Permanent Supportive Housing MHSA Webcast Training Series

1. Permanent Supportive HousingMHSA Webcast Training Series Leslie Wise Program Manager Corporation for Supportive Housing October 13, 2005

2. Our Mission CSH helps communities create permanent housing with services to prevent and end homelessness.

3. What Is Supportive Housing?A cost-effective combination of permanent, affordable housing with services that helps people live more stable, productive lives.

4. HOUSING PERMANENT: Not time limited, not transitional; AFFORDABLE: For people coming out of homelessness; and INDEPENDENT: Tenant holds lease with normal rights and responsibilities. SERVICES FLEXIBLE: Designed to be responsive to tenants’ needs; VOLUNTARY: Participation is not a condition of tenancy; and INDEPENDENT: Focus of services is on maintaining housing stability. Housing & Services

5. Supportive Housing is for People Who:  Are chronically homeless Cycle through institutional and emergency systems and are at risk of long-term homelessness Are being discharged from institutions and systems of care Without housing, cannot access and make effective use of treatment and supportive services

6. Services Make the Difference  Flexible, voluntary Counseling Health and mental health services Alcohol and substance use services Independent living skills Money management / rep payee Community-building activities Vocational counseling and job placement the services that make the difference in being housed versus homeless services such as these, in combination with a decent place to live, provide the support system people need to break out of the cycle of long-term homelessness the services that make the difference in being housed versus homeless services such as these, in combination with a decent place to live, provide the support system people need to break out of the cycle of long-term homelessness

7. Models for Supportive Housing: Traditional Development Creates a permanent asset to the community Involves acquisition and construction and the full compliment of development activities, including finding capital funding. Can take 2-3 years (or more) to develop Involves establishing on-going funding sources and providers for operating and services Now, how to create it. I will start on the housing side. There are two main options – traditional development or bricks and mortar approach vs. accessing existing housing. Each has it’s pluses and minuses so both should be considered when thinking about what you will pursue. And you can certainly work on more than one approach to serve your needs. Now, how to create it. I will start on the housing side. There are two main options – traditional development or bricks and mortar approach vs. accessing existing housing. Each has it’s pluses and minuses so both should be considered when thinking about what you will pursue. And you can certainly work on more than one approach to serve your needs.

8. Models for Supportive Housing: Accessing Existing Housing Sometimes referred to as “Housing First” Also might be referred to as Scattered Site Housing Integrates residents into the community Can “retrofit” existing affordable housing and add services in a single site Once secure rental subsidy secured, can move very quickly Involves establishing ongoing funding sources and providers for operating and services Sometimes referred to as “Housing First,” if you are moving people right into housing on the private market straight from the street or shelter. Also might be referred to as Scattered Site Housing - this model involves accessing existing rental units in the community and adding wrap around services Integrates residents into the community Also can look to “retrofit” existing affordable housing and add services in a single site Once secure rental subsidy, can move very quickly Involves establishing ongoing funding sources and providers for operating and services Sometimes referred to as “Housing First,” if you are moving people right into housing on the private market straight from the street or shelter. Also might be referred to as Scattered Site Housing - this model involves accessing existing rental units in the community and adding wrap around services Integrates residents into the community Also can look to “retrofit” existing affordable housing and add services in a single site Once secure rental subsidy, can move very quickly Involves establishing ongoing funding sources and providers for operating and services

9. Using existing apartments in the community Provider does not own units but might master lease No rehabilitation or construction involved – take apartments “as is” Owner of apartments typically private landlords who own large and small apartment buildings or 2-4 family houses Scattered Site: One Example Challenges of scattered site leasing: Unavailability of apartments in some markets; FMRs below market rents Clients screened out – criminal background checks, poor references, discrimination Poor housing quality limiting choices Why look at this approach? Development is scary and takes too long Development partners are hard to find Capital financing not readily available Fear of losing service funding “Ethical” issue – if someone is homeless, get them something, anything, rather than wait for the right kind of housing Challenges of scattered site leasing: Unavailability of apartments in some markets; FMRs below market rents Clients screened out – criminal background checks, poor references, discrimination Poor housing quality limiting choices Why look at this approach? Development is scary and takes too long Development partners are hard to find Capital financing not readily available Fear of losing service funding “Ethical” issue – if someone is homeless, get them something, anything, rather than wait for the right kind of housing

10. The city of SF acquires sites for the DAH program through “master leasing” Most units have private baths and shared cooking facilities DAH housing presently includes: The Camelot Hotel (51) Windsor Hotel (78 units) Star Hotel (54 units) Pacific Bay Inn (75 units) Le Nain Hotel (86 units) Broderick Street Adult Residential Care Facility (34 units).    Direct Access to Housing in CA This model involves take over large parts of privately owned property for use as SH. Housing Description: DAH housing presently includes the Camelot Hotel (51), Windsor Hotel (78 units), Star Hotel (54 units), Pacific Bay Inn (75 units), Le Nain Hotel (86 units) and the Broderick Street Adult Residential Care Facility (34 units). The majority of the units have private baths and shared cooking facilities.  At the residential care facility, three meals per day are prepared for the residents. The city of SF acquires sites for the DAH program through a practice known as “master leasing”.  The main benefits of this approach include the ability to rapidly bring units on-line and the reliance on private capital for the upfront renovation costs.  In addition, the renovated buildings combined with on-site services stabilize properties that have often been problematic for the surrounding neighborhood.   This model involves take over large parts of privately owned property for use as SH. Housing Description: DAH housing presently includes the Camelot Hotel (51), Windsor Hotel (78 units), Star Hotel (54 units), Pacific Bay Inn (75 units), Le Nain Hotel (86 units) and the Broderick Street Adult Residential Care Facility (34 units). The majority of the units have private baths and shared cooking facilities.  At the residential care facility, three meals per day are prepared for the residents. The city of SF acquires sites for the DAH program through a practice known as “master leasing”.  The main benefits of this approach include the ability to rapidly bring units on-line and the reliance on private capital for the upfront renovation costs.  In addition, the renovated buildings combined with on-site services stabilize properties that have often been problematic for the surrounding neighborhood.  

11. Identifying privately-owned buildings that are vacant or nearly vacant where the building’s owners are interested in entering into a long-term lease Negotiating improvements to the residential and common areas of the building prior to executing the lease SFDPH contracts with one or more organizations to provide on-site support services and property management Most buildings include a collaborative of two or more entities Key Components of Master Leasing Identifying privately-owned buildings that are vacant or nearly vacant where the building’s owners are interested in entering into a long-term lease with SFDPH.  These are triple net leases with the owner retaining responsibility only for large capital improvements. Negotiating improvements to the residential and common areas of the building prior to executing the lease. It is the owner’s responsibility to deliver the building with improvements completed and in compliance with all health and safety codes.  Improvements typically include build-out of supportive service and property management offices, community meeting rooms, community kitchens, and additional bathrooms.  All rooms are fully furnished prior to occupancy. SFDPH contracts with one or more organizations to provide on-site support services and property management.  Most buildings include a collaborative of two or more entities. Identifying privately-owned buildings that are vacant or nearly vacant where the building’s owners are interested in entering into a long-term lease with SFDPH.  These are triple net leases with the owner retaining responsibility only for large capital improvements. Negotiating improvements to the residential and common areas of the building prior to executing the lease. It is the owner’s responsibility to deliver the building with improvements completed and in compliance with all health and safety codes.  Improvements typically include build-out of supportive service and property management offices, community meeting rooms, community kitchens, and additional bathrooms.  All rooms are fully furnished prior to occupancy. SFDPH contracts with one or more organizations to provide on-site support services and property management.  Most buildings include a collaborative of two or more entities.

12. Dividing responsibilities Property managers maintain health and quality of life in the building as a whole Support service providers work with individual tenants and advocate on their behalf during periods of relapse Having mixed populations in buildings Ensures that not all tenants at a site require extensive support or have difficulties meeting terms of their leases Offering alternative accommodations at other sites during relapse or crisis Screening and structure can create supportive environments for those who agree to participation in treatment This is minority of extremely long-term homeless

13. Consensus among experts and policy-makers Responds to documented needs and preferences of consumers Documentation of supportive housing model(s) and agreement on (most) key principles A growing body of evidence from research Is Supportive Housing an Evidence-Based Practice?

14. More than 80% of supportive housing tenants are able to maintain housing for at least 12 months Most supportive housing tenants engage in services, even when participation is not a condition of tenancy Use of the most costly (and restrictive) services in homeless, health care, and criminal justice systems declines Nearly any combination of housing + services is more effective than services alone “Housing First” models with adequate support services can be effective for people who don’t meet conventional criteria for “housing readiness”

15. A Cost-Effective Solution  Providing a mentally ill person with permanent supportive housing costs only $995 per year more than allowing that person to remain homeless The most comprehensive case for supportive housing is made by a recently released study from the University of Pennsylvania's Center for Mental Health Policy and Services Research.  Researchers tracked the cost of nearly 5,000 mentally ill people in New York City for two years while they were homeless and for two years after they were housed.  They concluded: + Supportive and transitional housing created an average annual savings of $16,282 by reducing the use of public services: 72% of savings resulted from a decline in the use of public health services; 23% from a decline in shelter use; and 5% from reduced incarceration of the homeless mentally ill. This reduction in hospitalizations, incarcerations, and shelter costs nearly covered the cost of developing, operating and providing services in supportive housing.  After deducting the public benefits, the average NY/NY supportive housing unit cost only $995 per year. In other words, based on the most conservative assumptions - without taking into account the positive impacts on health status and employment status, or improvements to neighborhoods and communities - it costs little more to permanently house and support people than it does to leave them homeless. The reduction in hospitalizations, jail time, and shelter costs nearly covered the cost of building, operating and providing services in supportive housing The most comprehensive case for supportive housing is made by a recently released study from the University of Pennsylvania's Center for Mental Health Policy and Services Research.  Researchers tracked the cost of nearly 5,000 mentally ill people in New York City for two years while they were homeless and for two years after they were housed.  They concluded: + Supportive and transitional housing created an average annual savings of $16,282 by reducing the use of public services: 72% of savings resulted from a decline in the use of public health services; 23% from a decline in shelter use; and 5% from reduced incarceration of the homeless mentally ill. This reduction in hospitalizations, incarcerations, and shelter costs nearly covered the cost of developing, operating and providing services in supportive housing.  After deducting the public benefits, the average NY/NY supportive housing unit cost only $995 per year. In other words, based on the most conservative assumptions - without taking into account the positive impacts on health status and employment status, or improvements to neighborhoods and communities - it costs little more to permanently house and support people than it does to leave them homeless. The reduction in hospitalizations, jail time, and shelter costs nearly covered the cost of building, operating and providing services in supportive housing

16. Supportive Housing: It Works summary of key findings from a range of studies ER visits down 57% Emergency detox services down 85% Incarceration rate down 50% 50% increase in earned income 40% rise in rate of employment when employment services are provided More than 80% stay housed for at least one year These figures are from evaluations and studies undertaken in places such as Baltimore, Boston, San Diego, San Francisco, and Hennepin County, Minnesota. These figures are from evaluations and studies undertaken in places such as Baltimore, Boston, San Diego, San Francisco, and Hennepin County, Minnesota.

17. Hospital inpatient care for medical and psychiatric conditions Hospital emergency room visits – especially for the most frequent users of ER Psychiatric emergency and institutional care Residential mental health & substance abuse treatment – especially detox Jails and prisons Emergency shelters

18. Outpatient primary and specialty medical care Some mental health services (e.g. case management, pharmacy) Methadone (more consistent participation) Services to address substance-abuse problems, including services delivered outside of traditional treatment programs Vocational and employment services Probation

19. “Getting mentally ill people off the streets and into supportive housing costs taxpayers only slightly more than leaving them to fend for themselves…” The Wall Street JournalMay 2, 2001

20. To learn more about supportive housing visit www.csh.org