National Alliance to End Homelessness

Fact Sheets | January 24, 2010

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Chronic Homelessness
Updated January 2010

An estimated 63 percent of people who experience homelessness at any given point in time are individuals – or single adults. Most enter and exit the homeless system fairly quickly. The remainder live in the homeless assistance system; in a combination of shelters, hospitals, jails, and prisons; or on the streets. An overwhelming majority (80 percent) of single adult shelter users enter the homeless system only once or twice, stay just over a month, and do not return. Approximately 9 percent enter nearly five times a year and stay nearly two months each time. This group utilizes 18 percent of the system’s resources.

The remaining 10 percent enter the system just over twice a year and spend an average of 280 days per stay—virtually living in the system and utilizing nearly half its resources. Many of these individuals are defined by the Department of Housing and Urban Development (HUD) as chronically homeless. They often cycle between homelessness, hospitals, jails, and other institutional care and often have a complex medical problem, a serious mental illness like schizophrenia, and/or alcohol or drug addiction. There are approximately 123,790 chronically homeless individuals nationwide on any given night. Although chronic homelessness represents a small share of the overall homeless population, chronically homeless people use up more than 50 percent of the services.

Despite the difficulties in serving chronically homeless people, several cities have launched initiatives to end chronic homelessness, and many are showing results. In some cases, the results represent reductions in the number of people living on the streets. Cities with more advanced data systems are able to track reductions in chronic homelessness for people who are living in shelters. In most cases, these initiatives are part of larger efforts to end all types of homelessness.

• Chicago, Illinois reduced homelessness by 12 percent from 2005 to 2007. Homelessness among single adults declined from 4,038 to 2,807 over the same time period.
• Similar results were seen in Norfolk, Virginia. From 2006 to 2008, Norfolk reduced homelessness by 25 percent. Chronic homelessness declined from 126 in 2006 to 78 in 2008.
• Quincy, Massachusetts decreased chronic homelessness by 50 percent from 2005 to 2009.
• Wichita/Sedgwick County, Kansas had similar successes, reducing chronic homelessness by 51 percent from 2005 to 2009.

In addition to documenting their success at reducing chronic homelessness, many cities are also documenting the cost effectiveness of their efforts. Portland found that prior to entering the Community Engagement Program, 35 chronically homeless individuals each utilized over $42,000 in public resources per year. After entering permanent supportive housing, those individuals each used less than $26,000, and that included the cost of housing. While making progress toward ending chronic homelessness, Portland Oregon is saving the public over $16,000 per chronically homeless person.

The successes in these communities provide insight to effective strategies in ending chronic homelessness. Ending chronic homelessness requires permanent housing with supportive services, and implementing policies to prevent high-risk people from becoming chronically homeless.

• Housing. The most successful model for housing people who experience chronic homelessness is permanent supportive housing using a Housing First approach. Permanent supportive housing combines affordable rental housing with supportive services such as case management, mental health and substance abuse services, health care, and employment. The Housing First approach is a client-driven strategy that provides immediate access to an apartment without requiring participation in psychiatric treatment or treatment for sobriety. After settling into new apartments, clients are offered a wide range of supportive services that focus primarily on helping them maintain their housing.
• Prevention.The vast majority of people who become chronically homeless interact with multiple service systems, providing an opportunity to prevent their homelessness in the first place. Promising strategies focus on people who are leaving hospitals, psychiatric facilities, substance abuse treatment programs, prisons, and jails.

Although chronic homelessness represents a small share of the overall homeless population, its effects on the homeless system and on communities are considerable. Chronically homeless people are inefficiently served by the systems they interact with, including emergency shelters, emergency rooms, hospitals, and police departments. These systems in turn are adversely affected by chronic homelessness.

A landmark study of homeless people in Seattle, WA – known as "1811 Eastlake" – provides insight into the efficacy of permanent supportive housing on the chronically homeless population. “Housing First”, as the approach is termed, an approach to combating chronic homelessness by providing homes upfront and offering help for illnesses and addictions. The concept turns the traditional model, which typically requires sobriety before a person can get housing, upside down.

The 1811 Eastlake study compared 95 Housing First participants, with 39 wait-list control members and found cost reductions of over 50 percent for the Housing First group. While it is not the first published evidence of the service use reductions and cost savings that permanent supportive housing interventions can provide, it is worth highlighting because the level of the cost savings - almost $30,000 per person per year after accounting for housing program costs - are greater than some seminal studies that have shown more modest cost offsets through permanent supportive housing.

Guided by research, Congress has taken several steps to encourage the development of permanent supportive housing. Beginning in the late 1990s, appropriations bills have increased funding for HUD’s homeless assistance programs and targeted at least 30 percent of funding to permanent supportive housing. Congress has also provided funding to ensure that permanent supportive housing funded by one of HUD’s programs (Shelter Plus Care) would be renewed non-competitively, helping to ensure that chronically homeless people could remain in their housing.