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Normalisation of Housing and Living Conditions in the Field of Homeless Services: Some Financial Arguments


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Presentation given by Dr. Volker Busch-Geertsema, Association for Innovative Social Research and Social Planning (GISS) e.V., Bremen, Coordinator of the European Observatory on Homelessness, at a …

Presentation given by Dr. Volker Busch-Geertsema, Association for Innovative Social Research and Social Planning (GISS) e.V., Bremen, Coordinator of the European Observatory on Homelessness, at a FEANTSA seminar on "Funding strategies: Building the case for homelessness", hosted by the Committee of the Regions, June 2012

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  • 1. Normalisation of Housing and Living Conditions in the Field of Homeless Services: Some Financial Arguments 7th European seminar on local homeless strategies Funding strategies: Building the Case for Homelessness Co-hosted by the Committee of the Regions, FEANTSA and HABITACT Brussels, Friday 8 June 2012Dr. Volker Busch-Geertsema, Association for Innovative Social Research and Social Planning (GISS)e.V., Bremen, Coordinator of the European Observatory on Homelessness
  • 2. OverviewHousing First as an alternative to staircase systems:Quick normalisation of housing and living circum-stances as a better way of integrationNot only better but cheaper as well? Financialarguments in favour of Housing First and a quicknormalisation of housing and living conditions forhomeless peopleSome problems regarding usual financial argumentsPotentials of Cost-Effectiveness Studies in EuropeEnding homelessness: More than a financial question
  • 3. The Critique of the Staircase ApproachIn the staircase model homeless people have first toaddress their problems before moving to the next stage of aseries of steps towards ordinary self-contained housing(often considered as without further support)In this model homeless people have to be made “housingready” in different stages, with decreasing intensity ofsupport, control and supervision and increasing autonomyand privacyPermanent housing is understood as a “reward” forshowing (and maintaining) sobriety and compliance withtreatment and support plans
  • 4. Secondary housing market Primary housing market regular self- contained dwelling regular dwelling with rent contract Staircase of Transition with (time-limited) occupation agree- “final dwelling”, ment based on special conditions full security of tenure shared time-limited, no housing, “training security of tenure dwell-ings”, etc. shared dwellings near reception stage institution, stay time-limited and based on special conditions, shared facilities institutional setting, hostels, shelters, etc.more individual support, care, control, discipline lessless private space, autonomy, normality more © GISS Bremen
  • 5. Critique of Staircase Systems in EuropeStress and dislocation because of need to move betweendifferent "stages"Little privacy and autonomy at lower stages, lack of serviceuser choice and freedom – revolving doors and «frequentflyers»Standardised support in different stagesSkills learned in structured congregate settings often nottransferable to independent living situationFinal move to independent housing may take years and toomany homeless clients get "lost"Homelessness may increase rather than decrease with suchsystems (extending lower stages, bottleneck at upper end)
  • 6. Housing First regular self- contained dwelling with rent contract regular dwelling with (time-limited) occupation agree- ment based on special conditions shared housing, “training dwell-ings”, etc. flexible individual support in housing reception stageHomelessness…………………………………………………………………………….
  • 7. Housing First – the AlternativePriority for rapid access to mainstream housing; no “housingreadiness” and transitional steps requiredPermanent and affordable housing, self-contained withsecurity of tenureHarm reduction approach: No requirement of abstinence"Housing first", not "housing only”. Provision of adequate andpro-active support (with home visits) but no obligation toaccept treatment, therapy or abstinence. Originally AssertiveCommunity Treatment (ACT) essential element, but alsoIntensive Case Management (ICM)Orientation on recovery and community integrationEmphasis on NORMAL housing and living conditions
  • 8. Housing First:Not Only Better But Cheaper As Well?Homelessness may cost quite a lot of money Costs of ambulances and detentions by police, court proceedings etc. Costs of stays in emergency wards and detox units of hospitals, in prison, in mental hospitals etc.Most quoted example: Article in The New Yorker about“Million-Dollar Murray. Why problems like homelessness maybe easier to solve than to manage” (23 Februar 2006)  Policemen collected data on hospital bills and other charges during last ten years for long-term homeless alcoholic Murray Barr who had finally died in the street of intestinal bleeding  “It has cost us one million dollar not to do something about Murray” (…) “It would probably have been cheaper to give him a full-time nurse and his own apartment”
  • 9. Housing First:Not Only Better But Cheaper As Well?Savings on non-homelessness services often main argument “If it can be shown that homelessness programs produce positive outcomes for clients at relatively low cost and provide significant cost savings for mainstream non-homelessness services, then the case for intervention is well and truly established. “ (Zaretzky et al 2012,p. 2) Additional indicators:  Children placed in care  Decrease in evictions and reduced maintenance (with increased housing stability of users of tenancy support)
  • 10. Housing First:Not Only Better But Cheaper As Well?Example from Finland: Juha Kaakinen, programme leader ofFinnish Programme to end long-term homelessness in arecent presentation (From Housing First to EndingHomelessness):  “A survey carried out in a Tampere supported housing unit shows that housing with intensified support halves the use of social and health care services compared to service-use during homelessness. This equates, to 14 000 euros of savings per resident/year. The total annual savings for 15 residents in the unit in question amounted to 220 000 euros. The greatest savings were gained from the decreased use of institutional care and special health care. This housing unit has 22 independent flats and 5 support workers.” (Kaakinen 2012)
  • 11. Housing First:Not Only Better But Cheaper As Well?Some problems Reduction of the use of non-homelessness services through homelessness support: Real cost offsets against Housing First with ACT only for “high cost” homeless people Not all homeless people are heavy users of non-homeless services like health and justice system Duration of service use plays an important role. Housing First support is ongoing – potentially for years - while stays in hospital, prison or detox units are time-limited Savings are made in sectors for which other government departments might be responsible than those financing homeless services It might be difficult to realise the savings (some of them could only be realised by reducing places and personnel in criminal justice and health system)
  • 12. Housing First:Not Only Better But Cheaper As Well?Rosenheck 2000: Assertive Community Treatment (as in Housing First projects) only “cheaper” for “the most resource-intensive 10% of clients.”Poulin et al. 2010: “Supportive housing models for people with serious mental illness who experience chronic homelessness may be associated with substantial cost offsets, because the use of acute care services diminishes in an environment of housing stability and access to ongoing support services. However, because persons with substance use issues and no recent history of mental health treatment used relatively fewer and less costly services, cost neutrality for these persons may require less service-intensive programs and smaller subsidies.”
  • 13. Potentials of Cost-Effectiveness Studies in EuropeIn Europe comparing one type of service for homeless peoplewith others is an alternative strategy to show positive financialeffects. Housing First is not a cheap service, but staircasesystems aren’t either. Some examples from Germany:Type Costs p day Costs p month Costs p yearCaritas crisis 115.45 € 3,511.60 € 42,139.25 €accommodation Berlin*“Stationary” hostel Munich 93.89 € 2,855.78 € 34,269.31 €(including pocket moneyand full board)Halfway house in Berlin 42.89 € 1,304.57 € 15,654.85 €(social work and rent)*Floating support in Berlin 34.29 € 1,042.99 € 12,515.85 €(social work and Ø-rent)**Clients may claim minimum benefit for their subsistence in addition
  • 14. Potentials of Cost-Effectiveness Studies in EuropeImportant to note that Housing First can cover different types ofsupport services:  Not all homeless people with special needs will need Assertive Community Treatment (probably the most costly type of support in housing, see also Tsemberis at al 2012)  A majority might be better served with “Housing First Light”It should be relatively easy to prove that Housing First servicesare not only more effective but will also cost less if support inhousing is adjusted to specific individual needs  We need more studies on the costs of homelessness in Europe  There is great potential for cost-effectiveness studies comparing costs and effects of staircase systems with Housing First approaches
  • 15. Potentials of Cost-Effectiveness Studies in Europe Cost-effectiveness studies must provide a real basis for comparisons including duration and intensity of support and the costs of subsistence While there are some costs involved for increased mobility of support teams in “housing led” services (floating support in scattered housing) high costs for staircase systems and congregated housing originate from special requirements for concentrated accommodation (24 hours staffing, fire precautions, more potential conflicts, less use of self-help potential of clients) Floating support in housing will only be better AND cheaper, if intensity and duration of support are closely adjusted to the needs of (formerly) homeless people
  • 16. Ending Homelessness and Normalising Housing and Living Conditions of Homeless People: More than a Financial Question!! Even if more effective services for homeless persons might cost more than less effective provisions in some cases, “their value ultimately depends on the moral and political value society places on caring for its least well-off members” (Rosenheck 2000). “Researchers should be careful to consider (and explicitly observe) that the services utilization cost of homelessness is only one dimension of the moral issues raised by the problem. Other moral dimensions of homelessness include dehumanization, diminished capacity to actualize basic societal rights and privileges, and susceptibility to victimization, including violence” (Culhane 2008: 109.).
  • 17. Thank you for your attention!
  • 18. ContactDr. Volker Busch-GeertsemaGesellschaft für innovative Sozialforschung undSozialplanung e.V. (GISS, Association for InnovativeSocial Research and Social Planning)Kohlhökerstraße 2228203 Bremen, GermanyFon: +49-421 – 33 47 08-2Fax: +49-421 – 339 88 35Mail: vbg@giss-ev.deInternet:
  • 19. ReferencesBusch-Geertsema, V. (1998) Persönliche Hilfen in Normalwohnraum statt Einrichtungen fürWohnungslose. Bessere Hilfen für weniger Geld? Ein Bremer Kostengutachten appelliert fürUmsteuerung von Einrichtungen in normalen Wohnraum, in: Wohnungslos 4/1998, pp. 144-150Gladwell, M. (2006) Million Dollar Murray. The New Yorker February 13 & 20, 2006, pp. 96-107.Chart for Pathways Housing First copied from examples for provision in Germany (in German language): Lehmann, R. and Ballweg, T. (2012) Der Social Return On Investment einer stationärenEinrichtung der Wohnungslosenhilfe. Investitionen und sozialer Mehrwert am Beispiel des AdolfMathes Hauses, einer Einrichtung des Katholischen M.nnerfürsorgevereins München e.V..Forschungsbericht. Stand: 24.04.2012. (Munich and Eichstätt-Ingolstadt: KatholischerMännerfürsorgeverein and Kathoische Universität)Culhane, D. (2008) The costs of homelessness: a perspective from the United States, EuropeanJournal of Homelessness, 2, pp. 97-114.Flatau, P. and Zaretzky, K. (2008) The Economic Evaluation of Homelessness Programmes,European Journal of Homelessness, 2, pp. 305-320Kaakinen, J. (2012) Long-term perspectives: From Housing First to Ending Homelessness,presentation at Conference on “Housing First: A Key Element of European Homelessness Strategies”,23rd March 2012 hosted by the French Permanent Representation to the EU and FEANTSA, see
  • 20. ReferencesPoulin, S.R., Maguire, M., Metraux, S., Culhane, D.P. (2011) Service Use and Costs for PersonsExperiencing Chronic Homelessness in Philadelphia: A Population-Based Study. Psychiatric Services61, pp.1093–1098Rosenheck, R. (2000) Cost-Effectiveness of Services for Mentally Ill Homeless People: TheApplication of Research to Policy and Practice. Am J Psychiatry157, pp. 1563-1570Tsemberis, S. (2010a) Housing First: Ending Homelessness, Promoting Recovery and ReducingCosts, in: Gould Ellen, I. and O’Flaherty, B. (eds.) How to House the Homeless (New York: RussellSage Foundation).Tsemberis, S. (2010b) Housing First. The Pathways Model to End Homelessness for People withMental Illness and Addiction (Center City, Minnesota: Hazelden)Tsemberis, S., Kent, D., and Respress, C. (2012) Housing Stability and Recovery Among ChronicallyHomeless Persons With Co-Occuring Disorders in Washington, DC. Am J Public Health. 102,13–16Zaretzky, K., Flatau, P., Bauskis, A., Conroy, E, Burns, L., Spicer, B. and Clear, A. (2012) Cost offsetsof homelessenss assistance (paper presented at Homelessness Research Conference Melbourne 19-20 April 2012)