Implications for Policy and Practice Dennis P. Culhane University - PowerPoint PPT Presentation

Adult Homelessness: Risk Period or Cohort Effect? Implications for Policy and Practice Dennis P. Culhane University of Pennsylvania

1988 Ethnographic Field Study • Soup kitchens and shelters • Mostly young men in 20s and early 30s • Turnover

A Birth Cohort Phenomenon: Persons Born 1955-1965 Age Distribution, Male Shelter Users, US Census 2010(%) 2000(%) 1990(%) 31-33 49-51 12 40-42 % of Single Adult Male Homeless Pop. 1 in 3 sheltered 10 homeless single adult males was 8 age 46-54 in 2010 ( 1 in 5 in 2000 6 1 in 8 in 1990) 4 2 0 Source: Culhane et al. (2013)/ U.S. Census Bureau Decennial Census Special Tabulation

% Sheltered Single Adult Male Homeless Population Accounted For By Persons Ages 49+ and 55+, 1990-2010 Age 49+ Age 55+ 50 % of Single Adult Male Homeless Population 43.8 45 40 35 32.5 30 26.1 23.1 25 18.7 18.1 20 15 10 5 0 1990 2000 2010 Source: U.S. Census Bureau Decennial Census Special Tabulation

Aging Trend Consistent Across Cities . . . Age Distribution of Sheltered Adult Male Population, 2010 14% % of Sheltered Adult Male Population 12% 10% 8% Boston (Suffolk County) Houston (Harris County) 6% LA (LA County) Seattle (King County) 4% 2% 0% 75+ 18-21 22-24 25-27 28-30 31-33 34-36 37-39 40-42 43-45 46-48 49-51 52-54 55-57 58-59 60-61 62-64 65-74

. . . And sub-populations, such as Veterans Age Distribution of Homeless Veteran Population (based on users of VA specialized homeless programs) , 2000-2010 2000 2005 2010 64% of veterans 30 % of Homeless Veteran Population experiencing 25 homelessness in 2010 were age 50+ 20 ( 37% in 2000) 15 10 5 0 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 and older Source: U.S. Department of Veterans Affairs Homeless Program Data

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

Implications • High mortality risk – life expectancy of 64 • Onset of chronic diseases, disability, medical frailty • Homelessness programs not prepared or capable of managing • Without housing, excess demand for acute hospitalization and long-term care • Need for urgency and expanded housing capacity

Projected Health Care Costs Total Persons (Age 60+) Cumulative Cost (Age 60+) 100,000 $3.00 86,358 90,513 90,000 Cumulative Health Care Costs (in Billions) $2.50 $2.41 Total Homeless Persons Age 60+ 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 (Forecasted) 2020 (Forecasted) 2025 (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)

Conclusions • Cohort nature means this generation will fade away • Parallel to the “skid row” generation in 1940 - 1960’s • A future with substantially less homelessness, like the 1970s?

Not so fast… • Why them? • Easterlin: Baby boom/bust cycle • Latter half of cohort at risk of disadvantage in labor and housing markets • Coming of age boomers crowd out social welfare system • Economic shocks can exacerbate • Underground labor market, i.e. “crack”

Age Distribution of Prevalence Cohorts of Male Shelter Users in New York City, 1990-2010 31-33 14 12 46-48 % of Prevalence Cohort 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 Prevalence from 1990 - 2014 40,000 44% Increase 35,000 2000 - 2014 30,000 25,000 Shelter Users 20,000 15,000 10,000 5,000 - 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 All Shelter Users

Youngest and Oldest Account for 62% in Shelter Use Increase 10,000 45,000 9,000 40,000 8,000 35,000 Shelter Users by Age Group 7,000 30,000 All Shelter Users 6,000 25,000 5,000 20,000 4,000 15,000 3,000 10,000 2,000 5,000 1,000 0 0 All Shelter Users 25 and Younger 50 and Older

Share of Shelter Users 25 and Younger 35% 30% 86% increase 25% 88% among Proportion of All Shelter Users increase men among 20% women 15% 10% 5% 0% % Men 25 or Younger % Women 25 or Younger

Age Distribution of First-Time Entrants 2000-2014 600 500 400 Number of Entrants 300 200 100 0 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70+ Age 2000 2005 2010 2014

First-Time Entrants & Chronicity: 50 & Older 75% Increase 3500 25.0% in Chronicity (10.5% to 18.3%) since 3000 2008 20.0% 2500 % Staying Longer than 1 Year Shelter Entrants 15.0% 2000 1500 10.0% 1000 5.0% 500 0 0.0% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 First-Time Shelter Entrants % Chronic

Age Distribution of all Adults in Shelter: NYC 2014 16,000 14,906 14,724 6,105 1,271 14,000 1,714 12,000 10,905 5,620 10,000 9,061 8,211 4,314 7,571 8,000 7,332 1,512 3,219 3,108 2,189 1,030 6,000 724 1,107 713 684 4,000 2,000 5,582 4,178 4,034 3,779 4,419 5,669 11,739 - 18-25 26-30 31-35 36-40 41-45 46-50 50+ Singles Adult Families Families with Children

Conclusions • Is rising youth homelessness really a Millennial cohort effect? • GFC combined with larger birth cohort creating excess labor supply, greater social welfare demands • Underground labor market? Idle hands…Opiate addiction epidemic

Implications • Can’t repeat the emergency response of the 1980s and 1990s • Proactive engagement • Family conflict mediation • Behavioral health supports • Housing supports, including contingencies • Educational/vocational training, job subsidies • Long- term: Anticipatory planning….