Chronic homelessness & the

cost of doing nothing

Can we save money by doing the right thing?

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Who supports The Way Home Campaign?

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3,700 concerned citizens and 57 local and national organizations

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Agenda

• Welcome and introduction, Whitney Parnell, Capitol Hill Group Ministries

• Background on chronic homelessness, Kurt Runge, Miriam’s Kitchen

• Remarks from Co-sponsors

• Keynote speaker, Waldon Adams, PSH Resident and Advocacy Fellow, Miriam’s Kitchen

• Panelist presentations

• Solutions to chronic homelessness, Christy Respress, Pathways to Housing and Adam

Rocap, Miriam’s Kitchen

• Q and A

• Reception with light lunch

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Chronic homelessness - an individual or family who has been homeless for a year or more, or at least four times in the past three years and has at least one – and sometimes many - disabling conditions

On a given night in the District, there are approximately 1,800 individuals and 130 families who are chronically homeless

What is chronic homelessness?

Jeff used to live under a bridge in Foggy Bottom In Feb 2014, he moved into his own place.

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Donald was homeless for 15 years. Much of that time was spent outside at

Union Station before getting housing 5 years ago.

Nationally • Majority “single" adults • 75% male • 25% female •High rates of mental illness (60%) and/or substance abuse (80%) • High rates of chronic and life threatening conditions such as hypertension, asthma, HIV/AIDS, liver disease

Who is chronically homeless?

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Ending chronic homelessness is urgent

People who experience chronic homelessness die 4-9 times younger than the general population.

The average age of someone who is chronically homeless is in the 50s and average life expectancy is 61, compared to the U.S. average of 79.

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Ending chronic homelessness is possible

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The cost of chronic homelessness in D.C.

A Coordinated Entry System (CES) launches in D.C.

Image Courtesy of Chris Ko – Home for Good LA

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Over 3,350 assessments have been completed from Fall 2013 through February 2015.

Assessments from coordinated entry tell us the frequency of emergency services:

The cost of chronic homelessness in D.C.

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Methodology

The cost of chronic homelessness in D.C.

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It is estimated that in just one year’s time, DC’s 828 most vulnerable chronically homeless individuals:

The cost of chronic homelessness in D.C.

4,702 2,346 2,544 2,154 1,696 E.R. visits Police Ambulance Inpatient used a interactions rides stays crisis hotline

Emergency services totaling

$19 million a year

*Cost estimates are likely an underrepresentation of the true cost of chronic homelessness,

because they are based on self-reported data and do not capture all cost drivers.

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Of the 828 most vulnerable chronically homeless individuals, the top 50% of highest utilizers incur even greater costs:

3.1 short-term mental

health visits across the year

amounting to $2,516 in

Medicaid costs

3.4 police interactions amounting to

$615 to the police system

5.1 ambulance ride for 10 miles

amounting to $2,515 in costs to

Medicaid

8.7 visits to the ED amounting to $7,470

and 5 inpatient admissions amounting to

$27,727 to DC Medicaid

Ambulance

Services

Behavioral

Health Services Incarceration &

Police Costs

Inpatient/Emergency

Department Services

Annualized Costs:

Average of $40,843

per individual

PSH only cost $22,500 a year and drastically reduces the use of emergency services.

*Cost estimates are likely an underrepresentation of the true cost of chronic homelessness,

because they are based on self-reported data and do not capture all cost drivers.

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The cost of chronic homelessness in D.C.

Ricky

Took the ambulance 134 times to the hospital

Had four inpatient hospital stays

Used mental health crisis services 12 times

This represents $208,908 in medical costs alone.

PSH only cost $22,500 a year and drastically reduces the use of other emergency services.

-50

50

150

250

350

450

550

Mo

nth

ly V

olu

me

Total Visits vs. Unique Patients by Month (thru Jan 31, 2015)

Total Volume of Patients

87

61

49

40

30

37

27 29

37 39

51

36

44 47 48 49

71 68

41

66

85

98

90

104

0

20

40

60

80

100

120

0 1 2 3 4 5 6 7 8 9 1011121314151617181920212223

Vo

lum

e o

f V

isits

Hour of Day

Volume by Hour of Day Discharge Diagnosis

In 18 Months 57 patients each accumulated at least 36 visits to the

Emergency Department to qualify as a Super User Patient

Collectively during the 18 month period, these 57 patients totaled 2277 visits to

the Emergency Department

The total cost for the Emergency Department Visits =

$600,530

Inpatient Vs.

Outpatient

Visits Total Cost

Outpatient

(Emergency

Room Visit)

333 66,726

Inpatient 8 $59,709

Total $126,436

Human Cost

•Chronically Homeless x 7 Years

•Medical Diagnosis

• Traumatic Brain Injury

• Type II Diabetes

• Osteomyelitis and ulcer of toe

• Right Leg DVT

• Scabies

• Alcohol use vs. Abuse

Inpatient Vs.

Outpatient

Visits Total Cost

Outpatient

(Emergency

Department

Visit)

200 $24,364

Inpatient 18 $ 88,981

Total $ 113,345

Human Cost

•Chronically Homeless 5+ years

•Medical Diagnosis

• COPD – Chronic Obstructive Pulmonary Disease

• Alcohol dependence w/ Seizures

• Bipolar Disorder

• History of Suicide Attempts

• Is a Healthcare Intervention

• Will reduce Healthcare Cost

• Will result in better Healthcare Outcomes

• Will prevent fatalities

• Will enhance the overall effectiveness of

the Healthcare system

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Ending chronic homelessness IS possible

With Housing First,

anyone can be successfully housed

Insert picture here

Ending chronic homelessness IS possible

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Solutions - Housing

Permanent Supportive Housing

Rapid Re-housing

Flow Housing

The Housing must be:

targeted to the right people (Coordinated entry)

with few barriers (Housing First)

North Capitol Commons, PSH for veterans

Ending chronic homelessness IS possible

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How do we reach that goal?

Invest new resources in housing solutions

Use the resources we have better. Turnover and new construction need to be targeted

appropriately and Housing First. Pairing behavioral health services to housing.

Leverage new resources Medicaid Pay for Success

Ending chronic homelessness IS possible

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It’s urgent

We know what works

We can’t afford to do nothing