Defining an End to Homelessness

This blog is part of the “You asked for it” series. In December, on the OrgCode FaceBook page I asked people want blogs they wanted to see. These blogs are a direct response to the most popular suggestions. This one goes out to Angela in Waterloo. She asked for a blog about “How do you define ‘ending homelessness’. Some communities are saying they’ve ‘functionally’ ended it. Provide a clear definition of that, for example.”

When a person or family is housed, their homelessness has ended. That is rather absolute. But the question, I think, has more to do with how can we define “ending homelessness” at a city, regional or national level.

Those of you north of the border having likely heard lots about how Medicine Hat in Southeast Alberta is going to be the first city in Canada to end homelessness. They are certainly on track to do that. (As an aside, Tracy from our team used to live there and organized the infrastructure and plan to end homelessness for the city; Jeff from our team still lives there and used to do SPDAT assessments for entry into Rapid Re-Housing and Housing First; and, in the first few years of the program I visited the city at least four times a year to provide training and coaching). Does it mean all shelter beds will be closed in Medicine Hat? No. Does it mean that no one will ever experience homelessness ever again in Medicine Hat? No. What it does mean is that there is a housing focus to all service delivery; that they have adjusted investment in services to reflect solutions rather than crises; and, no person experiencing homelessness will ever have to spend 30 or more days homeless before getting housed again. The last Point in Time Count they did found less than a handful of people living outdoors. Even the Mayor of Medicine Hat has become a huge convert to Housing First.

Those of you south of the 49th Parallel likely have heard plenty about Phoenix and Salt Lake City ending chronic homelessness amongst veterans. This is a slightly different kettle of fish that required some thoughtful analysis and commentary in those communities to explain the remarks. In December 2013, Mayor Stanton of Phoenix declared on MSNBC that they had ended chronic homelessness amongst veterans. Only a couple weeks later, Mayor Becker of Salt Lake City made the same claim, also on MSNBC. For the sector as a whole, in cities far away from Salt Lake and Phoenix, this was an overall win – “proof” that it was possible to align political will and services to put an end to homelessness for this population. Within Salt Lake and Phoenix, however, you could still find veterans experiencing homelessness, which caused some to question exactly why Mayors Becker and Stanton had made such claims. Were they lying? Was it all spin? Or did the truth lie in how to define what was occurring?

The biggest problem with trying to define an end to homelessness (or defining “homelessness” itself for that matter), is that homelessness is always in a state of flux. While one person gets housing, another person may become homeless. As one chronically homeless person makes his way into housing, another person reaches (for example) the length of time threshold required to qualify as chronically homeless. Because homelessness is not static, there will always need to be a balance between real time data and population prioritization data, which likely is from a list compiled historically.

Phoenix is a good example of prioritization data historically influencing how the data was interpreted and considered. In short, it went something like this: through a Stand Down event for veterans on Veterans Day in 2011 a list of chronically homeless veterans was compiled with slightly more than 220 chronically homeless veterans identified; that data was updated and augmented through other sources; the number was down to 145 in February 2013, just over 50 in October 2013, and down to zero just before Mayor Stanton made the announcement. In real time (as of the day you read this) are there zero chronically homeless veterans in Phoenix? Unlikely. But don’t interpret that as failure. More on that in a moment.

The Salt Lake experience used a similar approach, and there are some lessons that should be learned from them as well. First of all, Salt Lake City demonstrates the importance of confirming homelessness status – including chronic homeless status or veteran status – as the number decreased from the initial list collected because of ineligibility. Salt Lake also experienced a situation encountered very commonly in other communities and with other populations: difficulty locating some people when it was time to house them, even when there were vouchers available.

Is change in eligibility status just a convenient way to decrease the size of the issue? No. The reality is that definitions matter when it comes to resource allocation, so not meeting eligibility criteria is very important. Should Salt Lake have waited until they had located and housed the last of all people they had first identified? Nope. You have to work with the population you can actually work with, and with absolute uncertainty as to where the un-locatable people went, it would be foolish to spend considerable resources waiting and tracking people down, especially when they may have left town.

What can actually be ended?

Chronic homelessness can be ended. It can be defined. There are support and service interventions, as well as resources, that allow for an end to chronic homelessness. Phoenix and Sal Lake City are examples of ending homelessness within a sub-population of the chronic homeless populations: veterans. If you look at Salt Lake City you will also see that some resources were not veteran-specific that were used, in addition to veteran-specific resources. It is entirely possible that ending chronic homelessness amongst non-veterans was influenced negatively by this decision.

Episodic homelessness can be ended. It, also, can be defined. There are support and service interventions, as well as resources like shallow or time limited subsidies, that allow for episodic homelessness to not be repeated. The case of Medicine Hat is one where both chronic homelessness and episodic homelessness, by measuring acuity and aligning system resources, allowed both groups to be addressed and not just one at the expense of the other.

In both of the above (chronic and episodic homelessness), a functional zero would be occurring when the availability of resources exceeds the size of the population needing the resources. In other words, your community would have enough things like vouchers, rent geared to income housing, and case manager resources to meet the needs of everyone in the episodic or chronic homelessness group that wanted the resources.

Would all shelters close in a community where this happens? No. There will still be people that experience homelessness for the first time. We will never be able to prevent all people from never becoming dislodged from housing – nor would it be a practical use of resources to attempt to do so.

Would there never be street (outdoor) homeless where this happens? You cannot guarantee that either. Housing is a voluntary choice. Nobody should ever be forced, tricked or coerced into accepting housing. But we should know each of those people by name and have a plan for each.

Are Phoenix, Salt Lake City and Medicine Hat examples of perfect systems? Not at all. I’d argue, for example, that Medicine Hat could still improve its diversion techniques, its use of interim housing, and expand its permanent supportive housing options. I’d also argue, for example, that Phoenix needs to wrestle its behemoth campus for singles into a unified, integrated support network across multiple organizations. I’d also argue, for example, that Salt Lake City needs an improved housing focus to things like the major day resources and street outreach. Each of these cities have accomplishments to be remarkably proud of, but none of them have yet achieved a unified, system-wide, functional end to homelessness. They have achieved it for subsets of the population – or in the case of Medicine Hat, are at the precipice of doing it as a whole.

What it all comes down to when we talk about definitions and achievements is that any end to homelessness has to look at the supply to demand relationship. Because chronic and episodic homeless populations are more easily identifiable, and arguably more stable and predictable, it is possible to better target and rationalize the use of resources for these groups. It is also possible to prioritize through an acuity tool, the order in which people that meet these groups should be housed and supported. Homelessness is ended when the availability of supply means no person or family has to experience homelessness for a prolonged period of time. To ensure the system becomes aligned in this way, it is helpful to: allocate resources specifically for chronic and episodically homeless people; prioritize within these resources (the most acute persons first); support and allocate resources differently for newer homeless persons; have a strong housing orientation to the entire service delivery system (shelters, outreach, drop-ins, day centers, food programs, etc.); eliminate any program that incentivizes homelessness, even if well intentioned (for example: access to employment or health services only if homeless); and, stop trying to heal or fix people or convert people to a particular faith, and instead focus on properly supporting imperfect people in housing, regardless of faith (or lack thereof) or perceived sins or shortcomings.

If you desire an absolute end to homelessness, it will be VERY different than what it is required to have a functional end to homelessness. Anabsolute end to homelessness would require undoing the policy and program implications from the last two generations. As I lay out what this would require, you will probably realize this to be a dream, not an attainable reality in our lifetime. To achieve absolute homelessness, the supply of truly affordable housing (ample available stock across all income cohorts and household sizes) would need to exceed demand; income assistance rates and government benefits would have to increase in just about every community and be indexed to inflation annually; minimum wages would need to adjust to living wages; access to health care would need to be free and readily available; resources to assist families and persons with inter-personal conflict would need to be readily available and free; mental health resources would need to be readily available and free; availability of employment for lower skilled persons would be necessary; reintegration would need to be improved for persons leaving incarceration and we would need to remove barriers to housing and employment for persons with a history of felony convictions; community-based care and support would need to be expanded in the health care system; free long-term and nursing care for older adults and persons with acute health issues would need to be expanded and free; transition programs for persons ageing out of care would need to be more robust and resourced differently than they are currently; integration and support programs for newcomers to the country would need to be expanded and resourced much more than they are currently; inter-generational trauma for some population groups (such as indigenous persons) would need to be better resolved; domestic and intimate partner violence would need to cease; all parents would need to become fully accepting of their gay, lesbian, bisexual, queer, questioning, transgendered, trans-sexual, and two-spirited children (and any variation of gender identity or sexual preference other than heterosexual) and never kick them out of the home; there would be more evidence on the types of substance use treatment is more effective than others in different situations and expanded upon, as well as being free; and, there would never be anyone displaced by fire or other unforeseen event or disaster.

So, it is probably best that we focus on a functional end to homelessness. We should look to places like Medicine Hat to see what that looks like in practice, and learn from places like Phoenix in Salt Lake City as they formed their approach and prioritized resources. We should scale the amount of resources we have to the size of the need, and allocate them through prioritization. We should do this through heightened coordination across service providers, and with the needs of the end user of services in mind always.