Housing is the Best Medicine
Supportive Housing and the Social Determinants of Health
CSH (Corporation for Supportive Housing) has released a new paper that demonstrates how access to safe, quality, affordable housing - and the supports necessary to maintain that housing - constitute one of the most basic and powerful social determinants of health.
From Supportive Housing Network of NY (SHNNY) - January 2, 2014
New Report: NY/NY III Supportive Housing Saved City $10,100 Per Tenant Per Year
On New Year's Eve, New York City released the first major report on the cost-savings impacts of supportive housing created under the New York/New York III Supportive Housing Agreement. Reviewing data from the first year of the agreement, the report found that homeless or institutionalized people placed into NY/NY III supportive housing saved taxpayers a net average of $10,100 per person per year. The entire report is available here.
The report's analysis confirms similar findings by more than 30 studies nationwide that showed how supportive housing can significantly reduce the costly public expenses associated with homelessness.
The New York/New York III Supportive Housing Evaluation was conducted by the NYC Department of Health and Mental Hygiene (DOHMH) in collaboration with the NYC Human Resources Administration (HRA) and the NYS Office of Mental Health (OMH). The evaluation is particularly significant because it compared two cohorts: those found eligible for and placed into NY/NY III housing and those who were also found eligible but did not receive a supportive housing placement. The study looked at two years of costs prior to placement/non-placement and one year post for everyone who was placed or not placed into NY/NY housing between 2007 and 2009.
The study measured public costs associated with participants' use of shelter, jail, cash assistance, food stamps, state psychiatric care and Medicaid. The report found that, after subtracting the NY/NY III housing and service costs, each NY/NY III tenant housed saves the public an average of $10,100 a year.
It’s time to eradicate chronic homelessness - and achieve savings for the state - by investing, redirecting funds to where they are most effective.
Addressing the housing needs of the homeless population is central to the mission and purpose of SHA - particularly those living with mental illness and substance abuse who are chronically homeless. SHA will continue to advocate for Housing First and to end homelessness in NJ.
The following is testimony submitted to Commissioner Velez, Commissioner Constable and members of the Interagency Council on Preventing and Reducing Homelessness by Gail Levinson, Executive Director, SHA:
December 17, 2013
Dear Commissioner Velez, Commissioner Constable and members of the Interagency Council on Preventing and Reducing Homelessness:
I am writing on behalf of the Supportive Housing Association of NJ (SHA), a 16-year-old membership organization representing housing developers and service providers all dedicated to creating permanent homes and providing supportive services for people with special needs so they can achieve stability and live successfully in communities across NJ.
The homeless population is one important component of the overall supportive housing community. Many of the developers who operate in NJ are committed to creating housing units for those in emergency situations. People who were formerly homeless are living successful lives through industry use of various HUD and DHS grants, through set-asides and priorities in the state’s LIHTC rounds and through the now depleted special needs housing trust fund. As a result of the Governor’s recent decision to expand Medicaid to people of very low income we now have a way of providing community services to the homeless in meaningful ways.
Housing First programs have been very successful. Housing First takes the person where they are and provides them with housing. They can deal with their other issues as they are housed.
There remain approximately 1,500 (2013 Point in Time Count) chronically homeless individuals who live on the sidewalks, in the shelters and in the train stations throughout NJ. They are psychiatrically and medically fragile and they use the emergency rooms as a safe haven and a warm place to stay for as long as the hospital staff will allow, at a cost to NJ that is high, unnecessary and inappropriate.
The real tragedy is that the problem is fixable - we’ve known that for years - but funds are currently not directed to where they would make the most impact as well as provide savings for the state. We know, for example, that by providing rental vouchers and quality supportive services at a cost as low as $65 a day, we can create housing stability for people. Instead we continue to spend our money on costly emergency rooms, long term care facilities, transitional housing and shelter services (except for the few that embrace and prepare for permanent housing), that do not end homelessness, but rather perpetuate it.
This is a story of investing, redirecting, achieving savings and eradicating chronic homelessness. Mercer County is trying hard to solve its homeless problem through these measures. Other counties have implemented programs but there is no state policy yet to support these efforts. The Federal direction is clear as articulated in the Hearth legislation but NJ continues to lag behind with no designed funding to begin to move to permanent housing. We have no policy yet in NJ that seriously focuses on ending homelessness.
What can be done?
1. What are other states doing? NY, our next-door neighbor, has initiated a Medicaid Redesign Program that invests state only dollars in housing and supports for its at-risk population with a corresponding savings in Medicaid expenditures. After only one year Governor Cuomo has released information estimating a savings of over $3 billion. NJ should take a serious look at how we can adopt a similar policy. SHA has arranged meetings with NY and NJ leadership, we have sent letters (attached to this testimony) and we have written articles but no one has taken any interest in further exploring a problem solving solution that is being rolled out across the Hudson with dramatic results.
2. The population of 1,500 chronically homeless in NJ has no designated state agency that is responsible for it. These individuals are largely outside the public mental health system and can often be found on the streets, in shelters, in and out of prisons and can be tracked through use of the emergency room system. SHA believes in the capability and oversight of the DMHAS that has the authority and the infrastructure to serve people with serious mental illness and substance abuse. These are the primary disabilities of the chronically homeless. If we are to make any headway, the new definition of serious mental illness that is being adopted by the state must capture this very fragile population so that the Division can claim these people, and savings going forward can be measured by tracking reduced use of high cost hospital-based services through Medicaid data. We need a special focus to achieve this goal.
3. Permanent supportive housing is the answer using a Housing First model. Counties are using their HUD vouchers for the chronically homeless but there will never be enough vouchers from only one source. Rental vouchers from DMHAS need to be set aside for this population as state policy. New Medicaid supportive services must also be available. The need for engagement services must be paid for when dealing with the chronically homeless. The apprehension about receiving services must be recognized and providers compensated for this difficult work. Adding a nurse to the team at our mental health agencies would be a great start to address the complex medical and behavioral health needs of the homeless, and should occur statewide.
4. Health Homes – This relatively new federal Medicaid funding option is, as you know, a community structure that coordinates primary and acute physical health care, behavioral health intervention and long term community based services and supports for people with multiple chronic illnesses. It is being used in NY and other states as a way of creating community stability, health and wellness by coordinating and integrating care at the local level. The federal government will cover the cost of Health Homes for 2 years at a rate of 90% with additional reimbursement for implementation and planning. While we are pleased that NJ is adopting Health Homes, it is doing so on a pilot basis – one area at a time. Little savings and fewer lives will be aided with this approach that is too slow and too measured. NJ must be bolder if we are to truly achieve change and save lives.
In closing I want to relay a discussion I had recently. I was attending a holiday event and sat next to a physician who works at one of NJ’s urban hospitals. She is an emergency room doctor. I asked about her work and she said that one of the saddest and most frustrating parts of her job is when homeless people come to the ER for services. They are treated even though she and her colleagues know that they come because they have no place to live and as a result have become medically fragile. This part of our system is clearly broken and in need of reform. The solutions are there, the numbers manageable and change needs to happen as soon as possible so we can boast that we are ending chronic homelessness in NJ.
What a day that would be!!!!
Gail Levinson, Executive Director
Supportive Housing Association of NJ
Remarks by Deborah Spitalnik, Executive Director, Boggs Center
Delivered at the 30th anniversary celebration of the Boggs Center, this is an important overview and personal reflection of the history of services for people with developmental disabilities in NJ, as well as a tribute to Elizabeth Boggs for whom the organization is named.