Supportive Housing Providers Association: What is Supportive Housing?

1. Supportive Housing Providers Association: What is Supportive Housing?

2. Our State • Big City: Chicago • Mid-sized Cities • Very Rural and Impoverished Areas • Great Geographical Distances

3. Supportive Housing Providers Association • 100+ member organizations across the state • More than 9,500 units of supportive housing • 12,000 men, women, and children • Advocacy, education, training, technical assistance, networking, resident services • Specializing in active, engaged members - including staff, residents, and boards

4. Supportive Housing • Is affordable housing combined with support services. • Helps individuals become stabilized in housing. • Positively impacts health—physical and mental health. • Helps individuals avoid returning to jail or prison. • Makes possible productive lives, including employment.

5. What Is Permanent Supportive Housing? HOUSING that is: • Permanent: Not time-limited, not transitional; • Affordable: For people coming out of homelessness; and • Independent: Tenant holds lease with normal rights and responsibilities. With Services that are: • Flexible: Designed to be responsive to tenants’ needs; • Voluntary: Participation is not a condition of tenancy; and • Independent: Focus of services is on maintaining housing stability.

6. Supportive Housing Serves • Individuals and families • People who have special needs such as: - Mental illness - Chronic, debilitating physical illness, such as HIV/AIDS - Substance abuse disorders - Chronically homeless

7. Individuals with Serious Mental Illnesses or Other Disabilities The Cycle: • Jail • Street • Hospital Emergency Room • State Operated Mental Hospital • Nursing Home, IMD, State Institution OR Supportive Housing

8. Who Needs Supportive Housing? • A portion of the homeless population that needs supportive housing to stay housed. • A portion of the prison and jail population that will need supportive housing to stay housed. • Individuals with disabilities living in - Institutions for Mental Disease, - Nursing Homes, or other State Institutions who could live better in the less restrictive setting of supportive housing.

9. Supportive Housing in Illinois: A Wise Investment! In April of 2009, SHPA released the first comprehensive study of supportive housing in Illinois, entitled: Supportive Housing in Illinois: A Wise Investment. The study was a collaboration by Supportive Housing Providers Association, CSH, and The Social IMPACT Research Center

10. Supportive Housing in Illinois: A Wise Investment! • The study looked at the cost-effectiveness of supportive housing. • 177 supportive housing residents around Illinois were enrolled in the study. • Their use of 6 systems was studied two years before entering housing comparing it to the two years after entering housing

11. Supportive Housing in Illinois: A Wise Investment! The 6 systems studied were: • Medicaid-reimbursed services • Uncompensated hospital services (not covered by Medicaid or private insurance) • State Mental Health hospitals • Substance Abuse Treatment • State Prison • Illinois County Jails

12. Supportive Housing in Illinois: A Wise Investment! • There was a cost decrease in all 6 systems studied from “before housing” to “after entering housing”. • There was a spending shift: • from use of expensive inpatient services before housing (nursing homes, inpatient care, state mental health hospitals) • to less expensive outpatient services after entry into housing (outpatient medical and psychiatric care, case management).

13. Supportive Housing in Illinois: A Wise Investment! • Prison stays dropped to zero; stays in county jails decreased 86%. • Nursing Home use decreased 97%. • Emergency Room total use decreased over 40% and the use of inpatient medical care went down 83%.

14. Supportive Housing in Illinois: A Wise Investment! • There was an average cost savings of $2,400 per person per year. • These cost savings greatly under represent costs due to data that was unable to be collected such as substance abuse costs, police contacts, soup kitchens, shelter stays, and many others.

15. Supportive Housing in Illinois: A Wise Investment! The study shows that Supportive Housing is cost effective: • It leverages federal funding: - Medicaid reimbursement - Renewable HUD rental subsidy - Capital funding, mostly from HUD • cost savings in public funding accrued from pre- to post- supportive housing, a 39% reduction overall.

16. Supportive Housing in Illinois: A Wise Investment! Supportive housing cost far less than other places where people with disabilities end up. The cost of serving a person in supportive housing is: • one half the cost of a shelter, • one quarter the cost of being in prison and • one tenth the cost of a state psychiatric hospital bed.

17. Additional Research Shows the Value of Supportive Housing ! Housing for Health Partnership in Chicago studied homeless people with inpatient hospitalization for chronic medical conditions, including: - (HIV/AIDS, - renal disease, - liver disease, - cancer, - COPD, - stroke, diabetes

18. Additional Research Shows the Value of Supportive Housing ! • Those who received “usual” care continued to use high amounts of costly emergency care • The intervention group who received recuperative care and access to permanent supportive housing used - 45% fewer days in nursing homes; - 42% fewer days in the hospital; and - 46% fewer ER visits

19. Housing IS Health Care! It is no surprise – • study after study has found that supportive housing programs work for people with disabilities, even those who are hardest to house, such as chronically homeless individuals with mental illnesses. • Housing is a key social determinant of health. • Housing is, in fact, an important health care service!

20. Supportive Housing Works Supportive Housing enables residents to: • Become stabilized in housing, • Have freedom and necessary support, • Get consistent proper medical care, • Avoid returning to jail or prison, • Manage their substance use, • Reconnect with family & community, • Take positive steps in their lives, including employment for those who are able.

21. Supportive Housing takes many forms across Illinois It is tailored to the community where it is located and the population it serves.

22. Types of Supportive Housing • Scattered site rental units in buildings owned & managed by another entity. • All in one building owned and managed by provider or partner. • 4 units to over 100 units • single homes Many different styles, for Families and individuals

23. Heritage Behavioral Health, Decatur Three supportive apartment buildings form a small community.

24. Southern Illinois Coalition for the Homeless . Eight two-and three-bedroom single family homes serve as supportive housing for families in a 24-county area

25. Grand Apartments. Located n downtown Rockford Zion Development Corporation, Rockford

26. Stenger Apartments, located in Cairo - near the downtown area Delta Center, Cairo

27. Brand New Beginnings, Chicago Family Supportive Housing, an apartment building for families.

28. Financing for Supportive Housing: the “Three –Legged Stool” Capital Funding Rental Subsidy or Operating Reserve Funding for Services

29. Capital FundingAcquisition, Rehab, New Construction Capital Funding

30. Financing Acronyms • IHDA=IL Housing Development Authority • HUD=US Dept. of Housing & Urban Development • SHP= HUD Supportive Housing Program • NSP=Neighborhood Stabilization Program • HOPWA= Housing Opportunities for Persons with AIDS • IDCEO=IL Dept. of Commerce & Economic Opportunity

31. Financial Acronyms • FHLB=Federal Home Loan Bank • IDHS=IL Dept. of Human Services • DMH=Division of Mental Health • CDBG=Community Development Block Grant

32. Sources of Capital Funding

33. Sources of Capital Funding

34. Sources of Capital Funding

35. Sources of Capital Funding

36. Sources of Rental Support Rental Subsidy or Operating Reserve

37. Sources of Rental Support

38. Sources of Rental Support

39. IDHS/DMH Bridge Subsidy • DMH Housing Policy: The Department of Human Services, Division of Mental Health (DMH) is supportive of the development and expansion of Permanent Support Housing (PSH) for individuals who meet defined criteria of eligibility and who are diagnosed with a serious mental illness. • DMH plans to devote its attention and future resources toward expansion of the Permanent Supportive Housing model – an acknowledged best practice.1 1 Illinois Division of Mental Health (2008). Illinois Division of Mental Health permanent supportive housing policy. Available at http://tinyurl.com/mmpzb3

40. DMH Priority Populations • Resident of a Long Term Care Facility (nursing facility), or • At risk of placement in a nursing facility, or • Extended long term patient (at least 6 months) in a State Hospital, or • An aging-out adolescent or young adult from an Individual Care Grants (ICG) program, or • A DCFS ward aging-out of guardianship, or • A resident of a DMH funded supported or supervised (including MH-CILA) residential setting, or • Experiencing chronic homelessness as defined by DMH.

41. Bridge Subsidy Initiative • Began with “test phase” in August 2008 and 1st Round in October 2008 • Tenant-based subsidy designed to help consumers “bridge” the gap between the time a consumer could leave the nursing home or other institution and the time they can access a Housing Choice Voucher (HCV) in the community • Consumers must be connected to their local DMH contracted mental health center in order to apply • No pre-determined length of “bridge” • Each consumer can access up to $2,000 in transition funds

42. Funding for Services Funding for Services

43. Sources of Service Funding

44. State Funding for Supportive Housing For a total of $23.9 million, providing services in over 8,500 supportive housing units to 10,106 men, women, and children. • FY 1999, $3.6 million • FY 2004, $1.75 million • FY 2005, $2.7 million • FY 2006, $1.7 million • For FY 2007, $4.2 million • For FY 2008, $3.9 million • For FY 2009, $4 million • For FY 2010, $1.4 million • For FY 2011, $1.4 million • For FY 2012, less than 1% cut.

45. State Funding for Supportive Housing For a total of $30.4 million, providing services in over 9,500 supportive housing units to 12,000+ men, women, and children.

46. Supportive Housing Funding fromDepartment of Human Services

47. Sources of Service Funding

48. HUD Homeless Funding, Continuums of Care, & Supportive Housing • Challenges: A person cannot enter HUD Continuum of Care funded permanent housing directly from jail, prison, nursing home, IMD, state run institution because a person must be homeless to be eligible. • Many people exiting these systems become homeless immediately if not sooner, they are then eligible to participate in HUD McKinney-Vento Programs. • It’s all in the definition!

49. Partnerships • IDHS & SHPA/Providers & Federal Funding, etc. • IDHS/DMH & CSH • Providers combining Federal, State, County, Township, and City Funding. • Providers partnering with developers, government entities, housing authorities • Others…