housing First policy a nonstarter in the U.S. At the local level, it’s a much different story. Many cities and counties have adopted the central tenet of the Housing First model, which is to make housing available to as many homeless people as possible without pre-conditions. And in some places, the results have been dramatic.
“We’ve come close to getting our numbers of chronically homeless people down to zero.”
Milwaukee, for example, has seen a 46% reduction in its overall homeless population, which includes a 92% reduction in unsheltered homelessness, since adopting a Housing First program in 2015, according to Eric Collins-Dyke, Assistant Administrator of the Milwaukee County Housing Division. During a recent Apple podcast, Collins-Dyke noted that Milwaukee’s progress has had ripple effects across the entire healthcare system, resulting in a large drop in emergency room visits, detox facility use, crisis services and psychiatric in-patient care.
As in many locations, Milwaukee’s Housing First program tends to prioritize chronic homelessness, which HUD defines as one uninterrupted year without housing or four episodes of homelessness over a three-year period totaling 365 days. And in this regard, it has been overwhelmingly successful. “We’ve come close to getting our numbers of chronically homeless people down to zero,” said Collins-Dyke.
But there’s a problem: Just think of how many people never reach HUD’s threshold whom most of us would nevertheless consider homeless—it’s a lot. Statistics vary across the country, but in Illinois, one study suggested that only one-quarter of people experiencing homelessness could be defined as chronically homeless. In Milwaukee, it’s even less, about 12-15% of the homeless population.
This is one of the reasons why even the most successful Housing First programs allow many homeless people to remain in limbo or fall through the cracks of the system. (Another is a lack of integration and cooperation with social services and the real-estate community, a topic that will be addressed in a future post.)
In many ways, the gaps in the U.S. Housing First models resemble those of government subsidized housing programs like Section 8, which tend to produce long wait lists and too many binary outcomes. If we’re really serious about eliminating homelessness, or even getting to a place where such a goal seems attainable, our current strategies will have to adapt and evolve in order to address the entire spectrum of the homelessness condition. And this is where a multi-tiered approach could take Housing First programs to the next level.
From Chronic to Complex: The Next Iteration
For a problem as complex as homelessness, no two solutions will look exactly alike. Even a system with more customized layers or tiers would have to be tailored to the specific needs of the homeless population in each city, and would require support from the various organizations within the community that are responsible for addressing the problem. But here are the broad outlines of a tiered solution that could be adopted throughout the country:
Tier One: Complex Cases
This tier would include not only the chronically homeless but also individuals with extreme physical or mental conditions (e.g., chronic mental illness) who are unlikely to ever work themselves out of homelessness and are legitimately at risk of dying in the street unless they are guaranteed housing.
If the top tier cannot be sufficiently expanded to all complex cases due to lack of funding or supply, then ideally there would be additional accommodations made that suit the varied types of homeless cases that do not make the cut. This could include dormitory or hostel-style accommodations, or other types of transitional housing that can bridge the gap from no home to permanent home.
Tier Two: Transitional Cases
This second tier would provide temporary or transitional housing for certain segments of the homeless population who still require housing but could be considered in a somewhat more stable situation, including employed homeless people who are earning too little money to afford long-term housing or individuals with shelter insecurity stemming from risky situations such as domestic abuse.
Transitional housing is just what its name suggests: a bridge to permanent, affordable housing. It is not in an emergency homeless shelter, but usually a room or apartment in a residence with support services. This type of housing could comprise single-room occupancy residences, such as dormitories or hostels with shared space. The transitional time can be short, say one or two years, and in order to qualify, the individual could be required to obtain permanent housing within that period, as well as gainful employment or income, even if Social Security assistance.
Tier Three: High Risk Cases
These are people who are not currently homeless but are at a high risk of becoming homeless in the near future, such as the mother of three who remains in a domestic violence household because otherwise she’d be homeless, or the person on the cusp of eviction because they've not been able to pay their rent in three months.
By creating this additional layer, we not only keep formerly homeless people in their homes, but we also begin to acknowledge the root causes of homelessness and take a step toward prevention, at least on the housing supply side. To fully address prevention, each program will have to incorporate additional strategies for a continuum of outreach and wraparound services. This space is dedicated to advancing ideas for comprehensive and more equitable housing solutions.
Adopting such a tiered approach won’t be easy—nothing about solving the homelessness problem is. Critics will say it’s too costly and risks further fragmenting the system by creating more intractable cases. There’s no doubt that a commitment to ending homelessness is a grind. It will require more resources, more partnerships at the community level and more people who are dedicated to solving the problem.
But one thing is clear: As of today, too many homeless people are left behind by the system. Ending chronic homelessness is a terrific milestone to reach, but it should be a starting point, not an endpoint. Adding more layers or tiers to a Housing First model that has already made tremendous strides is one way to address the complexity of the problem and ensure continued progress in the months and years ahead.
Let’s get started.
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