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By Sarah C. Threnhauser, MPA

In your community, how many shelter beds are needed for the homeless population? That question has taken on new significance in light of a recent legal decision. In September, a federal appeals court panel ruled that arresting homeless people for sleeping in public when there are insufficient shelter beds violates the 8th Amendment against cruel and unusual punishment (see Federal Appeals Court Prohibits Arresting Homeless People For Sleeping In Public When Shelter Beds Are Insufficient). The ruling applies to all areas covered by the 9th Circuit, which is based in San Francisco and includes the western portion of the country, including California, Arizona, and Washington.

How many beds are available for the homeless population nationally? The U.S. Department of Housing and Urban Development (HUD) estimates that in 2017 there were 899,059 beds available on a year-round basis; this includes emergency shelters (ES), safe havens (SH), transitional housing (TH), rapid rehousing (RRH), permanent supportive housing (PSH), and other permanent housing (OPH). Are those beds sufficient? Answering that question is complicated.

According to HUD, on any given night in 2017, 553,742 people were experiencing homelessness in the United States—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 The 2017 Annual Homeless Assessment Report (AHAR) To Congress). Looking at those estimates, the numbers may make it appear that we “have enough” shelter beds nationally. But geographic variations mean that the beds don’t always line up with the need. Many cities around the country report an inability to fill existing shelter beds (see Amid Homeless Crisis, Police-Run Shelter Beds Sit Empty and Why Do Thousands of L.A.’s Homeless Shelter Beds Sit Empty Each Night? Rats, Roaches, Bedbugs, Mold), while others report on a shortage of beds (see ‘We’re At Capacity Right Now’: Shelter Bed Shortage Forces Homeless Shelters To Turn People Away).

The issues mean that the homeless population comes frequently into contact with the criminal justice system. Formerly incarcerated people are 10 times more likely to be homeless than the general public, and in many cities around the country, homelessness is grounds for arrest (see Homeless Rate Nearly 10 Times Higher For Former Prisoners). While there isn’t a clear national picture on how many homeless people face arrest, a quick look around the country finds some patterns. Last year most arrests in Portland, Oregon were for homelessness—a group that counts for 3% of the population, but 52% of arrests (see Portland Homeless Accounted For Majority Of Police Arrests In 2017, Analysis Finds). And in Los Angeles earlier this year, the LAPD received criticisms for its 10% increase arrests of homeless people, which included 14,500 misdemeanor arrests and 6,400 felony arrests (see LAPD Defends Rising Arrests Of Homeless People). And in Colorado, 30% of all citations that Grand Junction issued are related to an anti-homeless ordinance (see Too High A Price: What Criminalizing Homelessness Costs Colorado).

Richard Louis

For more, I reached out to OPEN MINDS Advisory Board Member Richard Louis, III, who explained that he doesn’t see this lawsuit having an immediate effect on how the homeless population interacts with the criminal justice system. As Mr. Louis explained, there needs to be better coordination among law enforcement, mental health provider organizations, and social service agencies.

I don’t see a decrease in legitimate misdemeanor or felony arrests anytime soon. As thousands of homeless people live in the streets of the Greater Los Angeles area, law enforcement officers have taken on a dual role as peace officer and social worker. As an active duty reserve police officer in East Los Angeles, I have seen law enforcement officers increasingly involved in finding assistance for the homeless. Surprisingly a very large number of homeless people refuse all services making it difficult for local municipalities to address the problem. Arrests for sleeping in public places seems to be deceasing as the right to be homeless is a more common theme with surrounding city government officials.

Executives in health care organizations may think this is a discussion without great relevance for them, but the data is clear that lack of stable housing drives up health care costs. Data show that mortality rates for the homeless are three time greater than the general population. And when a consumer who is high utilizer of health care services gains supportive housing, average hospital cost savings are $3,022 per person per month, or 86% of prior costs (see Is Housing Health Care?). Over the past few years, health insurers have started paying more attention to issues of homelessness in hopes of lowering costs for the complex consumer population:

  1. In May, Kaiser Permanente announced plans to invest $200 million through its Thriving Communities Fund to address housing stability and homelessness (see Kaiser Permanente To Invest $200 Million Into Community-Based Efforts To Tackle National Homeless Crisis)
  2. In March, AmeriHealth Caritas announced that as part of its multi-year investment in providing support to the homeless population, they had provided grants to six Washington, D.C.-based organizations that provide homelessness prevention, crisis and transitional housing services, and support programs to address addiction and other issues (see AmeriHealth Caritas Invests $150K in Housing and Support Services in 2nd Phase of Its $250K Investment Commitment to Improve Health Outcomes).
  3. In May, Unitedhealthcare announced it had a one million dollar grant from United Health Foundation to Circle the City, a non-profit community health organization, to support the Medical Respite Center for the homeless at Maricopa Human Services in Phoenix, Arizona (see United Health Foundation Awards $1 Million Partnership Grant to Circle the City).
  4. In August, UPMC Health Plan announced that it will expand its program with non-profit provider organization Community Human Services to provide funding for case management to help support the homeless population in the Pittsburgh area of Pennsylvania (see Health Care Program That Helps Homeless Get Housing Will Expand).

While most of these programs are still operating at a smaller scale, I think the pressure on communities from new lawsuits related to housing for the homeless population, combined with the shift to more value-based care models, will continue to push payers, policymakers, health plans, and health systems to develop new solutions and new partnerships to better serve the homeless population. As Mr. Louis noted, “Hopefully with increased coordination between law enforcement, mental health, and social service agencies there will be increased access to stable living arrangements and access to other essential services that will result in less crime and fewer arrests.”

For more resources related to housing issues and serving the homeless population, see these resources in the OPEN MINDS Circle Library:

  1. The Future Of Housing Support
  2. The Number Of People Experiencing Homelessness Increased 1% Between 2016 & 2017
  3. Housing Is Health Care-The Services For The UnderServed Model
  4. Making The Health Care Social Service Link: The Community Care Behavioral Health Care Study
  5. Homeless Rate Nearly 10 Times Higher For Former Prisoners
  6. Only 20% Of Older Homeless Adults Have Advance Care Planning
  7. 10% Of Young Adults Experience Homelessness Each Year
  8. Rise In Proportion Of Head Start Children Who Are Homeless; Now Over 4%

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 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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