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  • Study of Supportive Housing in Illinois: Interim Report On Publicly-Funded Service Usage by Residents Prior To Entry Into Supportive Housing

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    Social IMPACT Research Center at Heartland Alliance for Human Needs and Human Rights
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    This study was launched to document and analyze supportive housing residents’ use of public services prior to entering housing and afterwards, in order to determine the cost savings of supportive housing to other systems. The hypothesis of the study is that supportive housing reduces a person’s usage of expensive, primarily public-funded services. The study tracks individuals’ amount of service usage for two years before they entered supportive housing, comparing it to their usage of services two years after, as well as the change in types of services utilized over time. The study included supportive housing residents across Illinois living in developments that had been in operation for at least one year, and that served individuals who are homeless or at risk of homelessness, and individuals who have a mental illness and/or who are formerly incarcerated. This second interim report provides a picture of the services supportive housing residents accessed within the two years before they entered supportive housing.

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    Study of Supportive Housing in Illinois: Interim Report on Publicly-Funded Service Usage by Residents Prior to Entry into Supportive Housing

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    This study was launched to document and analyze supportive housing residents’ use of public services prior to entering housing and afterwards, in order to determine the cost savings of supportive housing to other systems. The hypothesis of the study is that supportive housing reduces a person’s usage of expensive, primarily public-funded services. The study tracks individuals’ amount of service usage for two years before they entered supportive housing, comparing it to their usage of services two years after, as well as the change in types of services utilized over time. The study included supportive housing residents across Illinois living in developments that had been in operation for at least one year, and that served individuals who are homeless or at risk of homelessness, and individuals who have a mental illness and/or who are formerly incarcerated. This second interim report provides a picture of the services supportive housing residents accessed within the two years before they entered supportive housing.

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    53 views4 pages

    Study of Supportive Housing in Illinois: Interim Report On Publicly-Funded Service Usage by Residents Prior To Entry Into Supportive Housing

    Uploaded by

    Social IMPACT Research Center at Heartland Alliance for Human Needs and Human Rights
    This study was launched to document and analyze supportive housing residents’ use of public services prior to entering housing and afterwards, in order to determine the cost savings of supportive housing to other systems. The hypothesis of the study is that supportive housing reduces a person’s usage of expensive, primarily public-funded services. The study tracks individuals’ amount of service usage for two years before they entered supportive housing, comparing it to their usage of services two years after, as well as the change in types of services utilized over time. The study included supportive housing residents across Illinois living in developments that had been in operation for at least one year, and that served individuals who are homeless or at risk of homelessness, and individuals who have a mental illness and/or who are formerly incarcerated. This second interim report provides a picture of the services supportive housing residents accessed within the two years before they entered supportive housing.

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    Executive Summary August2008

    STUDYOFSUPPORTIVEHOUSINGINILLINOIS:
    InterimReportonPubliclyFundedServiceUsage byResidentsPriortoEntryintoSupportiveHousing

    Overview of Supportive Housing


    Supportivehousingisaffordablehousingcoupledwithsupportive servicesthatenableresidentstoremainhousedandensurelongterm housingstability.Itistypicallyoperatedbynonprofitserviceorhousing providers.Servicesprovidedvarybysitebuttypicallyincludecase managementandlinkagestospecialtyservicessuchasmentalhealthor substanceabusetreatment. Researchsuggeststhatstabilizingindividualsinsupportivehousingcan reducetheiruseofexpensivepubliccrisisservicessuchasemergency rooms,psychiatrichospitals,jails,andsubstanceabusetreatment 1 programs. Furthermore,thesecostdecreasesmayoffsetaportionof permanentsupportivehousingexpenditures,thusmakinginvestmentin thishousingmodelattractivetopolicymakersandotherswhoseekto maximizethevalueofpublicresourcesinvestedinprogramstoreduceand eliminatehomelessness.

    Background
    TheIllinoisbased SupportiveHousing ProvidersAssociation commissionedTheHeartland AllianceMidAmerica InstituteonPovertyto conductacoststudyof supportivehousingin Illinois,whichbeganin 2005.

    Research Team
    HelenEdwards,AlyssaNogaski, AmyRynellTheHeartland AllianceMidAmericaInstitute onPoverty

    Study of Supportive Housing in Illinois


    Thisstudywaslaunchedtodocumentandanalyzesupportivehousing residentsuseofpublicservicespriortoenteringhousingandafterwards, inordertodeterminethecostsavingsofsupportivehousingtoother systems.Thehypothesisofthestudyisthatsupportivehousingreducesa personsusageofexpensive,primarilypublicfundedservices. Thestudytracksindividualsamountofserviceusagefor2yearsbefore theyenteredsupportivehousing,comparingittotheirusageofservices 2yearsafter,aswellasthechangeintypesofservicesutilizedover time.ThestudyincludedsupportivehousingresidentsacrossIllinois livingindevelopmentsthathadbeeninoperationforatleastoneyear, andthatservedindividualswhoarehomelessoratriskof homelessness,andindividualswhohaveamentalillnessand/orwhoare formerlyincarcerated. Atotalof476supportivehousingresidentsin11countiesparticipatedin thestudy.Residentsinthestudyreportedhighratesofexperienceswith mentalillness,drugandalcoholrelatedissues,incarceration,andchronic physicalhealthproblems.Thesecharacteristicsareoftenassociatedwith highusageofexpensiveservices. Themajorityofthedataforthisstudyarefromadministrativerecords fromthefollowingentitiesinIllinois:IllinoisDepartmentofHealthcare andFamilyServices,theIllinoisDepartmentofCorrections,theIllinois DepartmentofHumanServicesDivisionofMentalHealthandDivisionof AlcoholismandSubstanceAbuse,andvariouscountyjailsandhospitals. DuetotheunavailabilityofdatabeforeJuly1,1999atonestateagency, datausedinthisstudyareforthetimeperiodofJuly1,1999toJune 30,2006.

    Project Advisors
    JanetSmith,CollegeofUrban PlanningandPublicAffairs, UniversityofIllinoisatChicago JacquelynAnderson,Carol Wilkins,SueAugustus,and KatrinaVanValkenburgh, CorporationforSupportive Housing SupportiveHousingProviders AssociationEvaluation CommitteeMembers

    Acknowledgements
    TheSupportiveHousing ProvidersAssociationgratefully acknowledgesthefollowing fundersfortheircriticalsupport ofthisproject:TheChicago CommunityTrust,Illinois DepartmentofHumanServices DivisionofMentalHealth,the MichaelReeseHealthTrust,The HarrisFamilyFoundation, LaSalleBank,ChaseBank, TheCommunityFoundationof NorthernIllinois,andPfizer.

    Caton,C.,Wilkins,C,&Anderson,J.(2007).Peoplewhoexperiencelongtermhomelessness:Characteristicsandinterventions.Oakland,CA: CorporationforSupportiveHousing.

    SummaryofPubliclyFundedServiceUsagebyResidents PriortoEntryintoSupportiveHousing
    Thissecondinterimreportprovidesapictureoftheservicessupportivehousingresidentsaccessedwithinthe2 yearsbeforetheyenteredsupportivehousing.Although476supportivehousingresidentsparticipatedinthe researchstudy,thisreportisbasedonthe436residentswhoenteredsupportivehousingafterJuly1,1999. Serviceusagewithinsixdifferentsystemsisreportedhere:Medicaidreimbursedservices,nonMedicaid reimbursedhospitalservices,statementalhealthhospitals,statesponsoredsubstanceabusetreatments,state prisons,andcountyjails. Thisreportdoesnotprovideafullpictureofstatefundedservicesusage.Servicessuchashomelessshelterand nonMedicaidfundednursinghomeuseswereleftoutduetothelimitedrecordkeepingsystemsinthestate.In addition,theseresultsunderrepresentactualserviceutilizationduetothefollowing: Afewrecordrequestswentunfilled(primarilyhospitalsandjails) Errorswereidentifiedwithinrecords Selfreportbyresidentsofpastserviceutilizationathospitalsandjails Forthisanalysis,thedataarebrokenoutintousersanduses.Auserisanindividualthatusedaservice duringthetimeframe,forexample,hasMedicaidcoverageandusesitduringthestudyperiod.Auseis calculatedwhenauserhasconsumedaservice,suchasabillableservicethroughMedicaid,orspenttimein prison.Inaddition,whenavailable,thenumberofdaysspentinahospitalorfacilityisincluded.Thesemeasures takentogetherprovideasnapshotofthedegreeofpubliclyfundedserviceutilizationofsupportivehousing residentsbeforetheymovedintosupportivehousing.

    MedicaidReimbursed Service Usage


    Medicaidisastateadministeredhealthinsuranceprogramthatisavailableonlytopeoplewith limitedincomeandwhomeetcertaineligibilityrequirements.Atotalof230(52.8%)residentswere coveredbyMedicaidatsomepointduringtheirpresupportivehousingtimeperiod.Themostexpensive Medicaidservices,inpatientmedicalcareandinpatientpsychiatriccare,wereamongtheleastutilized servicesthoughthoseusersthatutilizedinpatientcareuseditfairlyintensively.Pharmacyhadthemost usersandmostusesoutofalltheMedicaidreimbursedservices.Outpatientpsychiatriccarewasthe secondmostutilizedservicecategorywithover10,000uses,thoughlessthanhalfoftheMedicaidusers utilizedtheseservices.Inaddition,asmallnumberofresidentsspentaconsiderableamountoftimeliving innursinghomes. MedicaidReimbursedServiceUsage:Pre SupportiveHousingTimePeriod,N=230 Category1:InpatientCare InpatientMedicalCare InpatientPsychiatricCare Category2:Pharmacy,HomeHealth,MedicalEquip. Pharmacy Homehealthcareandmedicalequipment Category3:OutpatientCare OutpatientMedicalCare OutpatientPsychiatricCare Category4:Physiciancare,carebyotherproviders, dentalcare Physiciancare Carebyotherproviders DentalCare Other NursingHomeCare Average Number Number Number ofUses ofUsers ofUses perUser n=230 71 137 1.9 38 198 38 166 97 124 13,895 607 1,195 10,226 3.3 70.2 16.0 7.2 105.4 Average Number Number ofDays ofDays perUse 381 911 2.8 7.3

    191 82 64 24

    8,457 223 335 31

    44.3 2.7 5.2 1.3 6,922 223.3

    SummaryofPubliclyFundedServiceUsagebyResidents PriortoEntryintoSupportiveHousing,Continued

    HospitalBased Care Usage, NonMedicaid Reimbursed


    SincenotallresidentsinthestudywereeligiblefororcoveredbyMedicaid,medicalrecordswere requestedforthestudytimeperiodfrom56hospitalsacrossthestate.Ofthetotal,99residents(23%) receivednonMedicaidreimbursedhospitalcareduringthepresupportivehousingperiod.Twentyoneof these99residentshadMedicaidatsomepointduringtheirpresupportivehousingtimeperiod.Similarto theMedicaidfindings,whilelowernumbersofresidentsreceivedinpatientmedicalcareorpsychiatric care,thosethatdidconsumedahighvolumeofservices.Therewerealsohighnumbersofemergency roomandoutpatientcareuses. HospitalBasedCareUsage,Non MedicaidReimbursed:PreSupportive HousingTimePeriod,N=99 InpatientMedicalCare InpatientPsychiatricCare EmergencyRoom OutpatientMedicalCare OutpatientPsychiatricCare Average Average Numberof Number Numberof Number Daysper ofUses UsesperUser ofDays Use 60 2.6 219 3.7 13 200 455 39 1.4 2.9 6.6 5.6 330 25.4

    Number ofUsers 23 9 68 69 7

    State Mental Health Hospital Usage


    InadditiontothosereceivingMedicaidreimbursedpsychiatricinpatientcare,26residents(6.0%)spent timeinastatementalhealthhospitalsometimeduringtheirpresupportivehousingtimeperiod.These26 residentsaveraged1.2visitstoastatementalhealthhospitalduringthe2yearspriortosupportive housingentry.Visitsrangedfromonedayto415days,withanaveragestayof45.5days.Residents spentatotalof1,457daysinastatementalhealthhospitalinthepresupportivehousingtimeperiod.

    Substance Abuse Treatment Usage


    134residents(30.7%)utilizedtreatmentservicesthroughtheIllinoisDepartmentofHumanServices DivisionofAlcoholismandSubstanceAbuse(DASA)sometimeduringthe2yearspriortotheirentryinto supportivehousing.Amajorityoftheresidentsinsubstanceabusetreatmentreceiveditinanoutpatient setting.Slightlyover3outof10residentswhoreceivedtreatmentrequireddetoxification,whichisa medicallymanagedintensiveinpatienttreatmentthatismorecostlythanothersubstanceabuse treatmentoptions.Sixtypercentofresidentswhowereindetoxificationmovedontoresidential rehabilitation,anexpensive24hourstructuredandsupervisedtreatmentapproach. SubstanceAbuseTreatment Usage:PreSupportiveHousing TimePeriod,N=134 OutpatientTreatment CaseManagement Detoxification ResidentialRehabilitation PsychiatricEvaluation HalfwayHouse RecoveryHome Average Number Numberof Number AverageNumber ofUses UsesperUser ofDays ofDaysperUse 176 2.5 68 62 14 7 6 1.6 1.6 1.2 1.2 1.2 400 1,810 654 404 5.9 29.2 93.4 67.3

    Number ofUsers 70 56 42 40 12 6 5

    Time in State Prison


    Supportive Housing Providers Association
    TheSupportiveHousing ProvidersAssociation(SHPA)is astatewideassociationof organizationswhoprovide supportivehousing.SHPA enablesincreaseddevelopment ofsupportivehousingand supportsorganizationsthat developandoperate permanentsupportivehousing. Formoreinformationcall 773.359.0123oremail supportivehsg@aol.com.

    Therewere33residents(7.6%)inthesamplethatspentsometimeinastate prisoninthe2yearsbeforetheyenteredsupportivehousing.Thelengthof incarcerationrangedfrom1dayto604days.Theaveragelengthofstaywas 316.5days.Twothirdsofresidentsthatwereincarceratedbeforetheyentered supportivehousingspentmorethan6monthsinprison.Residentsspentatotal of10,445daysinprisoninthe2yearsbeforetheyenteredsupportivehousing.

    Time in County Jail


    Therewere24residents(5.5%)thatspentsometimeinacountyjailinthe 2yearsbeforetheyenteredsupportivehousing.Thelengthoftimespentin countyjailrangedfromzerodays(noovernightstay)to254days.Residents spentanaverageof46.4nightsincountyjail.Amajorityofresidentsthat hadspenttimeinacountyjailspentlessthan6monthsinjail.Residents spentatotalof1,576daysinthecountyjailsysteminthe2yearsbefore theyenteredsupportivehousing.

    Corporation for Supportive Housing


    Establishedin1992,the CorporationforSupportive HousingIllinoisofficeworksto promotethedevelopmentof supportivehousingtoend longtermhomelessness throughthreecoreproducts andservices:capacitybuilding toenhancethesupportive housingindustrysskillsand knowledgefinancialand technicalassistanceto partnersandpromotingpolicy reformsandcoordinated systems.Formoreinformation call312.332.6690oremail ilinfo@csh.org.

    Usage of Multiple Systems


    Only18percentofthe residents(80)didnot accessanyofthesystems studiedinthepre supportivehousingtime period.Justunderhalf (214)oftheresidents accessedonesystem.One thirdoftheresidents(142) accessedtwoormore systems.Noresident accessedallsixsystems.

    UsageAcrossSystems
    18% 9% 3to5systems 24% 2systems 1system 0systems 49%

    Conclusion
    Thisinterimreportfocusedontheusageofprimarilyexpensivestatefunded emergencyservicespriortoentryintosupportivehousing.Thoughnotafull pictureoftheusageofstatefundedservicesduetodatalimitations,itis clearfromtheseinitialfindingsthatsupportivehousingresidentsare frequentusersofexpensiveservicessuchasinpatientcare,psychiatric hospitals,jails,andsubstanceusetreatmentprogramspriortotheirentry intosupportivehousing. Thenextreportwillfocusontheserviceutilizationofresidentsafterthey enteredsupportivehousingandwillalsolookatthecostsofservicesused beforeandaftersupportivehousingentry.Itisanticipatedthattherewillbe adecreaseinserviceuseafterentryintosupportivehousingforatleast thosethatareusingthemoreexpensiveservicesduetothestabilizing effectsofsupportivehousing.

    The Heartland Alliance MidAmerica Institute on Poverty


    TheHeartlandAllianceMid AmericaInstituteonPoverty conductsresearchthatshines aspotlightonsocialissuesin ordertopromoteinformedand effectivepolicyandprogram solutions.Formoreinformation call773.336.6075oremail maip@heartlandalliance.org.

    Thisreportisavailablefordownload: www.heartlandalliance.org/maip/and www.supportivehousingproviders.org

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