Dr. Dennis P. Culhane Director of Research, Director of Research for - PowerPoint PPT Presentation

CCEH 16th Annual Training Institute Keynote Speaker Dr. Dennis P. Culhane Director of Research, Director of Research for the National Center on Homelessness Among Veterans

Emerging Opportunities in Homelessness Policy and Practice Dennis P. Culhane University of Pennsylvania

Cluster Distributions: Persons and Shelter Days (Single Adults in Philadelphia) 90% • Crisis: 80% – 1.19 stays 70% – 20.4 days • Episodic: 60% – 3.84 stays 50% – 72.8 days 40% • Chronic: 30% – 1.53 stays 20% – 252.4 days 10% 0% Transitional Episodic Chronic Crisis Crisi] % of Persons % Days Used

Characteristics by Cluster: Dated Data (Philadelphia) Nearly all chronically homeless people have a disability: Crisis

Clusters by Characteristics Most homeless people with a disability experience Crisis Homeless 100% Percentage of Population 90% 78.3 80% 73.8 74.6 71.5 70% 60% 50% Transitional Crisis 40% Episodic 30% Chronic 17.7 20% 14.1 15.1 10.5 11.1 11.2 10.8 11.3 10% 0% Mental Medical Substance Any Illness Abuse Diagnosis Background Characteristics by Cluster

Crisis Homelessness in the US in 2014 (Adults and Families): Scope: PIT: 452,747 Annual: 900,400 Annual Number of Persons Annual Number of Households Homeless Family in Family Households 14.2 34.5 Chronic Chronic Homeless 17.2 52.4 Homeless Adults Adults 68.6 Non- 13.1 Non-chronic chronic Homeless Homeless Adults Adults

Dynamics: • Pattern of Homeless Service Use among Sheltered Individuals: Length of Stay (AHAR) 37.5% 40 Percentage of users 33.5% 35 28.9% 30 25 20 15 10 5 0 7 days or less 8 to 30 days 31 to 180 days Length of Stay (Only stays less than 180 days)

Where Do the Single Adults Come from? S.A Tx Institution Institutions Jail Friends 2.7 24.4% 25.8% 13.4 Hospital Own house/Apt. 28.9 13.4% 22.1% 15 Psychiatric 14.3% Other Facility 40 Foster Care Family

Rapid Rehousing • Critical Time Intervention (CTI)- Potential for Medicaid reimbursement • SSVF- Veteran exemplar, approximately 120,000 non-chronic adult and family HHs served in 2017.

SSVF Rapid Rehousing: Housing Retention 1 0.98 Survival Proportion 0.96 0.94 0.92 0.9 Singles 1 Year 0.88 Singles: 15.7% Families 0.86 Families: 10.1% 0.84 0.82 0.8 1 18 35 52 69 86 103 120 137 154 171 188 205 222 239 256 273 290 307 324 341 358 Days Since SSVF

Critical Time Intervention • Critical Time Intervention (CTI) – Time-limited support during period of transition • Potential Medicaid reimbursement Phase 1: Transition (~3 months) Connect clients to supports Phase 2: Try-out (~3 months) Monitor client and support network Phase 3: Transition of Care (~3 months) End services with support network firmly in place

Crisis Homelessness Recap • Most homeless adult and family households experience crisis homelessness (68.6%) • 24.4% come out of institutions. • Most disabled adults experience crisis homelessness • SSVF proves rapid rehousing works • Medicaid could pay for CTI

A Birth Cohort Phenomenon: Persons Born 1955-1965 Age Distribution, Male Shelter Users, US Census 2010(%) 2000(%) 1990(%) 12 31-33 49-51 % of Single Adult Male Homeless 40-42 10 8 Pop. 6 4 2 0 Source: Culhane et al. (2013)/ U.S. Census Bureau Decennial Census Special Tabulation

Aging Trend Is Quite Distinct from the Aging of General Population 2010 (Homless Pop.) 2010 (General Pop.) 49-51 (11.3% ) 12 10 % of Total 8 6 4 2 49-51 (5.9% ) 0 Source: U.S. Census Bureau Decennial Census Special Tabulation

Age Distribution of Prevalence Cohorts of Male Shelter Users in New York City, 1990-2010 31-33 14 % of Prevalence Cohort 12 46-48 10 1990 8 1995 2000 6 2005 Emerging Young 4 2010 Adult Cohort 2 0 Source: Culhane et al. (2013)/ New York City Department of Homeless Services Shelter Utilization Data

Shelter use among singles 50 and older 13,000 12,157 11,199 11,000 9,723 244% Increase 8,768 9,000 7,833 7,373 6,884 6,661 7,000 6,361 6,244 5,993 5,805 5,274 4,882 5,000 4,532 4,176 4,089 3,973 3,782 3,531 3,000 1,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 -1,000

Shelter use among singles 18-25 6,000 102% 5,496 5,509 Increase 5,037 5,033 5,170 5,000 4,760 4,315 4,407 4,188 4,343 4,356 4,400 3,956 4,000 3,398 2,673 2,809 2,986 2,941 2,887 3,000 2,723 2,000 1,000 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Youngest and Oldest Account for 89% of Shelter Use Increase 40,000 14,000 35,000 12,000 Shelter Users by Age Group 30,000 10,000 All Shelter Users 25,000 8,000 20,000 6,000 15,000 4,000 10,000 2,000 5,000 0 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 All Shelter Users 25 and Younger Older than 50

Age Distribution of all Adults in Shelter: 2014 15,142 16,000 14,833 1,271 13,980 people 30 or younger 14,000 1,714 in adult-only households 12,000 10,872 6,105 9,020 10,000 8,103 7,474 7,266 5,620 8,000 1,512 3,219 4,314 2,189 1,030 12,157 6,000 3,108 1,107 724 713 684 4,000 5,509 5,561 4,353 4,145 2,000 3,993 3,682 - 18-25 26-30 31-35 36-40 41-45 46-50 51+ Singles Adult Families Families with Children

Projected Health Care Costs Total Persons (Age 60+) Cumulative Cost (Age 60+) 100,000 $3.00 Cumulative Health Care Costs (in Billions) 86,358 90,513 90,000 Total Homeless Persons Age 60+ $2.50 $2.41 80,000 68,709 $2.31 70,000 $2.00 54,658 60,000 $1.84 50,000 $1.50 $1.45 40,000 $1.00 30,000 20,000 $0.50 10,000 0 $0.00 2010 (Estimated) 2015 2020 2025 (Forecasted) (Forecasted) (Forecasted) Source: Author Estimates Based Data from U.S. Census Bureau, AHAR Report and U.S. Department of Veterans Affairs. Note: Cost estimates based on use of VA healthcare services and should be interpreted cautiously.

Can permanent housing lead to cost savings for health care systems? How much? Cumulative Cost (Age 60+) If Housed 100,000 $3.00 Cumulative Health Care Costs (in Billions) 90,000 $2.50 $2.41 80,000 $2.31 70,000 $2.00 $1.84 60,000 50,000 $1.50 $1.45 $1.45 ? $1.60 ? $1.50 $1.30 ? 40,000 $1.00 30,000 20,000 $0.50 10,000 0 $0.00 2010 (Estimated) 2015 (Forecasted) 2020 (Forecasted) 2025 (Forecasted)

Intervention Opportunities • Income – Younger: Jobs and Job Training – Older: SSI • Services – Younger: Behavioral Health Supports – Older: Chronic Disease Management • Housing – Younger & Older: Rapid Rehousing – Shallow Subsidies and PSH

Homeless among Families? • Family Options Study: Conclusive evidence of positive impact of housing subsidy • Challenge: How to manage demand and increase volume of vouchers? • For now, prevention and rapid rehousing are the “light touch” alternatives to shelters and hotels • Progressive Engagement is a moral hazard risk mitigation approach to identify sustained need… • But not ideal. Better to expand housing assistance, consider time limits and targeting to young families with pre-school children

Thank you for joining us! Save the date! CCEH 17th Annual Training Institute May 16, 2019