The integration of social services and housing is not a new concept. The services available near our housing have defined our sense of community. In our housing search, we look for places that have the services we need, such as shopping, day care, health care and employment.
Yet for some, the services they need are not easily found. This is particularly true for those with special needs, such as people with chronic mental illness, people living with HIV/AIDS, the physically or developmentally disabled, victims of domestic violence, and recovering substance abusers.
Supportive housing, in its broadest definition, is housing linked with social services tailored to the needs of the population being housed. Supportive services can be either on-site or off-site. Nonprofit housing developers and social service providers have long recognized the importance of comprehensively addressing the needs of their residents and clients. Housing and supportive services are interdependent; both are less effective in the absence of the other.
Supportive housing for special needs populations first emerged after the federal government encouraged policies to “deinstitutionalize” persons with mental illness in the early 1960s. Though insufficient in number, several models of group homes and supervised residences were developed. In the 1980s, economic forces, the conversion and demolition of many inner city SROs and a large reduction in federal housing subsidies saw an emergence of the “new homeless” – mothers with young children, veterans, and migrant farm workers, for example.
The term “supportive housing” became widespread in 1987, when HUD, under the Stewart B. McKinney Homeless Assistance Act, created the Supportive Housing Demonstration Program, which provided funds to develop and operate transitional and permanent housing for homeless populations. This was one of the first HUD programs to provide funding for supportive services.
As a result of the crisis atmosphere at the local level created by the burgeoning homeless population and HUD’s compartmentalization of programs, an emergency transitional permanent housing continuum for the homeless was created. In this model, the homeless are assessed at emergency shelters, transferred to a transitional housing program with on-site services, and then placed in permanent housing (if available) up to two years or more after entering the shelter system. For many, the cycle has been repeated a number of times, in a large part due to the lack of permanent affordable housing.
Emergency shelters and transitional housing programs have a finite length of stay, which may vary anywhere from a few nights for emergency shelters to two years for transitional housing. With stays of up to three months, emergency shelter in one part of the country is called transitional housing in another. There are many different types of emergency shelter and transitional housing, ranging from barracks-type facilities, to shared living quarters, to individual apartments or houses.
Transitional housing is viewed more as a program, with social services the primary focus, than as housing. The major focus of transitional housing is to help people increase their coping and life management skills to resolve crises in their lives, gain access to community-based resources, and move into independent permanent housing. Residents are expected to participate in on-site activities and receive services as a condition of their stay. Transitional housing is more expensive than permanent housing because of the on-site services and 24 hour staffing usually provided.
Transitional housing may be an appropriate setting for those whose present circumstance requires targeted supportive services to regain stability and develop skills, such as victims of domestic violence, recovering substance abusers, and pregnant and parenting teenagers. However, for some, transitional housing represents one more unnecessary move and adjustment to new rules and regulations.
For the general low-income population, a more resident-friendly and cost effective method that many nonprofit agencies have found is to focus on developing permanent housing with social services available (but not mandatory) either on-site or nearby. This serves to directly integrate the formerly homeless into communities; provides for increased family stability and avoids costly school and day care transfers; allows families to adjust to their surroundings, rather than prepare for another move; and changes the focus from crisis response to community building.
There are numerous successful permanent supportive housing models across the country. Many organizations seek staff to develop the housing on their own, others hire consultants, and still others work with a nonprofit housing developer in either a partnership or “turnkey” arrangement, in which the building is developed by one organization and “turned over” to another to operate and provide services.
One agency that both develops housing and provides supportive services is AIDS Services of Dallas (ASD), which has provided high quality supportive housing to 647 men, women and children living with AIDS since 1987. ASD’s success is a result of several factors: the planning and consideration given to physical design; the high quality of service delivery; the philosophy of providing comprehensive and flexible services; and, most importantly, the spirit of hope and compassion ASD brings to people living with AIDS.
AIDS Services of Dallas originally intended to develop housing and use the supportive services available from local providers. However, ASD quickly realized that this arrangement could not adequately meet its residents’ needs, because off-site service providers were not able to quickly respond to the cyclical nature of the disease. ASD began to provide supportive services, including home health care, food services, social work, nursing case management, and child and adult recreation.
ASD decided to develop several multifamily developments nearby to ensure the delivery of high quality services in a coordinated and cost effective manner. Currently, 73 residents live in two adjacent buildings, and an additional 64 residents will be moving in the fall to an SRO one block away. Plans are also underway to construct a residence for families one block away. This proximity allows the buildings to easily share staffing and services and reduces the cost of operations.
ASD met the changing needs of its residents by designing a flexible program in which services ebb and flow according to residents’ needs. Residents determine the level of services they wish to receive, which range from basic social support to 24-hour care for those in the terminal phase of the disease. This model enables residents to benefit from a home-like environment and have access to a continuity of care at a significantly lower cost than a hospital or nursing home.
Community Housing Associates (CHA) in Baltimore, Maryland took a different approach to providing supportive housing. CHA was established in 1989 as a nonprofit housing development and management subsidiary of Baltimore Mental Health Systems (BMHS), which administers Baltimore’s publicly-funded mental health services.
CHA has developed and currently manages 61 units of scattered-site housing for people with chronic mental illness in 37 buildings across the city. Most of the properties are townhouses occupied by both individuals and families. Some of the units are master-leased to service providers for occupancy by their own clients. CHA selects vacant properties that do not require zoning changes to minimize community opposition.
CHA clearly delineates housing functions from supportive service functions. CHA develops and manages independent living units but is not directly involved in any aspect of social services. Instead, CHA arranges for case managers from the lead mental health agency in that neighborhood to be responsible for ensuring that the residents have access to services. This model is both cost effective and easily adaptable to a variety of settings.
Whatever model it chooses, a nonprofit that decides to develop supportive housing must address a wide range of issues depending on resident needs and local conditions. These issues include: Should the housing be single-site or scattered site? Should the project serve mixed populations or one specific population? Should services be provided on-site or off-site? Should the residence be licensed? Should there be restrictions beyond the traditional lease? In deciding what model is most appropriate for them, organizations should think carefully about their abilities (including legal and fiscal), long term goals, fundraising potential, and relationship with nonprofit housing agencies.
Those of us who create supportive housing have an obligation to ensure that it is thoughtful, well planned, and that it creates its own sense of community. Most of us are able to find the support and services we need from our family, friends, and community. For those who are homeless, at risk of homelessness, or who otherwise lack a support system, supportive housing can provide the links they need to live independently.