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Ending Homelessness in Our Time: Why Smart Government Is Key Wednesday, December 14, 2011 - by Shaun Donovan

In the current political climate, the debate over governments role has often been about more versus less, more government services, programs, and taxpayer dollars, versus reduced services, fewer rules, and less federal investment.

But my two decades of experience in the public and private sectors tells me that families sitting around the kitchen table and sending their kids to school every morning aren’t interested in abstract theories about whether government should be big or small. They simply want to know whether it can be smart and whether their tax dollars are producing results that impact their lives and communities in a positive way.

Of all the challenges I’ve faced as President Obama’s Secretary of Housing and Urban Development (HUD) these past three years, few illustrate this point more clearly than the issue of homelessness. America pays an extraordinary price for homelessness: from the tremendous human toll it takes on the men, women, and especially children caught up in the nightmare existence of life on the streets, to the costs associated with the revolving door of shelters, emergency rooms, and jail cells that result. Perhaps the steepest cost associated with homelessness is the mistaken belief that nothing can be done to stop it.

Less than a decade ago, it was widely believed that people we often refer to as chronically homeless—those who struggle with chemical dependency and mental illness and cycle through the shelter, criminal justice, and healthcare systems—would always be homeless. Some even suggested these people wanted to be homeless.

But leaders outside Washington—from rural Mankato, Minnesota, to urban San Francisco—refused to believe the chronically ill, long-term homeless population couldn’t be helped. More than 300 communities committed themselves to ending chronic homelessness, partnering with local and state agencies and the private and nonprofit sectors. By combining housing and supportive services, they led a remarkable fight that has reduced the number of chronically homeless by more than a third in five years.

These communities are proving what just a few years ago seemed nearly impossible: that homelessness can be solved in America. Not reduced or managed, but actually ended.

That is why President Obama’s bold commitment to ending homelessness is so important. In releasing Opening Doors: the Federal Strategic Plan to Prevent and End Homelessness in 2010, President Obama made clear that ending homelessness is the right thing to do for Americas homeless population and the smart thing to do for taxpayers.

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The most far-reaching and ambitious plan in our history to put the nation on a path toward ending all types of homelessness, Opening Doors, represents the culmination of more than a decade of testing new approaches and implementing new strategies in communities around the country. It commits our country to ending chronic homelessness and homelessness among veterans in five years, and ending homelessness for families, youth, and children within a decade, while putting us on a path to end all homelessness – breaking down bureaucracy and funding what works to get results.

Doing What Works

Over the past three decades, we’ve learned a lot about homelessness. The most important lesson is that in almost every case, homelessness isn’t an intractable problem, but one that can be solved with the right tools and approaches.

Second, we’ve learned that one size doesn’t fit all: different populations have different needs that sometimes require very different solutions. For instance, where a veteran returning from Afghanistan might need treatment for post-traumatic stress disorder to stay stably housed, the solution to homelessness for a family may be something as simple as paying a security deposit or a utility bill.

At a time when we should be using every taxpayer dollar as effectively and efficiently as possible, we need to focus our resources on doing what works – on evidence-based solutions that have been tried, tested, and have produced results. The two approaches that have shown the most success for the largest number of people are permanent supportive housing and rapid re-housing.

Permanent Supportive Housing

Over the last five years, and beginning with the Bush administration, the emergence of permanent supportive housing—housing connected with health and social services—has literally changed the face of homelessness in many communities. Working in collaboration with the federal government, localities have created thousands of units of permanent supportive housing and reduced the number of chronically homeless people across the nation by more than a third.

The number of beds for permanent supportive housing has increased by 34 percent since 2007. Because affordable housing with necessary services generally costs less than those associated with multiple emergency room visits and stays in jail, this shift in focus to permanent supportive housing has saved significant money for the taxpayer.

Armed with this proven success, HUD, with support from President Obama and Congress, has made an unprecedented commitment to permanent supportive housing to end homelessness for people with severe disabilities and long histories of homelessness.

Homeless Prevention and Rapid Re-Housing

Another proven solution to ending homelessness that we’ve embraced is the combination of prevention and rapid re-housing. In 2009, the American Recovery and Reinvestment Act created the Homeless Prevention and Rapid Re-housing Program (HPRP), and earlier

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this year, the program marked an important milestone, saving more than 1 million people from homelessness.

HPRP has helped homeless men and women transition into permanent supportive housing – often providing those at risk of homelessness with something as simple as a security deposit. For the majority of the people assisted by HPRP to date, it was the programs ability to help them find or stabilize housing arrangements quickly and effectively that made the difference.

Grantees report that fully 90 percent of people assisted by HPRP in its first year successfully found permanent housing. In a state like Michigan, 94 percent of homeless persons in rapid re-housing didn’t fall back into homelessness. That’s an impressive record.

We’ve seen similar successes across the country. These funds have helped speed progress in states like Utah, which over the last few years has invested in permanent supportive housing – helping reduce chronic homelessness by nearly 70 percent since 2005. By targeting its HPRP resources to rapid re-housing, Utah was able to reduce chronic homelessness an astounding 26 percent over the last year alone.

In addition, HPRP introduced a new federal commitment to help people avoid homelessness altogether. According to the report, more than three out of every four people assisted by HPRP received homelessness prevention services.

While the lives of those who were homeless or at risk of homelessness have been helped dramatically by the HPRP approach, just as significant is how HPRP is fundamentally changing the way communities respond to homelessness, as the U.S. Conference of Mayors put it.

For instance, Cleveland’s Continuum of Care program is using HPRP funds to create a central intake system that provides customized services to those entering the shelter system. This helps the community not only manage beds and services more effectively but also ensures that households are transitioning to permanent housing as quickly as possible.

Cleveland provides a good example of how a federal program like HPRP is helping communities move from fragmented, duplicative programs to a comprehensive 21st century system that targets resources to those most in need – not with top-down rules, but with flexible tools from the ground up.

Using Existing Resources More Effectively

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In times of economic uncertainty, existing resources often fail to match the scale of need. Again, getting better results is not necessarily about more resources, its about using the resources we already have better and smarter.

In addition to using HUD resources that already target our homeless population, we are reaching out to our Public Housing Agency (PHA) partners and our private and non-profit assisted housing sponsors to guide and support them to become full partners in the effort to end homelessness.

We are encouraging peer-to-peer mentoring by PHAs that are already deeply involved in the effort to end homelessness in their communities. Plus, we are working with federal partners to improve coordination between social service agencies and PHAs to ensure formerly homeless residents have the support they need to stay in their new homes and maintain their health.

But using resources more effectively isn’t only about doing more with less. Just as often, it is also about small investments that yield big savings. One study, reported in the Journal of the American Medical Association, centered on Seattle’s 1811 Eastlake supportive housing project. Researchers examined 75 of the centers chronically homeless residents – half of whom had serious mental illness and all of whom struggled with alcohol addiction. In the year before participants in the program entered supportive housing, the 75 residents collectively spent more than 1,200 days in jail, and visited the local medical center more than 1,100 times at a cost to Medicaid of more than $3.5 million.

In the year after entering 1811 Eastlake, days spent in jail were cut almost in half. Medicaid costs dropped by more than 40 percent because hospital visits dropped by almost a third.

Another study in Chicago reached a similar conclusion. Housing assistance provided to homeless patients suffering from HIV, AIDS, or other chronic illnesses made medical services that were available so much more effective that the days in the hospital dropped 42 percent, days of required nursing home care dropped 45 percent, and most critically of all, the number of emergency room visits dropped 46 percent.

These kinds of studies have an impact on what is possible, even in tight budget environments. When I was the housing commissioner in New York City, Mayor Bloomberg and I worked with Governor George Pataki, to enter into NY/NY III –a billion dollar investment to create 9,000 new units of supportive housing for the homelessness.

Given his background in business, Mayor Bloomberg was motivated by data proving that supportive housing successfully kept people off the streets. Governor Pataki was attracted to the long-term savings – the fact that that the real cost to the taxpayer wasn’t the cost of housing the homeless, but what resulted if we didn’t.

Focusing on a Clear Set of Measurable Results

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These examples show us that government cant produce results if it doesn’t measure success. Already, HUD collects extensive data on homeless men, women, and children through annual on-the-street point-in-time (PIT) counts and through housing and shelter counts in almost every county in the nation. In addition, this year VA and HUD released a first-ever supplement to the Annual Homeless Assessment Report that specifically focuses on veterans.

This data shows declines in urban homelessness and increases in rural and suburban. Importantly, it allows us to target our efforts to the communities with the greatest need.

At the HUD headquarters building in Washington, DC, we have a map that visually represents where veterans are homeless in our country, and another map that shows where HUD-Veterans Affairs Supportive Housing (VASH) vouchers are being used – and they are virtually identical. To build on this progress, we kicked off a new process called HUDStat to hold our programs accountable for their performance.

HUDStat is already paying dividends when it comes to homelessness. Last year we partnered with the U.S. Department of Veterans Affairs (VA) to establish joint goals and monitor progress in the fight to end veterans homelessness. HUDStat helped identify promising practices and problems. Where problems arose, HUD staff quickly began to address those issues, often in collaboration with their counterparts at VA. As a result of focusing on performance and problem solving the number of veterans housed under the interagency HUD-VASH program increased by nearly 20 times in just two years. By June 2011, HUD and VA assisted nearly 30,000 veterans surpassing the programs target by 50 percent. Because of this progress, we’ve requested another 10,000 vouchers for HUD-VASH in our proposed FY2012 budget.

In the coming year, we will continue to track performance on our efforts to end veterans homelessness while adding performance measures around both family homelessness and homelessness among persons with disabilities. With data that shows the real progress were making—and the challenges that still remain—we can make the case, even in a tough budget environment, that this investment works and actually saves taxpayers money.

Coordinating Across Partners

As our work with the VA reminds us, homelessness is far more than simply a housing problem. Certainly, every homeless person living on the street lacks affordable housing, but just as often, they lack access to health and social services, and employment opportunities as well.

That’s why our efforts at HUD to end homeless have included partnerships with the Departments of Health and Human Services (HHS), Labor (DOL), VA, and Education. One partnership with DOL and VA prevents homelessness among veterans returning from Iraq and Afghanistan. Another partnership includes HUD, HHS, and the Department of Education designing a program for homeless families. Even though new funding has not yet been provided, the partnership is focusing on ways to collaboratively accomplish the goals using existing resources.

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As the HUD-VASH partnership has proved, new partnerships can be challenging at first, but communities have shown us they can be overcome and are leading the way.

For example, the Greater Kansas City area is developing a Housing Sustainability Plan that integrates many of the strategies in Opening Doors – forging partnerships at the metropolitan level among governments, local businesses and non-profits, philanthropies, and the investment community.

Nashville is using some of its HUD neighborhood stabilization grants, which help communities buy up vacant and abandoned properties, to provide rental housing to families that have lost their homes to foreclosure.

As these communities prove, ending homelessness wont be accomplished by the federal government alone or government at any level – but rather by partners across the spectrum.

Ending Homelessness in our Time

As we finish the first year of the Obama administrations effort to end homelessness under the Opening Doors strategic plan, there is much work left to be done. But already we are beginning to see results—even in the midst of the most difficult economy in decades—as we work to end homelessness among families and children by 2020, end chronic and veteran homelessness by 2015, and put ourselves on a path to end all types of homelessness.

In this age of budget deficits, some say we cant afford to be that ambitious, but I believe we cant afford not to. Whether its Utah ending homelessness for 7-in-10 of the hardest-to-house members of the population or HUD-VASH beating its goal of housing homeless veterans by nearly 50 percent, these efforts demonstrate that the real issue isn’t big or small government, but smart government.

With smart government, we can solve big problems. Few problems are bigger than homelessness. And to be sure, we will have to make our case for resources in not just this budget cycle, but in every one.

By focusing on approaches with proven success, by finding new and better ways to use existing resources, by building partnerships to provide comprehensive solutions, and by holding ourselves accountable for producing results, we can make that case – and we can end homelessness in our time.

Much work remains to be done. But with President Obama in the White House, we not only have a president who believes that no one should experience homelessness, we also have the leadership, tools, and plan in place that we need to see a day in which no one will.