Knoxville’s Ten-Year Plan (TYP) is focused on ending chronic homelessness. The TYP seeks to stabilize people in permanent supportive housing, and then to help them reintegrate into society. This approach is demonstrated to be effective in cities in which it has been deployed. It has been shown to cut costs and to maximize benefit, both to the community and to homeless people.
The following Q & A will help you gain a basic understanding of the TYP.
What is chronic homelessness?
The U.S. Department of Housing and Urban Development (HUD) defines a chronically homeless individual as “an unaccompanied disabled individual who has been continuously homeless for over one year or who has had at least four episodes of homelessness in the past three years.” HUD estimates that 10-15% of homeless people in the USA are chronically homeless.
Does that mean 10-15% of the homeless people I see on the street in and around Knoxville are chronically homeless?
Probably not. Agencies that work with homeless people in Knoxville believe that HUD’s national percentages are too low for our community. Our major service providers believe that in Knoxville, the number of chronically-homeless people is probably considerably higher than the national 10-15%.
Why does the Ten-Year Plan focus on chronically-homeless people? Why not work to end all homelessness?
Chronic homelessness is the starting point. Although the people in this category make up only a small proportion of the homeless people in the United States, they consume about 50% of all resources utilized by all homeless people. This is due to their heavy consumption of public social services, including law enforcement, jails, drug clinics, psychiatric facilities, and hospital emergency rooms. Our society will be improved when all homelessness is a thing of the past, but we will be most effective as we address the issue strategically. It makes good strategic sense to focus on the fewest people who consume the most resources.
What does our community spend each year to support a chronically homeless person?
Dr. Roger Nooe, Professor Emeritus in the University of Tennessee College of Social Work, and Knoxville’s leading expert on the study of homelessness, recently tracked 25 chronically homeless people over the course of approximately one year. Dr. Nooe’s study concluded that these 25 people, cycling repeatedly through jail, alcohol & drug treatment, and hospital usage, would incur costs of approximately $929,000. That’s an average of approximately $37,000 each. That conservative estimate does not include the costs associated with food and shelter; if you factor the cost of food and shelter back into the equation, Knoxville’s average costs per person may actually exceed national averages.
We already have many agencies that work with the homeless. Aren’t they working to end homelessness?
It is true that Knoxville’s homeless service providers have helped people become permanently housed. In fact, right now, there is an unprecedented degree of cooperation between all kinds of different agencies to make that happen. But in the past, success in helping people into housing did not happen as often as it could have.
Why not?
Knoxville’s approach to homelessness has been much like that of most other communities. Our goal has not been laser-focused on ending homelessness. Instead, and with the very best of intentions, we have sought to manage almost all homelessness with what should be short-term solutions to emergency problems. We’ve become very good at delivering emergency care, and for some homeless people this kind of help is the best, most appropriate approach. But for others, it’s not.
Who is it appropriate for?
This kind of help is best applied to people facing a crisis, an emergency. People in these kinds of situations face an episode of homelessness, but they don’t live in a chronic state of homelessness. In fact, the majority of homeless people experience homelessness on an episodic basis. They lose a job, have their home foreclosed, or fall on hard times in other ways, and just like that, they’re on the street. In our community they can gain access to the resources they need to get back on their feet. Knoxville’s homeless service providers have had great success in helping many episodically-homeless people to leave homelessness.
Don’t we do things differently for chronically-homeless people?
In the past, we’ve tended to treat all homeless people alike. Homeless people are hungry, so we give them food. They don’t have money to buy clothes, so we give them shoes, shirts, pants and coats. They get cold, so we distribute blankets. They have no dwelling, so we offer them a bed in a shelter. They have no medical care, so we use tax dollars to defray the costs of their use of emergency medical services. And the list goes on.
Those seem like good things to do for people in need. Aren’t they?
Well, yes, and no. These resources are essential to support people as they transition through episodic homelessness, and Knoxville provides them very well. However, they are not by themselves designed to move homeless people out of their state of homelessness.
Until we buy into to the goal of bringing an end to the institution of chronic homelessness, we as a society and as a local community will simply manage homelessness. That, in turn, will merely help some people to be more comfortable in a lifestyle of homelessness.
What difference will the TYP make?
Coordinated care and coordinated response. Our TYP is a strategy to end chronic homelessness, not just to make it more manageable. The top priority is to coordinate our community’s resources so that our community maximizes its ability to help homeless people off the streets and into a permanent home. The TYP is built on the platform of Permanent Supportive Housing. Under the TYP, a chronically-homeless person’s first step out of a lifestyle of homelessness is stabilization in Permanent Supportive Housing. Thus, developing and sustaining housing, delivering effective ongoing case management, and tracking case management delivery are immediately critical to the TYP’s success.
What is Permanent Supportive Housing?
Permanent Supportive Housing (PSH) is the cornerstone of, and the platform for, the TYP. Our plan commits us to permanently housing homeless people as rapidly as possible while providing those now-housed people with customized supportive social services to ensure that the greatest possible number of them stays successfully housed and moves towards independence. This model is humane, it is tested and proven, and it is cost-effective.
Why is PSH particularly cost effective?
Permanent Supportive Housing reduces the amount of money a community spends to serve homeless people. Several studies support this statement, and their number is growing. Here’s a link to one from Portland, Maine. This study leads off with an especially good executive summary, but the whole thing is worth reading.
What this and studies like it demonstrate is that people in permanent supportive housing dramatically reduce their need for, and consumption of, psychiatric inpatient services, and other emergency services, such as emergency rooms, jails, and emergency shelters. In communities in which the model has been applied, the cost of Permanent Supportive Housing is offset by savings in emergency services, jails, and law enforcement.
But PSH isn’t cost-free, is it? Are there hidden costs?
PSH would incur cost for housing, but that cost would be offset by US Government funding via HUD’s various programs for low-income housing. The cost that would stay in our community is the cost of supportive services. The TYP estimates that these costs would approximately cut in half the amount of money our community currently spends on supporting a chronically-homeless person.
What are the obstacles to implementing PSH in Knoxville?
There are two main obstacles to overcome here, and they’re common to most communities with similar plans to ours. In order to move the TYP forward in Knoxville, we must increase the supply of affordable housing and ensure efficient, effective delivery of supportive services.
What kind of housing do we need more of? How do we get more of it?
Knoxville, like most cities across the US, faces a shortage of affordable rental housing. That shortage presents a special challenge to Knoxville’s TYP. Homeless people are housed in rental housing, specifically low-income rental housing. As the pool of available low-income housing shrinks, competition for it becomes more intense. Developing more low-income rental housing in Knoxville, specifically to house homeless people, is essential to the success of our efforts to end chronic homelessness.
How will we pay for this low-income rental housing development?
Development costs will be funded in various ways, largely at government expense with monies already appropriated specifically for affordable housing.
What are the “supportive services” that chronically homeless people need?
The most critical piece is the case manager. Every person housed in the context of the TYP will have an ongoing relationship with a case manager. Case managers are the point of connection between the client and all of the other services available to help keep him or her stabilized: mental health services, primary medical care, drug and alcohol treatment programs, etc.
How many clients can one case manager take on?
The TYP calls for a caseload of 25-30 clients per case manager. It should be noted that this is one of those things that will tend to be highly variable. Caseload can be greatly affected by the kinds of cases being managed.
What happens to a person who’s housed? Do they just hang around? Do they get jobs?
The TYP sees every homeless person as a unique individual, and we want to do everything we can to help each of them to reach his or her fullest potential as a functioning member of our community.
Once a formerly-homeless person is stabilized in permanent supportive housing, she is in a much better position to work towards reintegrating with the society in which we all take part. The TYP sees stabilization and reintegration as two sides of the same coin.
What’s the stabilization side of the coin?
Permanent Supportive Housing and excellent data tracking. That means affordable housing and case managers. There’s also a data collection component called Homeless Management Information System (HMIS).
What about reintegration?
Reintegration happens in employment and healthy community.
No person can reach his potential until he starts to be a productive member of society. The TYP calls for one homeless service provider agency to take the lead in preparing formerly-homeless people for employment. Some of them will have a great deal of potential and others, especially those with severe, persistent mental illness, will not. We have to recognize that some chronically-homeless people may have such severely-debilitating issues that they will never be able to work, and that our expectations should be matched to the life-situations and capabilities of individuals. But wherever people fall on that continuum of potential, we want to help them be the very best they can be.
The TYP also calls for Knoxville’s faith-based community to step into the gap between the community of the streets, and help formerly homeless people to build bridges they can cross to the larger, healthier community.
So, ending chronic homelessness means a lot more than just getting people into their own apartment, right?
Absolutely. This whole movement to end chronic homelessness is about the power of an individual being part of a community. It’s essential to emphasize that reintegration is really the ultimate goal of the Ten-Year Plan. Ending homelessness, whether it’s chronic or episodic, means bringing down the barriers that separate people from one another. It means a whole community being open to considering the one once regarded as “other” to be a part of the healthy whole. It means extending to our formerly-homeless neighbors the very sense of belonging we all long for, and upon which we all depend.