Implications for Policy and Practice Dennis P. Culhane University - - PowerPoint PPT Presentation

Adult Homelessness: Risk Period or Cohort Effect? Implications for Policy and Practice

Dennis P. Culhane University of Pennsylvania

1988 Ethnographic Field Study

• Soup kitchens and shelters
• Mostly young men in 20s and early 30s
• Turnover

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 1 in 3 sheltered homeless single adult males was age 46-54 in 2010 (1 in 5 in 2000 1 in 8 in 1990)

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

Age Distribution, Male Shelter Users, US Census

23.1 26.1 43.8 18.1 18.7 32.5 5 10 15 20 25 30 35 40 45 50

1990 2000 2010 % of Single Adult Male Homeless Population

% Sheltered Single Adult Male Homeless Population Accounted For By Persons Ages 49+ and 55+, 1990-2010 Age 49+ Age 55+

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

Aging Trend Consistent Across Cities . . .

0% 2% 4% 6% 8% 10% 12% 14%

18-21 22-24 25-27 28-30 31-33 34-36 37-39 40-42 43-45 46-48 49-51 52-54 55-57 58-59 60-61 62-64 65-74 75+ % of Sheltered Adult Male Population

Age Distribution of Sheltered Adult Male Population, 2010

Boston (Suffolk County) Houston (Harris County) LA (LA County) Seattle (King County)

. . . And sub-populations, such as Veterans

5 10 15 20 25 30

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 and

• lder

% of Homeless Veteran Population

Age Distribution of Homeless Veteran Population (based on users of VA specialized homeless programs) , 2000-2010

2000 2005 2010

64% of veterans experiencing homelessness in 2010 were age 50+ (37% in 2000)

Source: U.S. Department of Veterans Affairs Homeless Program Data

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

Implications

• High mortality risk – life expectancy of 64
• Onset of chronic diseases, disability, medical

frailty

• Homelessness programs not prepared or

capable of managing

• Without housing, excess demand for acute

hospitalization and long-term care

• Need for urgency and expanded housing

capacity

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.

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

$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)

Cumulative Cost (Age 60+) If Housed

? ? ?

Can permanent housing lead to cost savings for health care systems? How much?

Conclusions

• Cohort nature means this generation will fade

away

• Parallel to the “skid row” generation in 1940-

1960’s

• A future with substantially less homelessness,

like the 1970s?

Not so fast…

• Why them?
• Easterlin: Baby boom/bust cycle
• Latter half of cohort at risk of disadvantage in

labor and housing markets

• Coming of age boomers crowd out social

welfare system

• Economic shocks can exacerbate
• Underground labor market, i.e. “crack”

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

Shelter Prevalence from 1990 - 2014

• 5,000

10,000 15,000 20,000 25,000 30,000 35,000 40,000 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Shelter Users

All Shelter Users

44% Increase 2000 - 2014

Youngest and Oldest Account for 62% in Shelter Use Increase

5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 All Shelter Users Shelter Users by Age Group All Shelter Users 25 and Younger 50 and Older

0% 5% 10% 15% 20% 25% 30% 35%

Proportion of All Shelter Users

% Men 25 or Younger % Women 25 or Younger

Share of Shelter Users 25 and Younger

86% increase among men 88% increase among women

Age Distribution of First-Time Entrants 2000-2014

100 200 300 400 500 600 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70+

Number of Entrants Age

2000 2005 2010 2014

First-Time Entrants & Chronicity: 50 & Older

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 500 1000 1500 2000 2500 3000 3500 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

% Staying Longer than 1 Year Shelter Entrants

First-Time Shelter Entrants % Chronic

75% Increase in Chronicity (10.5% to 18.3%) since 2008

Age Distribution of all Adults in Shelter: NYC 2014

5,582 4,178 4,034 3,779 4,419 5,669 11,739 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 14,906 10,905 9,061 7,571 7,332 8,211 14,724

• 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 50+ Singles Adult Families Families with Children

Conclusions

• Is rising youth homelessness really a

Millennial cohort effect?

• GFC combined with larger birth cohort

creating excess labor supply, greater social welfare demands

• Underground labor market? Idle

hands…Opiate addiction epidemic

Implications

• Can’t repeat the emergency response of the

1980s and 1990s

• Proactive engagement
• Family conflict mediation
• Behavioral health supports
• Housing supports, including contingencies
• Educational/vocational training, job subsidies
• Long-term: Anticipatory planning….