Waiting Lists to Nowhere for the “Un-houseable”: How Not to Do Coordinated Access

Assessing for the sake of assessing sucks. That isn’t coordinated access. That is a bureaucratic response (and not just government) to the issue that solves nothing.

Recently I was in a community that has been putting coordinated access into place over the last few months. In an effort to get community buy-in, their weekly meeting of housing providers allows for over-ride of assessment if the person is deemed to be too complex. Want to guess what is happening? They have a list of dozens of names of people with higher acuity that no housing provider is stepping up to house.

Creating waiting lists of people with complex issues instead of solving their homelessness is not about ending homelessness. It is a waiting list to nowhere.

Who are these people on the waiting list? Yes, they all have higher acuity. To a person they have co-occurring, complex issues across quite a spectrum – substance use, mental health issues, physical health issues, involvement in high risk and exploitive situations, numerous interactions with emergency services, and more. But in addition to that, they are almost exclusively people that have been housed several times before. They are the waiting list of people waiting to be re-housed…people that previous attempts at housing have broken down because of partying, guests, drug use, noise complaints, loneliness, paranoia, etc.

If we want to truly end homelessness this is the exact population we need to figure out not only how to house, but how to keep housed. If we want coordinated access to work we can’t allow there to be an over-ride to not accept the “unhouseable” and instead we need to put our collective wisdom together to figure it out.

Study after study, community after community, shows that 80% or more of people with complex issues in a Housing First program will remain housed. That means that at least 20% in each community are not. I suspect that is the group on the waiting list to nowhere. It is when we figure out how to meaningfully house and support this group that coordinated access will really make a difference and we will truly end homelessness.