Dr. Dennis P. Culhane Director of Research, Director of Research for - - PowerPoint PPT Presentation

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Apr 04, 2023 225 likes •484 views

CCEH 16th Annual Training Institute Keynote Speaker Dr. Dennis P. Culhane Director of Research, Director of Research for the National Center on Homelessness Among Veterans Emerging Opportunities in Homelessness Policy and Practice Dennis P.

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Dr. Dennis P. Culhane

Director of Research, Director of Research for the National Center on Homelessness Among Veterans CCEH 16th Annual Training Institute Keynote Speaker

SLIDE 2

Emerging Opportunities in Homelessness Policy and Practice

Dennis P. Culhane University of Pennsylvania

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Cluster Distributions: Persons and Shelter Days

(Single Adults in Philadelphia)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Transitional Episodic Chronic

% of Persons % Days Used

Crisi]

Crisis:

– 1.19 stays – 20.4 days

Episodic:

– 3.84 stays – 72.8 days

Chronic:

– 1.53 stays – 252.4 days

Crisis

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Characteristics by Cluster: Dated Data (Philadelphia)

Nearly all chronically homeless people have a disability:

Crisis

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Clusters by Characteristics

78.3 71.5 74.6 73.8 11.2 10.8 14.1 11.1 10.5 17.7 11.3 15.1

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Mental Illness Medical Substance Abuse Any Diagnosis Percentage of Population Background Characteristics by Cluster Transitional Episodic Chronic

Crisis Most homeless people with a disability experience Crisis Homeless

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Crisis Homelessness in the US in 2014 (Adults and Families):

Scope: PIT: 452,747 Annual: 900,400

34.5 13.1 52.4

Annual Number of Persons

Homeless in Family Chronic Homeless Non- chronic Homeless Adults Adults 14.2 17.2 68.6

Annual Number of Households

Family Households Chronic Homeless Non-chronic Homeless

Adults Adults

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Dynamics:

Pattern of Homeless Service Use among Sheltered

Individuals: Length of Stay (AHAR)

37.5% 28.9% 33.5% 5 10 15 20 25 30 35 40 7 days or less 8 to 30 days 31 to 180 days Percentage of users Length of Stay

(Only stays less than 180 days)

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Where Do the Single Adults Come from?

24.4% 22.1% 14.3% 13.4% 25.8% Institution Friends Own house/Apt. Other Family 28.9 40 15 13.4 2.7

Institutions

S.A Tx Jail Hospital Psychiatric Facility Foster Care

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Rapid Rehousing

Critical Time Intervention (CTI)- Potential for

Medicaid reimbursement

SSVF- Veteran exemplar, approximately

120,000 non-chronic adult and family HHs served in 2017.

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SSVF Rapid Rehousing: Housing Retention

0.8 0.82 0.84 0.86 0.88 0.9 0.92 0.94 0.96 0.98 1 1 18 35 52 69 86 103 120 137 154 171 188 205 222 239 256 273 290 307 324 341 358 Survival Proportion Days Since SSVF

Singles Families 1 Year Singles: 15.7% Families: 10.1%

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Critical Time Intervention

Critical Time Intervention (CTI)

– Time-limited support during period of transition

Potential Medicaid reimbursement

Phase 3: Transition of Care (~3 months)

End services with support network firmly in place

Phase 2: Try-out (~3 months)

Monitor client and support network

Phase 1: Transition (~3 months)

Connect clients to supports

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Crisis Homelessness Recap

Most homeless adult and family households

experience crisis homelessness (68.6%)

24.4% come out of institutions.
Most disabled adults experience crisis

homelessness

SSVF proves rapid rehousing works
Medicaid could pay for CTI

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A Birth Cohort Phenomenon: Persons Born 1955-1965

2 4 6 8 10 12

% of Single Adult Male Homeless Pop. 2010(%) 2000(%) 1990(%)

31-33 40-42 49-51

Source: Culhane et al. (2013)/ U.S. Census Bureau Decennial Census Special Tabulation

Age Distribution, Male Shelter Users, US Census

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Aging Trend Is Quite Distinct from the Aging of General Population

2 4 6 8 10 12

% of Total

2010 (Homless Pop.) 2010 (General Pop.) 49-51 (11.3%) 49-51 (5.9%)

Source: U.S. Census Bureau Decennial Census Special Tabulation

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2 4 6 8 10 12 14 % of Prevalence Cohort

Age Distribution of Prevalence Cohorts of Male Shelter Users in New York City, 1990-2010

1990 1995 2000 2005 2010

Emerging Young Adult Cohort

31-33 46-48

Source: Culhane et al. (2013)/ New York City Department of Homeless Services Shelter Utilization Data

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3,531 3,782 3,973 4,089 4,176 4,532 4,882 5,274 5,805 5,993 6,244 6,361 6,661 6,884 7,373 7,833 8,768 9,723 11,199 12,157

1,000

1,000 3,000 5,000 7,000 9,000 11,000 13,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Shelter use among singles 50 and older

244% Increase

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2,723 2,941 2,887 2,673 2,809 2,986 3,398 3,956 4,315 4,407 4,188 4,343 4,356 4,400 4,760 5,037 5,033 5,170 5,496 5,509 1,000 2,000 3,000 4,000 5,000 6,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Shelter use among singles 18-25

102% Increase

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Youngest and Oldest Account for 89% of Shelter Use Increase

2,000 4,000 6,000 8,000 10,000 12,000 14,000 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Shelter Users by Age Group All Shelter Users

All Shelter Users 25 and Younger Older than 50

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5,509 4,145 3,993 3,682 4,353 5,561 12,157 3,219 1,107 713 684 724 1,030 1,714 6,105 5,620 4,314 3,108 2,189 1,512 1,271 14,833 10,872 9,020 7,474 7,266 8,103 15,142

2,000

4,000 6,000 8,000 10,000 12,000 14,000 16,000

18-25 26-30 31-35 36-40 41-45 46-50 51+

Singles Adult Families Families with Children

Age Distribution of all Adults in Shelter: 2014

13,980 people 30 or younger in adult-only households

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54,658 68,709 86,358 90,513 $1.45 $1.84 $2.31 $2.41

$0.00 $0.50 $1.00 $1.50 $2.00 $2.50 $3.00 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 100,000

2010 (Estimated) 2015 (Forecasted) 2020 (Forecasted) 2025 (Forecasted)

Cumulative Health Care Costs (in Billions) Total Homeless Persons Age 60+

Total Persons (Age 60+) Cumulative Cost (Age 60+)

Projected Health Care Costs

Source: Author Estimates Based Data from U.S. Census Bureau, AHAR Report and U.S. Department of Veterans Affairs. Note: Cost estimates based on use of VA healthcare services and should be interpreted cautiously.

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$1.45 $1.84 $2.31 $2.41 $1.45 $1.60 $1.50 $1.30