Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. 1. Introduction

02/24/2012

People with complex physical and behavioral health conditions are at high risk of losing housing. Once homeless, many make frequent and often avoidable use of emergency rooms and inpatient hospitalization. Their health conditions can usually only be ameliorated if they have a safe, stable, and secure living environment, but their homelessness often exacerbates health difficulties, making it increasingly unlikely that people can get back into housing on their own. Extensive evidence accumulating over the past decade shows that housing homeless people who have significant, co-occurring health and behavioral health needs makes engagement in cost-effective care possible. In turn, housing coupled with appropriate care and supportive services reduces health risks, restores functioning, and facilitates recovery. This package of housing plus supportive services is known as permanent supportive housing (PSH).2 PSH also helps people avoid actions and decisions that would cause them to lose their housing again and return to the inappropriate and expensive use of crisis health services (Burt, Wilkins, and Mauch, 2012; Caton, Wilkins, and Anderson, 2007).

Research reveals the value of PSH, but also indicates that the nature of its supportive services component varies considerably. Variation often depends on tenant characteristics and funding sources, which themselves are intricately linked. This paper describes the differential access to services and supports for three groups of chronically homeless people who already live in PSH or would benefit from doing so. Its goal is to identify what the differences are across groups, why they exist, and where Medicaid comes into the picture. To help readers less familiar with the idea of PSH understand this discussion better, this introduction provides a brief description of the housing and service components of PSH.

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