Supported housing
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Supportive housing is a combination of
housing Housing, or more generally, living spaces, refers to the construction and assigned usage of houses or buildings individually or collectively, for the purpose of shelter. Housing ensures that members of society have a place to live, whether ...
and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
. It was developed by different professional academics and US governmental departments that supported housing. Racino, Julie A. (2014). ''Public Administration and Disability: Community Services Administration in the US''. NY, NY and London, UK: CRC Press, Francis and Taylor

Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with
homelessness Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and adequate housing. People can be categorized as homeless if they are: * living on the streets, also kn ...
and who also have very low incomes and/or serious, persistent issues that may include
substance use disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...
s (including
alcoholism Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomi ...
),
mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles Stress (biology), stress, interpersonal relationships, and decision-maki ...
,
HIV/AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
,
chronic illness A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three m ...
, diverse disabilities (e.g.,
intellectual disabilities Intellectual disability (ID), also known as general learning disability in the United Kingdom and formerly mental retardation,Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010). is a generalized neurodevelopmental disorder characterized by signifi ...
, mobility or sensory impairments) or other serious challenges to stable housing.


Supportive housing in rehabilitation

Supportive housing can be coupled with such social services as job training, life skills training, alcohol and substance use disorder treatment, community support services (e.g.,
child care Child care, otherwise known as day care, is the care and supervision of a child or multiple children at a time, whose ages range from two weeks of age to 18 years. Although most parents spend a significant amount of time caring for their child(r ...
, educational programs, coffee klatches), and case management to populations in need of assistance. Supportive housing is intended to be a pragmatic solution that helps people have better lives while reducing, to the extent feasible, the overall cost of care. As community housing, supportive housing can be developed as mixed income, scattered site housing not only through the traditional route of low income and building complexes. Supportive housing has been widely researched in the field o
psychiatric disabilities
and
psychiatric rehabilitation Psychiatric rehabilitation, also known as psych social rehabilitation, and sometimes simplified to psych rehab by providers, is the process of restoration of community functioning and well-being of an individual diagnosed in mental health or emotio ...
, based in part on housing and support principles from studies of leading community integration organizations nationally. In addition, supportive housing has been tied to national initiatives in supportive living (usually
developmental Development of the human body is the process of growth to maturity. The process begins with fertilization, where an egg released from the ovary of a female is penetrated by a sperm cell from a male. The resulting zygote develops through mitosi ...
and
intellectual An intellectual is a person who engages in critical thinking, research, and reflection about the reality of society, and who proposes solutions for the normative problems of society. Coming from the world of culture, either as a creator o ...
disabilities) to cross-disability transfer and to national and international efforts on developing homes of one's own. Supported housing in the field of mental health is considered to be a critical component of a community support system which may involve supported education, supported or transitional employment, case management services, clubhouses, supported recreation and involvement of family and friends often translated into psycho-educational programs. As a widely supported means to address homelessness, supportive housing seeks to address two key problems: * Without housing, there is at best a highly problematic basis from which to mitigate the factors which lead to homelessness (e.g., inadequate income) and expensive problems which burden social service systems. * Without supportive services, the tenant is likely to regress (have a difficult time) for the reasons that are presumed by service providers and government to lead to their loss of housing in the first place. In the capacity building context, support services can be integral to maintaining the housing, the tenant or cooperative relationships, the financial and economic security, the contribution to the family and neighborhoods, and the growth opportunities to return to a valued life situation. In the 21st Century, supportive housing is linked to
affordable housing Affordable housing is housing which is deemed affordable to those with a household income at or below the median as rated by the national government or a local government by a recognized housing affordability index. Most of the literature on af ...
("affordable housing crisis") which affects communities throughout the US. The 1990s developments and creation of the term supportive housing encompass models of community housing ("and disability") from the 1970s (e.g., first
United Way United Way is an international network of over 1,800 local nonprofit fundraising affiliates. United Way was the largest nonprofit organization in the United States by donations from the public, prior to 2016. United Way organizations raise funds ...
mental health agency in New York) to new investments in new supported housing developments in the late 2000s (NYS Governor's press release). Supportive housing encompasses a range of approaches including single sites (housing developments or apartment buildings in which units are designated as supportive housing) or scattered-site programs in which participants often use rent subsidies to obtain housing from a private landlord and supportive services may be provided through home visits. Services in supportive housing are flexible and primarily focused on the outcome of housing stability. New approaches to supportive housing include explorations of home ownership for people with disabilities, and a range of diverse consumer-directed, personal assistance and community support services focused on community integration and support. Most common, however, with collaborations involving state, federal, and local governments and non-profit sectors are congregate housing programs with service enhancements and increasing choices. From 2002 to 2007, an estimated 65,000 to 72,000 units of supportive housing were created in the United States. This represents about half the supply of supported housing units. Of the new units added, about half were targeted towards chronically homeless individuals, and one-fifth were for homeless families. According to the
United States Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Ur ...
(HUD), the number of Permanent Supportive Housing beds in the US increased from 188,636 to 353,800 between 2007 and 2017. Although of the shelter population, the majority remain as single, adult males of minority groups (approximately 65%), 38% were between 31 and 50 years old, and 38% had a disability; the rest were homeless families with a high concentration (likely due to high housing costs) in the states of California, New York and Florida.


Populations served

Sponsors of supportive housing projects generally aim to serve a specific population; the characteristics of those served and the housing program range widely: However, supporters of regular housing and support services in the community suggest choice based on other personal, social, and situational factors than specific population basis (e.g., choice of roommates or housemates, neighborhoods they live in). Targeted population groups (homeless initiatives) include: * Adolescents (including those in foster care or aging-out of foster care) * Elders (those who choose or require supportive services in a regular housing environment) * Single-parent households * Nuclear families (and multi-generational households) * Mental health clients/residents who have been diagnosed with a mental illness such as depression,
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
disorders,
bipolar disorders Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
,
anxiety disorders Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
, or
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
* People with multiple needs, including medical ones (including people who have
HIV/AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
,
alcoholism Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomi ...
, addictions, or other chronic illnesses) * Foster homes (including the need for adult and children models) * Maternity homes (e.g., use of
midwives A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; c ...
) * People maturing out of
transitional housing Transitional housing is temporary housing for certain segments of the homeless population, including working homeless people who are earning too little money to afford long-term housing. Transitional housing is set up to transition residents into ...
(recovery homes and halfway houses) * People with
substance use disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...
(e.g.,
opioids Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid u ...
) or combined diagnoses often post-treatment and families. Today, important new populations for supported housing in regular neighborhoods include working families, especially those with high proportional housing costs, older adults who need intensive (enriched) services to avoid nursing home placements, and people who need places to live due to the closure of the old style, institutional psychiatric care. Increasingly, supportive housing may be required as unemployment increases, for newly emerging groups such as newly legalized gay and lesbian partners, multi-generational immigrant groups in the new multicultural world, and for those adolescents aging out of their parents' homes to new community options. One of the 2000s textbooks on Supported/supportive Housing is a report on state projects in the US for older adults which includes use of the home and community-based (HCBS) waiver, efforts to reform more than 43 congregate residential categories in states, use of housing subsidies for low income persons, assisted living options, "comprehensive case/care management", and technical area such as "at-risk" housing and non-profit development.


Benefits of supportive housing for specific populations groups

Supportive housing proposes to be a comprehensive solution to a problem rather than a band-aid fix (such as a
shelter Shelter is a small building giving temporary protection from bad weather or danger. Shelter may also refer to: Places * Port Shelter, Hong Kong * Shelter Bay (disambiguation), various locations * Shelter Cove (disambiguation), various locatio ...
). While many of those who stay in the shelter system remain in or return to the system for extended periods of time, a much higher percentage of those who are placed in supportive housing remain housed on a more permanent basis.Chronic Homelessness Brief
, National Alliance to End Homelessness
This idea is also referred to as the
Housing First Housing First is a policy that offers unconditional, permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was first discussed in the 1990s, and in the following decades became government policy ...
model, an approach to combating chronic homelessness by providing homes upfront and offering help for illnesses and addictions. The concept turns the traditional model, which typically requires
sobriety Sobriety is the condition of not having any measurable levels or effects from alcohol or drugs. Sobriety is also considered to be the natural state of a human being at birth. A person in a state of sobriety is considered sober. Organization ...
(or prerequisites that can be used for enhanced services before a person can get housing), upside down. Research has shown that coupling permanent housing with supportive services is highly effective at maintaining housing stability, as well as helps improve health outcomes and decreases the use of publicly funded institutions. A review of the impact of these services found that they can improve health outcomes among chronically homeless individuals, including positive changes in self-reported mental health status, substance use, and overall well-being. In the Collaborative Initiative to Help End Chronic Homelessness (CICH), participants who had been homeless for an average of eight years were immediately placed into permanent housing. The CICH evaluation reported that 95% of those individuals were in independent housing after 12 months. A study of homeless people in New York City with serious mental illness found that providing supportive housing to the individuals directly resulted in a 60% decrease in emergency shelter use for clients, as well as decreases in the use of public medical and mental health services and city jails and state prisons. Another study in Seattle in 2009 found that moving "people with chronic alcoholism" into supportive housing resulted in a 33% decline in alcohol use for clients. There is significant support for the contention that supportive housing also costs less than other systems where its tenant base may reside, such as jails, hospitals, mental health facilities, and even shelters. Research on the overall costs to the taxpayer of supportive housing has consistently found the costs to the taxpayer to be about the same or lower than the alternative of a chronically homeless person sleeping in a shelter. The CICH evaluation showed that average costs for healthcare and treatment were reduced by about half, which the largest decline associated with inpatient hospital care.Supportive Housing is Cost-Effective
," National Alliance to End Homelessness
The use of supportive housing has been shown to be cost-effective, resulting in reductions in the use of shelter, ambulance, police/jail, health care, emergency room, behavior health, and other service costs. For example, one 2016 report identified studies documenting that these services can reduce health care costs, emergency department visits, and length of stays in psychiatric hospitals. The Denver
Housing First Housing First is a policy that offers unconditional, permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was first discussed in the 1990s, and in the following decades became government policy ...
Collaborative documented that the annual cost of supportive housing for a chronically homeless individual was $13,400. However, the per-person reduction in public services recorded by the Denver Housing First Collaborative came to $15,773 per person per year, more than compensating for the annual supportive housing costs. When paired with
low-income housing Subsidized housing is government sponsored economic assistance aimed towards alleviating housing costs and expenses for impoverished people with low to moderate incomes. In the United States, subsidized housing is often called "affordable hous ...
(or mixed-income housing), government subsidies (such as section 8 or Housing choice vouchers) and other revenue generating operations, supportive housing residences are claimed by their supporters to be capable of supporting themselves and even turning a profit (which can be used for enhanced services and amenities for the residents by a non-profit organization). According to a 2007 study done by the
National Alliance to End Homelessness The National Alliance to End Homelessness is a United States-based organization addressing the issue of homelessness. The Alliance provides data and research to policymakers and elected officials in order to inform policy debates. They also work ...
, supportive housing helps tenants increase their incomes, work more, get arrested less, make more progress toward recovery, and become more active, valued and productive members of their communities.


Impact on neighborhoods

Supportive housing can help people facing health challenges to continue to live in the community. However, proposals for new housing projects often faced local opposition, largely based on fears regarding adverse effects on property values and crime rates, local businesses, and the quality of life in the surrounding neighborhood. A 2008 study in Toronto, Canada reported: * There is no evidence linking supportive housing to property values and crime rates * Supportive housing tenants contribute to local businesses * Neighbors do not think the supportive housing buildings have a negative impact * Positive contributions of supportive housing tenants to the community One of the benefits of supportive housing which is integrated into the community is that local opposition and fears are minimized. Neighborhoods have been studied as part of the development of community support, and as places for the development of personal connections and neighborhood relations. In addition, a capacity-based approach to neighborhood development can be made integral to the development of supportive housing, including aspects of neighborhood asset building. In many ways, these projects can be a return to neighborhood-based control of services' planning which resulted in the 1990s in new housing developments, after school programs, parent support groups, respite care and similar initiatives in the field of children's mental health,


Limitations, impediments and challenges affecting the development of Supportive Housing


Financial feasibility

Prevailing rental rates and prices for housing in many US real estate markets complicate efforts to acquire and adapt existing buildings and building sites for use as supportive housing. The combination of circumstances confronting supportive housing proposals and their advocates can produce the belief that most such housing proposals are unfeasible. Some projects fail to materialize because of a real or perceived lack of government program funds, charitable grants, bank loans or a combination of such funding to pay for the cost of creating and operating financially viable supportive housing. Other organizations, however, have accessed diverse mix and match funding for highly visible community demonstrations for special population groups.
Enterprise Community Partners Enterprise Community Partners, formerly The Enterprise Foundation, is a national nonprofit organized around three central goals: to increase housing supply, advance racial equity and build resilience and upward mobility. Founded in 1982 by develo ...
is one of many nonprofit organizations that finances supportive housing through tax credits, grants and loans. They pioneered the financing of supportive housing through the
low-income housing tax credit The Low-Income Housing Tax Credit (LIHTC - often pronounced "lie-tech", Housing Credit) is a dollar-for-dollar tax credit in the United States for affordable housing investments. It was created under the Tax Reform Act of 1986 (TRA86) and gives ...
in 1991, overturning the conventional wisdom that investors would not embrace these projects. Consultants specialize in the creative use of housing financing, and supportive housing consultants and technical assistance collaboratives are now available for assistance to localities. Early directions for financing of housing and support services in the community included financing sources, such as
housing cooperative A housing cooperative, or housing co-op, is a legal entity, usually a cooperative or a corporation, which owns real estate, consisting of one or more residential buildings; it is one type of housing tenure. Housing cooperatives are a distin ...
programs, mixed income housing associations, community development block grants, loans for accessibility programs, tax exempt bonds, trust funds, housing subsidies, and low interest loans. The housing communities and institutes in the US, as early as the early 1980s, included Institute for Community Economics, McAuley Institute, Women's Institute for Housing and Economic Development,
Habitat for Humanity Habitat for Humanity International (HFHI), generally referred to as Habitat for Humanity or Habitat, is a US non-governmental, and nonprofit organization which was founded in 1976 by couple Millard and Linda Fuller. Habitat for Humanity is a C ...
, the Housing Technical Assistance Project of the ARCs, Local Support Corporation (LISC),
University of Vermont The University of Vermont (UVM), officially the University of Vermont and State Agricultural College, is a public land-grant research university in Burlington, Vermont. It was founded in 1791 and is among the oldest universities in the Unite ...
(Center for Community Change through Housing and Support), Creative Management Associates, Enterprise Foundation, and National Housing Coalition. The
US Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Urb ...
regularly makes available free information on housing financing and developments in the US through their website, including "Research Works" (in 2011, also on sustainability and green initiatives) and "US Housing Market Conditions". Specific technical resources are available to providers and researchers such as on Section 8 or housing vouchers (portable vouchers)


Government policies and plans

Where traditional solutions—institutions, charitable organizations or other methods—are recognized as inadequate solutions for the situation, national, regional and local officials have come to believe that homelessness is a problem that can and should be solved by other means. In some areas, this produced a movement to find alternative solutions rather than continuing to fund the traditional solutions, including shelter system, jails, asylums and hospitals. In addition to homelessness, the movement today is to downsize or close psychiatric centers (e.g., Olmstead initiative) and develop regular options for housing and support in the local communities; these population groups have also been counted in some reports as the homeless populations. In the US, hundreds of city governments have produced "10-year plans" that provide for supportive housing to end chronic homelessness because the Bush administration began pushing for creation of the plans in 2003. The goal: put the homeless people with complex situations and needs into permanent or transitional "supportive" housing with counseling services that help them get healthy lifestyles of their own choosing. The evidence shows supportive housing may be a viable solution: the number of street people in cities across the United States has plummeted for the first time since the 1980s. In 2005–2006, Miami, Florida reported a 20% decline in homeless populations and dozens of other US cities reported similar census results: San Francisco, CA (30%), Portland, OR (20%), Dallas, TX (28%), New York, NY (13%).U.S. homeless numbers decline / NATIONWIDE: 'Supportive' housing seen as good start San Francisco Chronicle (CA), May 14, 2006 Guided by research,
Congress A congress is a formal meeting of the representatives of different countries, constituent states, organizations, trade unions, political parties, or other groups. The term originated in Late Middle English to denote an encounter (meeting of ...
has taken several steps to encourage the development of permanent supportive housing. Beginning in the late 1990s, appropriations bills have increased funding for the
United States Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Ur ...
's homeless assistance programs and targeted at least 30 percent of funding to permanent supportive housing. Congress has also provided funding to ensure that permanent supportive housing funded by one of the United States Department of Housing and Urban Development programs (Shelter Plus Care) would be renewed non-competitively, helping to ensure that chronically homeless people could remain in their housing. The 2009 legislative mandate from the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act created bipartisan political support to adopt a collaborative approach to end homelessness. From this effort spawned the
United States Interagency Council on Homelessness The United States Interagency Council on Homelessness (USICH) is an independent federal agency within the U.S. executive branch that leads the implementation of the federal strategic plan to prevent and end homelessness. USICH is advised by a Co ...
's Opening Doors Strategic Plan to Prevent and End Homelessness in 2010. With a focus on permanent supportive housing as a means of ending chronic homelessness, the plan outlines an interagency effort aligning mainstream housing, health, education, and human services.


Imperfect markets

In seller's markets: where demand exceeds the supply of permanent supportive housing, many housing providers can be selective when admitting tenants. While this can lead to an improved quality of life and a relatively high success rate for the most fortunate applicants, the unsuccessful homeless remain in unsatisfactory situations. To some extent, this problem is being addressed by "first step" programs aimed at preparing people for residency in permanent housing. Exclusionary practices always exist in the residential and housing fields, against human rights laws, however, there does remain lack of an affordable, accessible supply of housing the US, similar to the waiting lists for portable housing vouchers.


Lack of expertise in development and operations

One impediment to the development of additional housing stock where it is otherwise needed, permissible and feasible is the lack of real estate acquisition, development & financing expertise in the government agencies and non-profit (non-governmental) organizations interested in serving those who need and want supportive housing. The
United States Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Ur ...
is trying to bridge that information and knowledge gap with the availability of regular reports on market and housing conditions throughout the nation, and statistics on all kinds of housing developments (e.g., home ownership, multifamily structures). In addition, there is a widening affordability gap in housing, especially with the lowest income households. Experts point to several factors contributing to this gap: erosion in the housing stock, high housing prices, a drop in real wages, a decline in middle wage jobs, increases in transportation costs, expensive development requirements, regulatory constraints, and insufficient housing assistance funds to meet the needs.


Economic impact on society

Studies cited by supporters (who represent the advocacy and provider sectors listed below) conclude that supportive housing is a cost-effective solution for the problems of several populations; it is substantially less costly than most alternatives used to address the problems of homeless people, including shelters, institutions and hospitals. Current arguments are that supportive housing often reduces the cost of emergency services for health care provided by governmental and non-profit agencies. The chronically homeless, the 10-20% who are continually on the street with addiction and mental problems impose heavy costs on their communities in hospital, jail and other services—hundreds of thousands of dollars apiece annually in some instances. * For example, the average daily cost to house a person in various institutional settings in New York City (2004) ** Supportive housing $41.85 ** Shelter $54.42 ** Prison $74.00 ** Jail $164.57 ** Psychiatric hospital $467 ** Hospital $1185 Per a study published in JAMA in 2009, a supportive housing development called 1811 Eastlake saved taxpayers $4 million in the first year of operation alone, because these residents are now off the streets and out of emergency rooms and in a safe, steady and supportive living environment. The 1811 Eastlake study compared 95
Housing First Housing First is a policy that offers unconditional, permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was first discussed in the 1990s, and in the following decades became government policy ...
participants, with 39 wait-list control members and found cost reductions of over 50 percent for the Housing First group. While it is not the first published evidence of the service use reductions and cost savings that permanent supportive housing interventions can provide, it is worth highlighting because the level of the cost savings – almost $30,000 per person per year after accounting for housing program costs – are greater than some seminal studies that have shown more modest cost offsets through permanent supportive housing. 1811 Eastlake provided assistance to homeless people with extensive health issues and still saw a savings of nearly $30,000 per tenant per year in publicly funded services, all while achieving improved housing and health outcomes. In Oregon, Portland's Community Engagement Program provides housing and intensive services to homeless individuals with mental illness and addictions. The program reduced the cost of health care and incarcerations from $42,075 to $17,199. The investment in services and housing during the first year of enrollment was averaged to approximately $9,870. This represents a 35.7% ($15,006 per person) annual cost saving for the first year following enrollment in CAP. Supportive housing can be considered to be a human right to a decent life in the US. The cost-benefits can be viewed as immeasurable when viewed through the lenses of benefits to self, family, friends, neighbors, community organizations, health, safety and welfare (government), and local communities. For example, cost-benefits typically relate to governmental expenditures, which may involve cost-shifting among governmental levels and departments, and benefits usually refer to the governmental benefits related to its agenda (e.g.,
Deinstitutionalization Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the la ...
, transinstitutionalization, , decategorisation,
community integration Community integration, while diversely defined, is a term encompassing the full participation of all people in community life. It has specifically referred to the integration of people with disabilities into US society from the local to the nationa ...
) expressed for the individual and family as life outcomes. However, supportive housing, especially as assisted living, may be congregate in nature either related to hospital and nursing home systems reform on one hand (e.g., Pynoos ''et al''., 2004), or in psychiatric, to its categorical disability service system with roots in community services systems and psychiatric hospitals. In the field of intellectual disabilities, the term supportive living is more common with , small size homes and apartments with choice options throughout local communities.


From supported housing to housing and support

The US has experienced an effort to move from facility-based services to more of a housing and support approach in regular homes in typical neighborhoods. This movement, involving state-federal and university collaboration, has involved the development of principles of housing and support which could apply across different disability groups interested in moving from the facility-based (bundled program) approach to housing and support. These principles are: * Housing for all. * Integrated housing. * Choice. * Supports based on the individual. * Separation of housing and support. Supported housing, in particular, involves moving from traditional residential models in mental health community services (e.g., halfway houses and group homes, transitional residences/apartment programs, Fairweather Lodges) to the newer community support approaches which allow greater choice and flexibility in roommates, homes, and neighborhoods. In particular, this period supported consumer housing preferences to form the basis for better quality housing and recognition of consumer choice. However, the primary concern remained the requirements of residential providers (no zero reject policy, this field), especially when addictions were identified as the primary concern for a few people/residents. Supportive housing, in addition to quality assurance procedures, are meant to ensure quality of care and quality of life; Sheehan and Oakes (2004) indicate that residents may be reluctant to complain on satisfaction surveys since they may be relocated to even stricter nursing facilities. However, these projects have included Real Systems Change Grants to enhance opportunities for independent living for people with disabilities and to assist 3 communities (in Connecticut) to become models of inclusion of people with disabilities and to transition from the nursing facilities. Supported housing (which is the first community living to involve housing, though NGO purchasing and leasing of community homes preceded this development) now is in its 4th decade in the university-governmental and community sectors, and was also succeeded by models of housing and health from the traditional medical sectors.


Supportive housing providers

In the US, supported or supportive housing providers are the voluntary, non-profit service sector organizations (NGOs) which contract with the governments (federal, state, local, now tribal and territorial) to provide both the housing and services which were originally bundled in institutional facilities. State governments, and increasingly, the private sector have directly offered these options (or their new service alternatives) as the governments have reorganized toward health services (e.g., increase in short term rehabilitation in a nursing facility;
United States Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Ur ...
's housing-health nexus) through the US
Centers for Medicare & Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer ...
. On ownership of housing per se (priority for low income and minorities, Fall 2012, US HUD), the governments have become mute (while this week in 2021, declaring entire apartment buildings unfit for occupancy), with no separate housing boards at the non-profit associations at the local levels yet visible and transfer of public, low income housing to the private sector or tenant ownership. In addition, housing and inclusion by Summer 2016 was with public safety, and the legal communities expanded fair housing cases by Summer 2014 (''Evidence Matters'', US HUD, 2014, 2016). Public housing authorities are responsible for the aging housing stock in the US and for the direct or contractual operation of low and moderate income housing, among other responsibilities. The
United States Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Ur ...
has a range of programs (e.g., mortgage financing programs for home-ownership; Family Self Sufficiency programs) which vary with federal administration. Primary view of housing and neighborhoods is on shaping children's futures (Fall 2014, US HUD) similar to
President Carter James Earl Carter Jr. (born October 1, 1924) is an American politician who served as the 39th president of the United States from 1977 to 1981. A member of the Democratic Party, he previously served as the 76th governor of Georgia from 19 ...
and First Lady Roslyn Carter's work with
Habitat for Humanity Habitat for Humanity International (HFHI), generally referred to as Habitat for Humanity or Habitat, is a US non-governmental, and nonprofit organization which was founded in 1976 by couple Millard and Linda Fuller. Habitat for Humanity is a C ...
and families with children with emotional needs. The
United States Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Ur ...
supports plans for the development or redevelopment of communities ("planned communities", US Congress) in 2019 and the development of "large scale housing and mixed use developments" (e.g., mixed income housing projects such as through the Madison Mutual Housing Association and Cooperatives; housing-business-transportation-recreation-schools projects), including on Indian reservations and land in the US.Racino, J. (2014). Housing and disability: Toward inclusive, sustainable, and equitable communities. In: J. Racino (Ed.), ''Public Administration and Disability: Community Services Administration in the US''. (pp. 123-156). NY, NY, London, and Boca Raton, FL: CRC Press, Taylor and Francis. The US federal level is also involved with foreign humanitarian aid packages and with disaster relief programs (e.g., US HUD, Winter 2015), making housing a priority in its international work. For example, the rebuilding of
9th Ward The Ninth Ward or 9th Ward is a distinctive region of New Orleans, Louisiana, which is located in the easternmost downriver portion of the city. It is geographically the largest of the 17 Wards of New Orleans. On the south, the Ninth Ward is bou ...
of New Orleans, Louisiana after the
Hurricane Katrina Hurricane Katrina was a destructive Category 5 Atlantic hurricane that caused over 1,800 fatalities and $125 billion in damage in late August 2005, especially in the city of New Orleans and the surrounding areas. It was at the time the cost ...
(ASPA, 2018, Denver, CO).


Supported/supportive housing governmental assistance

*
US Department of Housing and Urban Development The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the Secretary of Housing and Urb ...
– USA
Crisis
– UK * Supportive housing program, Winnipeg, Manitoba, Canada * Supported housing, state of New York


See also


Permanent Supportive Housing for Homeless People — Reframing the Debate

Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness

Permanent Supportive Housing: Addressing Homelessness and Health Disparities?

Addressing Chronic Disease Within Supportive Housing Programs

Detroit’s focus on supportive housing drives down homelessness 15 percent


References


Further reading

* AcademyHealth. (2016, July)
Rapid Evidence Review: What Housing-related Services and Supports Improve Health Outcomes among Chronically Homeless Individuals?
* Bassuk, Ellen L.; Geller, Stephanie
The Role of Housing and Services in Ending Family Homelessness
(2006). ''Housing Policy Debate'' 17(4): 781–806. * Braisby, D., Echlin, R., Hill, S. & Smith, H. (1984)
Changing Futures: Housing and Support Services for People Discharged from Psychiatric Hospitals
London: King's Fund Project Paper. * Carling, P.J., Randolph, F.L., Blanch, A.K. & Ridgeway, P. (1988). A review of the research on housing and community integration for people with psychiatric disabilities. ''National Rehabilitation Information Center Quarterly'', 1(3), 1–18. * Carling, P.J. (1993, May). Housing and supports for persons with mental illness: Emerging approaches to research and practice. ''Hospital and Community Psychiatry'', 44(5): 439–449.
PMID PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintain the ...

8509074
''; DOI
10.1176/ps.44.5.439
* Cuomo, A.M. (2014). HELP. All Things Possible: Setbacks and Successes in Politics and Life (pp.80–136). NY, NY: Harper Collins Publishers. ; * Dilys Page. (1995, April). Whose services? Whose needs? ''Community Development Journal,'' 30(2), 217–235. DOI
10.1093/cdj/30.2.217
* Fitton, P. & Wilson, J. (1995). "A home of their own: Achieving supported housing". In: T. Philpot & L. Ward (Eds.), Changing Ideas and Services for People with Learning Disabilities. (pp. 43–54). Oxford: Butterworth-Heinemann, Ltd. ; * Friedman, Donna Haig, et al.
Preventing Homelessness and Promoting Housing Stability: A Comparative Analysis
The Boston Foundation, June 2007. * Knisley, M. B. & Fleming, M. (1993, May). Implementing supported housing in state and local mental health systems. ''Hospital and Community Psychiatry'', 44(5),456–460.
PMID PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintain the ...

8509076
DOI
10.1176/ps.44.5.456
* Lakin, K. C. & Racino, J.A. (1990). Formation of the Rehabilitation Research and Training Centers on Families and Community Living in US Education. Washington, DC: University of Minnesota and Syracuse University in conjunction with the RRTCS of the USA. * Livingston, J. & Srebnik, D. (1991, November). States' strategies for promoting supported housing for persons with psychiatric disabilities. ''Hospital and Community Psychiatry'', 42(11), 1116–1119.
PMID PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintain the ...

1743638
DOI
10.1176/ps.42.11.1116
* McCarroll, Christina

The Christian Science Monitor, May 1, 2002 * O’Flaherty, Brendan
Making room : the economics of homelessness
Cambridge, Mass. : Harvard University Press, 1996. ; * Quigley, John M.; Raphael, Steven
The Economics of Homelessness: The Evidence from North America
''European Journal of Housing Policy'' 1(3), 2001, 323–336. * O'Hara, A. & Day, S. (2001, December)
Olmstead and Supportive Housing: A Vision for the Future
Washington, DC: Center for Health Care Strategies and the Technical Assistance Collaborative. * Pynoos, J., Hollander-Feldman, P., & Ahrens, J. (2004). Linking Housing and Services for Older Adults: Obstacles, Options, and Opportunities. NY, NY: The Haworth Press. ; * Racino, J. A. (1989, August). Selected Issues in Housing. Prepared for US conference distribution, Rehabilitation Research and Training Center on Community Integration, Syracuse University, Center on Human Policy. * Racino, J. (1999). "State policy in housing and support: Evaluation and policy analysis of state systems". In: Policy, Program Evaluation and Research in Disability: Community Support for All. (pp. 263–287). London: Haworth Press. ; * Racino, J. (2014). "Housing and disability: Toward inclusive, equitable, and sustainable housing and communities". Public Administration and Disability: Community Services Administration in the US. NY, NY: CRC Press, Francis and Taylor. ; * Ridgeway, P. & Zipple, A.M.(1990, April). "The paradigm shift in residential services: From the linear continuum to supported housing approaches." Special Issue: Supported Housing: New approaches to residential services. ''Psychosocial Rehabilitation''. Boston, MA: Center for Psychiatric Rehabilitation, Sargent College of Allied Health Professions, Boston University. DOI
10.1037/h0099479
* Rogers, E.S., Farkas, M., Anthony, W., Kash, M., Harding, C., & Olschewski, A. (2009)
Systematic Review of Supported Housing Literature 1993–2008
Boston, MA: Boston University Center for Psychiatric Rehabilitation. * Roncarati, Jill
Homeless, housed, and homeless again
Journal of the American Academy of Physician's Assistants (authorized for involuntary care by psychiatrists; active legal cases), June 2008.
PMID PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintain the ...

18619107
DOI
10.1097/01720610-200806000-00090
* Sheehan, N. & Oakes, C. (2004). "Public policy initiatives addressing supportive housing: The experience of Connecticut". In: Pynoos, J., Holander-Feldman, P. & Ahrens, J. (Eds.), Linking Housing and Services for Older Adults: Obstacles, Options, and Opportunities. pp. 81–113). New York: Haworth Press. ; * Surles, R.C. (1989). Supported Housing Implementation: A Report to the New York State Legislature. Albany, NY: New York State Office of Mental Health. * Taylor, S.J. (1987)
A Policy Analysis of the Supported Housing Demonstration Project
Pittsburgh, PA. Syracuse, NY: Syracuse University, Center on Human Policy, Community Integration Project. {{OCLC, oclc=27721422 * US Housing and Urban Development. (2010, July). Homeless Costs and Interventions: A Portrait of Homelessness in 2009; Low Income Housing Tax Credits' Boost Affordable Rental Housing Supplies; Snapshot of Worst Case Housing Needs in the US. "Research Works." Washington, DC.


External links


Corporation for Supportive Housing

Supportive Housing Network of New York

The Supportive Housing Providers Association (SHPA)

Child Welfare & Supportive Housing Resource Center
Homelessness solutions Deinstitutionalisation Public housing Living arrangements Social care in the United States Housing in the United States