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By Monica E. Oss

We have a housing and homelessness crisis of sorts in the U.S. On any given night, 553,742 people in the country are experiencing homelessness, according to federal statistics. Approximately two-thirds (65%) of that population were staying in emergency shelters or transitional housing programs, and about one-third (35%) were in unsheltered locations (see How Many Shelter Beds Are Enough?). And 11 million Americans are considered “housing insecure”—living in substandard or overcrowded housing with frequent moves due to family economics (see Housing Instability).

We’ve covered the direct link between housing, health status, and health care costs before. A recent report looking at hospitalizations among the homeless population in three states found hospitalizations increased by an average of 38.4% from 2007 to 2013. Approximately 52% of these 185,292 hospitalizations were for mental illness or addiction disorder (see The Blending & Braiding Of Housing & Health Care Funding).

Health plans and health systems have recognized that housing is a key issue. Last year we saw a number of private health plans make large commitments to finding housing solutions (see The Future Of Housing Support)—including Kaiser Permanente (see Kaiser Permanente Invests In Affordable Housing Complex In Oakland, California For $5.2 Million As Part Of Initiative To Improve Community Health By Addressing Housing Insecurity), AmeriHealth Caritas, Unitedhealthcare, and UPMC Health Plan.

We’re also seeing more activity by cities in addressing the housing issue—for good reason. For most municipalities, homeless individuals in public places is in direct conflict with urban renewal, commercial development, and tourism (see Hotels And Retailers Hit Hard By California Housing Crisis’ Ripple Effect). As mentioned in the report, Socio-Economic And Environmental Impact Of Homelessness In Olympia, Washington:

…tourism is also affected by homelessness. People are less inclined to tour an area that seems “rundown” due to a fear of an increased crime rate and large drug use population. People are also less likely to visit due to higher crime rates (often associated with homeless, which also attributes to larger budgetary needs to fund law enforcement and clean up crews) and the potential to be hassled for money. Most of us can only sympathize so much before we just avoid the area all together, thus creating a potential to scare away new and old business. This directly correlates to a decline in profits from local businesses and because of all these factors, contributes to declining land values.

The response in most municipalities hasn’t necessarily been to expand the available capacity for housing. Rather it has been to make homelessness illegal. While it’s hard to get a picture of how many cities in the U.S. have laws making “homelessness” illegal, a survey from the National Law Center on Homelessness and Poverty found that since 2007, the number of reported homeless encampments in the United States has increased by 1,300%, and of the 187 cities in the survey, the number of bans on camping in public increased by 69%; bans on sleeping in public also increased by 31% (see Housing Not Handcuffs).

But all of that may soon change. Ordinances that make it illegal to sleep in public places may be declared unconstitutional if the municipality hasn’t provided adequate housing alternatives. Or so a federal court ruled recently in Idaho. In April, a federal appeals court rejected a petition by the city of Boise that the full appeals court reconsider a September 2018 ruling in which homeless persons cannot be punished for sleeping outside on public property in the absence of adequate alternatives (see Ruling Stands: Homeless Cannot Be Punished For Sleeping Outside In The Absence Of Adequate Alternatives).

I would argue that Chambers of Commerce need to get on top of this issue and push for more systematic federal and state programs to address homelessness—or, with the trickle-down effect of inadequate funding, face the need for city-funded initiatives to keep their city streets and parks from serving the role of temporary housing. The challenge from the public sector is that while the federal government operates three major programs that provide housing support, the $44.7 billion combined spending on this has remained stagnant since 2009 (see The State Of The Nation’s Housing 2018). Some of the city-specific initiatives we’re covered include:

  1. San Diego County Creating Pay-For-Results Project For Housing Services
  2. Ramsey County, Minnesota Funds Permanent Supportive Housing Program For People With Chronic Homelessness
  3. Denver Supportive Housing Social Impact Bond Program Sees 85% Success Rate
  4. Microsoft Pledges $500 Million To Support Seattle Affordable Housing
  5. Lane County, Oregon Launches Pay-For-Success Project For Forensic Housing & Re-Entry Services
  6. New Jersey Launches ‘Housing First’ Pilot Project To Address Needs Of Homeless Individuals
  7. Los Angeles To Pilot Backyard Housing Model For Reducing Homelessness
  8. Seattle To Impose Housing Performance Target Penalties On Homeless Provider Organizations
  9. Partnership Seeks To Create Homeless Housing Complex In Bremerton
Richard Louis

My colleague Richard Louis, OPEN MINDS West Region Vice President, has a unique perspective working in both health and human services—and serving as a reserve police officer in Los Angeles County. He noted:

Here in California, city municipalities and law enforcement agencies have already significantly reduced, if not stopped citing homeless persons for sleeping in public areas. Considering the enormity of the homeless problem in some parts of California (like Los Angeles), new efforts and collaborations have begun to increase capacity in homeless shelters and build new supportive housing. With over 50,000 homeless identified in Los Angeles County alone, these new resources are slow, coming due to a lack of adequate funding and communities fighting to keep these housing projects out of their cities due to concerns about public safety.

For provider organizations in the health and human service space, this ruling is surely welcome as it will keep the number of persons who need behavioral health and/or addiction treatment services out of the jails where adequate treatment is not always available. Homeless outreach programs have increased and many city police departments now have programs where an officer is partnered with a mental health professional and they are focused on diverting these people from jail and into community treatment settings, with access to local housing and other social services (see Mental Evaluation Unit).

I think we will see more stress between municipalities, law enforcement, and the health care system around housing. But the Idaho court decision makes this an issue for business groups as well. For more on the challenges and solutions in housing, check out these resources from the OPEN MINDS Circle Library:

  1. The Housing To Heath Care Evolution
  2. The Blending & Braiding Of Housing & Health Care Funding
  3. What Housing Supports Are Available For Veterans?
  4. Is Housing Health Care?
  5. Housing Is Health Care-The Services For The UnderServed Model
  6. The Blending & Braiding Of Housing & Health Care Funding
  7. How Many Shelter Beds Are Enough?
  8. Homeless Rate Nearly 10 Times Higher For Former Prisoners
  9. North Carolina Corrections To Launch Pilot Medical & Mental Health Transitional Housing Services
  10. Florida Medicaid To Launch Behavioral Health Housing Pilot

And to learn more about the federal system for supporting the homeless population, check out U.S. Spending On Housing Assistance Programs: $44.7 Billion In 2016. This OPEN MINDS market intelligence report provides an overview of federal housing assistance programs, participation in these programs, and trends over time. And stay tuned as we continue to cover this issue.

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