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The St Louis Contrarian

Providing Independent and Intelligent Insight on St. Louis Public Policy Issues

Archive for the tag “homelessness”

Do We Have an Affordable Housing Crisis in St. Louis?

The answer to this question is how you structure the problem. The National Low Income Housing Coalition has done the most work of any organization on this issue on a national level. They pose the problem by taking the median rental rate in the community and factoring in the minimum wage income. Not surprisingly they concluded that virtually now where in the United States is housing affordable.

There are several problems with this approach. The minimum wage is not a good indication of a community's earning capacity. Many minimum wage workers are students, part time workers, and those new to the work force. Many live with parents or double or triple up. Also most minimum wage workers don't remain at that pay level for a long time, as they move up the ladder. The minimum wage was never intended to be a living wage, rather just a starter for low skilled workers. Many minimum wage workers also work 2 or more jobs.

A better gauge of housing affordability is the relationship between the median income and the median rent. This gives us kind of an average, not perfect, but much better. Let's look at some numbers as a point of comparison:

St. Louis Metro Area

Median Income- $52243 for a family of 4 in the City of St. Louis
Median Rent -2 bedroom- $1291
Therefore the monthly median income of $4354 can afford a monthly rent of $1306 at the 30% threshold. This represents 100.01% of the median rent.

One may conclude that on the whole rent is affordable in the St Louis area for the median household.

Boston
Median Income-$67846
Median rent-2 bedroom-$3166
Therefore the monthly income of $5654 can support a monthly rent of $1696 at the 30% threshold. This represents 54% of the median rent.

The Boston market on the whole is not affordable.

This approach seems to be useful in making comparisons among communities. It also does not relieve our community of our responsibility to provide affordable housing. After all, median income is a statistic. There are thousands of people in our metro area who cannot afford the median rent and do not have access to adequate rental housing.

Written by Paul Dribin

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Homeless Prevention

An article in How Housing Matters makes an important point about homelessness in cities such as St. Louis. That article demonstrates the most successful approach to combating homelessness is a housing first model. This approach requires building affordable supportive housing for homeless people, housing them, and providing supportive services at the same time.

An interesting point about the St. Louis homeless situation. Biddle House run by St. Patrick’s Center serves anyone who wants it 3 meals a day, 7 days a week. When the Larry Rice shelter closed, people at Biddle prepared for more clients. They never came. We suspect Larry never had as many clients as he claimed. Written by Paul Dribin

Here is the copy of the article from How Housing Matters:

What Cities Can Do to Combat Homelessness

August 03, 2017

by Steven Brown

The most recent Annual Homeless Assessment Report to Congress points out the number of people experiencing homelessness has fallen every year since 2010, representing a 13.7 percent drop between 2010 and 2016. Homelessness fell even more dramatically among certain subpopulations over the same period. Chronic homelessness fell 27 percent, veterans homelessness was cut by nearly half and was eliminated in dozens of places across the country, and homelessness among families with children decreased 23 percent.

Though the number of people experiencing homelessness has declined nationally, many large cities have experienced increases in their homeless populations. Since 2010, homelessness increased slightly more than 1 percent. In many of these cities, the number of people in shelters has decreased while the number of people on the street has gone up dramatically. In Los Angeles, the number of people experiencing homelessness went up more than 33 percent in the past two years and increased more than 42 percent for people outside of shelter. In New York City, homelessness spiked 39 percent in the past year. Chicago, Denver, Seattle, and several other large cities saw similar increases.

Despite the trends, many cities—including Atlanta, Cleveland, and New Orleans—experienced significant declines in homelessness. What are these cities doing well? Houston is a prime example. After a peak in homelessness in 2011, Houston adopted a Housing First model for addressing homelessness. Officials and homelessness providers in the areas developed the Houston/Harris County Continuum of Care in 2012 and worked with local agencies to create The Way Home, an action plan with goals to address area homelessness. The goals of The Way Home are to

create a system to identify the chronically homeless and match them to appropriate affordable housing,
coordinate a service system to support long-term housing stability, and
create enough permanent housing to meet the demand.
Before The Way Home, area service providers and nonprofits were an uncoordinated “tangle of services,” but the city worked to coordinate local efforts, including adopting the Homeless Management Information System to match people to appropriate, stable housing within 30 days of system entry and assessment. The city redirected over $100 million in federal, state, and local funding, with help from local businesses, to build and maintain over 2,500 additional permanent supportive housing units with wraparound services. Since the introduction of The Way Home, homelessness in Houston, Harris, and Fort Bend counties has fallen 60 percent, and their Continuum of Care was recently recognized as one of 50 in the country that has effectively ended veterans homelessness.

The gains Houston has made toward ending homelessness through a Housing First approach and coordinated entry are laudable and impressive. Other cities have tried or are trying similar approaches, yet still struggle with a steady or growing homeless population.

One additional reason the gains may have been more effective in Houston is their more accessible housing market. According to US Department of Housing and Urban Development data, the fair market rent for a one-bedroom rental in Harris County stayed flat between 2011 ($767 a month) and 2016 ($773), and the most recent Census Bureau data for the county show an 8.9 percent vacancy in rental housing. Atlanta, Cleveland, and New Orleans have also used a Housing First approach and seen their homeless populations fall, and so have other cities with comparably lower rents and slower rental growth.

Compare this with Seattle and King County, which saw a 25 percent increase in fair market rent for one-bedroom rentals (2011: $977, 2016: $1,225) and has a rental vacancy rate of 3.4 percent. Decreasing housing affordability in an area can make it more difficult for people on the margins to stay in their homes and can prevent people in shelters or permanent supportive housing from jumping into private market housing.

But cities, including many coastal ones, with rising rents and rising populations experiencing homelessness can still fight the rising tide. Boston has experienced recent spikes in homelessness, but is in a state that has a right-to-shelter law. Even though the number of people and the length of stay in emergency shelters is increasing, the number of people “on the street” is among the lowest in the country, and the area is seeing declines in people returning to shelter. Though emergency shelter can have challenges (e.g., turnover, privacy, safety), shelters have the advantage of staff who can help coordinate services and transitions to more stable housing. Boston’s challenge, and the challenge of other cities in a similar position, is to build a better bridge between shelter and self-supported housing.

While homelessness is down in much of the country, many cities still struggle. Cities that have brought down their populations have done so through a Housing First approach, a tight coordination between public, nonprofit, and private stakeholders, and a clear path for permanent and stable housing. Houston’s Housing First, integrated Homeless Management Information System model, and close coordination between agencies have led to an end of veterans homelessness and a nearly 50 percent reduction in homelessness overall. Although rents haven’t risen there as quickly, the approach shows that getting people into permanent supportive housing may be the best solution. The Family Options Study showed that of transitional housing, rapid re-housing, and vouchers, vouchers proved the best option for helping homeless families achieve residential stability, and other studies have shown that rapid re-housing can work in certain contexts.

The best way for cities to help their homeless populations is to house them and support them with services to help them find stable employment, health care, and child care services. Though this may be challenging for cities with limited affordable units and rising rents, these are the steps that must be taken to support these most vulnerable of populations.

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Issues Affecting Housing and Healthcare

Here is an article from the Housing Matters website that discusses the positives and negatives of trying to link housing with healthcare services.

The Future of Integrated Health and Housing Programs

June 14, 2017

by Josh Leopold, Brenda C. Spillman, Eva H. Allen

Americans spend more on health care, but have lower life expectancies and worse health outcomes than any other developed country. This disparity arises partly from a lack of attention to social determinants of health, which include income, education, and housing.

States, localities, and organizations throughout the country have taken advantage of opportunities created by the Affordable Care Act (ACA) and other health system delivery and payment reforms to improve health outcomes by integrating housing and health care.

But the prospects of ACA repeal and the president’s proposed budget for fiscal year 2018 threaten to reverse recent progress in collaborations between housing and health care providers. Deep cuts to the US Department of Housing and Urban Development (HUD) and Medicaid could make it harder for states to provide basic care to low-income people and leave fewer resources to improve outcomes through integrated health care and housing.

How can housing support health?

Lack of housing makes it hard for vulnerable people (such as the elderly and those with disabilities or experiencing homelessness) to manage chronic health conditions, leads to reliance on emergency rooms for health care and emergency shelter, and contributes to poor health outcomes and reduced life expectancy.

Supportive housing combines a rental subsidy with case management and has been shown to reduce health care spending and improve health outcomes for people experiencing chronic homelessness. In subsidized housing, health care and social services available on-site can help people stay healthy enough to remain at home and avoid hospitalizations and nursing home admissions.

How can housing and health care providers collaborate?

Several ACA provisions aimed to improve care coordination and shift the health care system to value-based payments, where providers have more flexibility in the services they provide, but also are more accountable for improving patient outcomes. Value-based payments are intended to motivate health care providers to take a “whole-person” approach that includes addressing social determinants of health.

The Urban Institute conducted a review of nearly 40 state and local health and housing initiatives. By encouraging cross-sector collaboration, using community resources strategically, and taking advantage of health reform opportunities, many states and communities integrated health care with housing and other services to improve vulnerable populations’ health and well-being.

Three initiatives were particularly promising:

New York State’s Medicaid Redesign Team used state savings generated by Medicaid system reforms to pay for housing for high-needs populations, including construction of new affordable housing units, rental assistance, and supportive services to residents. The state recently committed an additional $1 billion to develop 6,000 new units of supportive housing in the next five years as part of a larger commitment to build 20,000 supportive units over the next 15 years.
Houston’s Integrated Care for the Chronically Homeless initiative paired housing vouchers from HUD with health care and case management services funded by the Medicaid Delivery System Reform Incentive Payment program to serve people experiencing homelessness who have chronic physical and mental health conditions and are high users of costly medical services. Early program results show reductions in participants’ preventable emergency department use, improved mental health functioning, and reduced depression rates.
Housing with Services in Portland, Oregon, brought together several organizations, from nonprofit service providers to Portland’s housing authority to the largest Medicaid health insurer, to coordinate health care and social services for low-income seniors and people with disabilities living in federally subsidized housing. Evaluation results indicate that program participants were more likely than those not connected to the program to use preventive and mental health services, had better access to long-term services and supports, and experienced less food insecurity.
What are barriers to these collaborations?

Although many health and housing partnerships have developed or been strengthened since the ACA’s passage, several obstacles limit the reach of such partnerships, a problem that budget cuts will only exacerbate. In interviews, local leaders and national experts frequently cited the widespread shortage of affordable housing as an obstacle to creating and sustaining housing and health care collaborations. Federal Medicaid funds can sometimes be used for housing-related services, but cannot pay for room and board. Some state Medicaid agencies, hospital networks, and health insurance plans have invested in rental assistance and affordable housing development, but they remain the exceptions.

Competing priorities, restrictions on the use of health care funding for nonclinical services, and lack of housing-related expertise make it unlikely that the health care sector will become a significant funder of new affordable housing. One policy expert said advocates have been overly focused on “trying to find ways that Medicare and Medicaid should fund housing that we eliminated at the HUD level.”

Proposed budget cuts would hamper efforts to integrate housing and health care

The proposed budget aims to cut HUD by $7.4 billion and eliminate the Housing Production Trust Fund and Community Development Block Grants. In addition, the proposal to cut the corporate tax rate from 35 percent to 15 percent has already made affordable housing development more difficult. The proposed cut has reduced investment in Low-Income Housing Tax Credits, the primary funding source for affordable housing, because investors are less motivated to buy the credits to offset their income taxes.

In this environment, housing providers may focus on stemming losses rather than supporting new collaborations. The vulnerability of housing and health partnerships to changes in federal funding was demonstrated recently, when HUD advised the Houston Housing Authority to stop issuing new vouchers for the remainder of the year because of an anticipated budget shortfall.

The budget also calls for reductions in federal Medicaid spending, that, coupled with reductions proposed in the House-passed health plan, would cut Medicaid spending 47 percent over 10 years.

These proposals could slow or reverse the momentum for housing and health care integration. Given the promise of housing and health collaboration for the nation’s most vulnerable populations, further reducing the stock of affordable housing and supportive services could thwart progress in improving their health care outcomes and quality of life.

An earlier version of this post was published on Urban Wire, the blog for the Urban Institute.

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TAGS: Health, housing, Budget
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