Headline

Over 14 years, individuals experiencing chronic homelessness enrolled in a permanent supportive housing program had low housing retention and high mortality.

Context

Permanent supportive housing (PSH) using the “Housing First” model provides affordable housing with support services to individuals experiencing homelessness without the requirement of receiving behavioral health care prior to entering housing. The Community Support for People Experiencing Chronic Homelessness PSH program in Boston was a partnership between multiple organizations to provide housing to chronically unsheltered adults. Through the program, participants were also eligible to receive integrated primary and behavioral health care directly on the streets, in apartments, at the clinic, and when inpatient. This study followed 73 participants for 14 years providing a longitudinal analysis to describe participant outcomes.

Findings

While 82 percent of program participants receiving PSH were still housed after one year, only 36 percent of individuals still had housing after five years, and only 12 percent after 10 years. Almost half of the participants died while housed. Moves to new apartment occurred frequently, and 38 percent of the cohort were moved to avoid eviction. Each move increased the likelihood of the tenant returning to homelessness and increased the risk of death. See also a related infographic summarizing the study findings.

Takeaways

While the PSH program included supportive services, chronically unsheltered individuals may need more long-term medical and supportive services to address their multimorbidity and support them in managing their housing.