National conversation: ‘Housing First’ approach can meet the demands of homeless union

Earlier this month, a new group called the ATL Homeless Union formed in Atlanta, GA. As a group of unsheltered individuals, they’ve voiced frustration around the same incremental approaches to addressing homelessness which lack any meaningful change to present conditions.

Their strategy: set up camp outside of Atlanta’s City Hall to call attention to the problem of homelessness with a daily rally at 11:30 a.m. ATL Homeless Union has declared only four demands, but they are big demands — demands that would require a radical shift in the city’s approach to addressing homelessness.

Though the changes necessary to meet the demands of the ATL Homeless Union are significant, they are not unreasonable. In fact, every single demand on this list could be met using the Housing First approach.

We demand homes. With the millions of dollars we spend on shelters and services, we can house every unhoused person in the City. The City should convert vacant and City-owned properties into permanent homes for those who are unhoused. We demand that the City invest pandemic relief funds in long-term housing solutions.

Here in Philadelphia, we’ve found that it actually costs less to house a person than it does to let them continue to be homeless. When we add up all of the costs associated with a person living unsheltered — ambulance services, police interventions, emergency department visits, medical and psychiatric hospitalizations, soup kitchens, shelter nights, and sometimes incarceration — it averages out to be much more than the cost of subsidizing rent and providing appropriate services.

It costs more than $155 a night for inpatient rehabilitation services and $113 a night to house an individual in a congregate housing. Housing an individual in their own efficiency or 1-bedroom unit through the Housing First model costs only about $80 per night. When we couple this with the fact that Housing First agencies are renting vacant market rate apartments and helping to retain the local tax base, you’ve got a win/win. Housing First services, such as those offered through Pathways to Housing PA, are good for the person who is now housed, and good for our community as a whole.

A 2011 study also showed that our program is less expensive per person than comparable programs serving the same population. We’re half the cost of other permanent supportive housing programs for individuals experiencing chronic homelessness and about two-thirds the cost of residential drug and alcohol programs for folks experiencing chronic homelessness and mental illness. Those percentages remain true today.

We demand healthcare. We need primary care access so that we don’t have to go to the emergency room every single time we need basic healthcare. Preventive care saves lives and taxpayer money. All unhoused people should have access to regular preventive medical care.

Among the unhoused population, there are countless unmet health needs and many barriers to care. Our participants report interacting with providers who demonstrate a lack of cultural competence, misunderstandings of the social determinants of health impacting those experiencing homelessness, and a perpetuation of stigma against marginalized populations, like those with psychiatric disabilities or individuals using substances. By offering healthcare services onsite through our Integrated Care Clinic, we are able to meet our participants’ needs in a safe, familiar, and comfortable environment.

Over the last year, our onsite clinic (a satellite site of Project HOME’s FQHC, Stephen Klein Wellness Center) served 378 unique individuals over 3,873 visits. In fact, approximately 70% of our participants access this clinic for care each year. Being able to integrate the physical, mental, and behavioral healthcare in a location that is familiar to our participants can tremendously reduce barriers to care.

Our providers are sensitive to the chronic health issues faced by our participants, while our service coordinators can facilitate connection to the preventive healthcare resources.  We offer on-demand services and meet our participants where they are — both literally and figuratively. Our providers and staff will travel outside of the office to participant homes or into the community to render needed care.

We demand water. The City controls the Water Department. Especially during this pandemic, we need water to stay sanitary. The City should guarantee showers, bathrooms, and handwashing stations for unhoused people.

In the summer of 2019, Philadelphia experienced a serious outbreak of Hepatitis A, recording approximately 426 cases, primarily in poor and underserved neighborhoods most greatly impacted by the opioid epidemic. The individuals most at risk of contracting the virus were those experiencing homelessness and those using drugs. The public health emergency was met with pop-up vaccine clinics, installation of public toilets and handwashing stations, as well as distribution of 7,000 hygiene kits including soap, hand sanitizer, cleansing wipes, condoms, and waste disposal bags.

While this response was effective, we know that a more comprehensive and sustainable response would include the provision of permanent housing to those in need. There is a dignity afforded in the ability to wash in the comfort of one’s own home. Unfortunately, this privilege is not accessible to those who are unhoused, and who must instead rely on public spaces to practice hygiene. This can be a dehumanizing process that may require individuals to engage in other, sometimes unwanted, services.

We demand a seat. The City is busy talking to everyone except us about what we need. We deserve a seat at the table. We need to be consulted about the policies that will impact our lives. The City should follow our leadership.

A critical tenet of the Housing First model is Consumer Choice and Self-Determination. At Pathways to Housing PA we believe that people are able to define, prioritize, and achieve their own recovery goals. Our staff are there to provide support, resources, and to act as partners in the collaborative problem-solving process.

This framework guides all the services that we provide. We ask what our participants want to do, and how we can help them get there. We provide multiple opportunities for participant feedback through events such as our monthly tenants’ meeting and advocacy program. We provide opportunities to help our participants attend events such as the National Alliance to End Homelessness’s Capitol Hill Day, the Department of Human Services’ Region 3 Opioid Task Force Town Hall on medication for opioid use disorder considerations for individuals in recovery, and other legislative visits in our state capital. Our participants want an active role in advocating for systems change and sharing the message of Housing First, and it’s our responsibility to provide these opportunities.

We understand that people with lived experience deserve to have their voices heard. We have supported participants in speaking at Philadelphia City Council meetings and engaging in a Day of Action to call Congress to advocate on issues impacting those with lived experience of homelessness and co-occurring disorders.

Housing is a basic human right and everyone deserves a safe place to call home.

The CEO of Atlanta’s lead agency in the Continuum of Care noted that “the city and partners for HOME [don’t] necessarily have leverage or control over those things” that serve as barriers for those experiencing homelessness to enter services. But we believe it is the responsibility of those in power to reassess policy priorities to serve the most vulnerable in their community. By enabling a Housing First approach, those barriers can be removed.

Housing is a basic human right and everyone deserves a safe place to call home.

We applaud the Atlanta CoC’s current initiative — a Housing Surge, to move the 800 people who were experiencing chronic homelessness into permanent supportive housing. However, if the vast majority of their funding will come through pandemic relief funds, they will also need to quickly identify a sustainable approach based on the values of Housing First.