Priority Lists, Not Waiting Lists

Let us put an end to waiting lists for housing (or – gulp – shelter for that matter).

Let us replace those lists with priority lists.

Waiting lists, with some exceptions, are not designed to serve those with the deepest needs. They are designed to serve those that have waited the longest. But here’s the thing – if I have really deep needs it is entirely possible that I will die before my time comes up on a waiting list.

Imagine if emergency rooms took the waiting list mentality. Last night, Sally stubbed her toe. She goes to the ER and is told by triage that there is nothing they really do for a stubbed toe and that she should go home. Sally insists on waiting. This morning, around 6am, Bernie sliced his finger while making breakfast. He goes to the ER. Triage tells him they aren’t sure if he is going to need stitches or not. They bandage him up. They tell him to take a seat until a doctor becomes available. They tell him that if anything changes or gets worse, to come back to the triage window. Fred had a heart attack at 9am.

Sally is still waiting.

Bernie is still waiting.

Who gets served next?

Fred.

But why? Haven’t Sally and Bernie been waiting longer? Yes they have. But Fred’s needs are more acute than Sally and Bernie. If you don’t serve Fred right away he may die. Bernie can wait a little bit. Sally, well, she may want to be served and be willing to wait all day, but she doesn’t really need the ER services.

In just about every scenario, a reasonable person would expect the person with the most urgent needs to be served next. Except that isn’t how we tend to operate affordable housing, supportive housing, or intensive support programs. Even when there is modified chronological access (a fancy term for being able to jump the queue a little bit), it is rarely based upon acuity in its totality, but rather preference for a priority population that may not be grounded in evidence.

In an era of better assessments of client needs and coordinated access, I want you to rip apart your waiting lists. Delete them from your computer. Replace them with a priority list. Triage access to housing based upon who has the highest priority for that housing and the supports that come with it. Don’t manage access by who has waited the longest. That has nothing to do with who needs it the most.