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Evaluation of Housing for Health Permanent Supportive Housing Program

by Sarah B. Hunter, Melody Harvey, Brian Briscombe, Matthew Cefalu

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Research Questions

  1. Did HFH PSH recipients use fewer public services in the year after receiving housing compared to the year prior?
  2. Did the change in service use produce net savings to the county?
  3. Was the program associated with self-reported improvements in participants' health?

Housing for Health (HFH), a division within the Los Angeles County Department of Health Services (DHS), was established to provide supportive housing to DHS patients with complex medical and behavioral health issues who were experiencing homelessness. HFH goals are to improve patients' health, reduce costs to the public health system, and demonstrate DHS's commitment to addressing homelessness within Los Angeles County. RAND conducted a formative evaluation to provide early feedback on program implementation and performed an outcome evaluation examining the effects of the PSH program on county service utilization and service costs. RAND also analyzed data from a survey on health functioning both at housing entry and a year later among a small convenience sample of HFH participants. Our findings suggest that DHS succeeded in implementing the HFH PSH program. Thousands of individuals who formerly experienced homelessness, many with complex chronic physical and mental health conditions, have been stably housed. Los Angeles County data demonstrate a dramatic reduction in service use, especially for medical and mental health services. Overall, the cost reductions more than covered the year's worth of supportive housing costs, as we observed a net cost savings of 20 percent.

Key Findings

  • Clients' use of public services, especially medical and mental health services, dropped substantially, including emergency room visits and inpatient care. Costs, correspondingly, also decreased.
  • Across all the services examined, the associated costs for public services consumed in the year after receipt of supportive housing declined by close to 60 percent.
  • Participants' self-reported mental health functioning improved after receiving housing, though self-reported physical health was largely unchanged.
  • Although the number of individuals arrested and the number of jailed arrests decreased during the year after receiving housing, the number of jail days increased following PSH entry by an average of 2.76 days.

Recommendations

  • The program should continue, with close monitoring of the longer-term costs and benefits.
  • Further studies should examine whether the HFH PSH model is effective for populations other than those currently targeted by the program.
  • We recommend a more rigorous study, such as the use of a comparison group, to more confidently conclude that the decreases in service utilization and costs are due to the HFH PSH program.
  • Increased incarceration costs due to the increased length of jail stays over time should be examined to determine how this might potentially inform recruitment and retention strategies and influence longer-term program effects.
  • We recommend gathering data from a broader range of service providers to examine the broader societal impact of the HFH PSH program model.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methodology

  • Chapter Three

    Results

  • Chapter Four

    Key Findings, Recommendations, and Conclusions

  • Appendix A

    Comparisons of Cost Studies' Results

  • Appendix B

    Interview Protocol

  • Appendix C

    Sensitivity Results

The research described in this report was conducted by RAND Health.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.