Blog: Homelessness Ends Here

On August 29, 2005, Hurricane Katrina slammed into the Louisiana Gulf Coast taking more than 1,600 lives and displacing more than a million people – including thousands of people with serious and long-term disabilities.  Four years later, Louisiana is well on the way to completing the nation’s largest and most comprehensive Permanent Supportive Housing Initiative ever undertaken. 

Within five months of Katrina’s landfall, the Louisiana Recovery Authority formally adopted the goal of creating 3,000 new Permanent Supportive Housing (PSH) opportunities for the hurricane’s most vulnerable victims.  This decision was not simply a victory for Louisiana’s PSH advocates and people with disabilities – but has had national significance as well.  Louisiana’s comprehensive PSH Initiative – conceived in the aftermath of these devastating storms – has now become a model that is influencing PSH policy at the federal level and in numerous states across the country.

Much has been written, seen and heard about Katrina and its aftermath – including the devastation and human suffering caused by this catastrophe, as well as successful redevelopment initiatives in New Orleans and other localities.  However, there is still very little public awareness of this extraordinary effort by Louisiana citizens – including government officials, non-profit groups, and PSH advocates – as well as national partners such as the Technical Assistance Collaborative (TAC), to create the nation’s first comprehensive Permanent Supportive Housing program in the United States.  This success story would not have been possible without the significant role played by philanthropic organizations.

Permanent Supportive Housing

The PSH model combines deeply affordable rental housing with voluntary, flexible, and individualized community-based services to assist people with the most severe and complex disabilities to live successfully in the community.  PSH is not a new model of housing.  Successful efforts to create PSH units in numerous states have been well documented over the years and a significant body of research has proven that successful outcomes for people and cost savings to government are achieved through the PSH approach.

Beechgrove Homes in Jefferson Parish, LA has 15 of 100 mixed-income units occupied by PSH-eligible households.

From the beginning, PSH stakeholders in Louisiana were determined to turn the Katrina/Rita disasters into an opportunity to create PSH at a scale that had never before been attempted.  This level of effort was necessary to respond to the dire circumstances that the lowest income people with disabilities faced post-Katrina – devastating levels of homelessness, institutionalization, isolation and separation from family and friends, and a lack of even basic community supportive services.   Louisiana PSH stakeholders also recognized that they had a unique opportunity to benefit from what had been learned from numerous PSH initiatives undertaken over the past 20+ years in communities across the nation. 

Louisiana’s PSH goal was truly ambitious and far reaching.  Rather than simply create 3,000 PSH units, Louisiana set out to create the nation’s first comprehensive PSH system that would help the State achieve several important policy objectives that had never before been attempted through one PSH initiative. Those policy objectives included:  (1) addressing chronic homelessness; (2) reducing the unnecessary confinement of people with serious disabilities in nursing homes and other high-cost restrictive settings; and (3) improving the state’s fragile behavioral health system through the implementation of evidence-based models of housing and services.

Melville Charitable Trust and Robert Wood Johnson Foundation

As early as January of 2006, the Melville Charitable Trust (Melville) recognized that Louisiana intended to break new ground in PSH policy and systems development and that an unparalleled level of collaboration and capacity building across state agencies and among various PSH stakeholder groups would be needed.   Louisiana PSH stakeholders also understood that technical assistance and capacity building resources from national PSH advocates as well as philanthropic organizations with an interest in the PSH approach would improve their chances for success.  Fortunately, generous grants were provided for Louisiana’s PSH Initiative by Melville and the Robert Wood Johnson Foundation (RWJF).  This funding – which included multi-year capacity building grants to Louisiana PSH groups – was provided through the Technical Assistance Collaborative (TAC) – a national non-profit with extensive PSH expertise and previous experience in Louisiana. 

Progress and PSH Profiles

Louisiana is well on the way to completing the 3,000 unit PSH initiative despite the fact that it took more than 2 ½ years to obtain all the federal recovery resources needed to finance the program.  As of November 2009:

• More than 700 severely disabled PSH households are being assisted;
• More than 800 new PSH units are in the development “pipeline”
• More than 120 new PSH households are entering the program every month
• By June of 2010, more than half of the 3,000 unit goal will be completed.
• By June of 2011, more than 2,500 PSH households will be receiving assistance

Although this data is compelling, a snapshot of families assisted best illustrates the comprehensiveness of Louisiana’s program.  These profiles demonstrate the value and effectiveness of Louisiana’s PSH policy – which emphasizes vulnerability, risk and cost to public systems regardless of the type of disability or the length of time that someone has been homeless:

Lisa and her son John– At the time Lisa R. entered the PSH program in September 2008, she and her five year old son had been homeless for five consecutive years due to her addictive disorder.  Her son had never had a place to call home, and had only lived on the streets and in emergency shelters since his birth.  Lisa and her son moved into their own PSH unit just outside New Orleans in September of 2008.  Since that time, she has obtained full-time employment with health benefits for herself and her son, maintained her sobriety, received counseling, enrolled her son in school, started her own housekeeping business, and has successfully maintained housing for the first time in over five years.

Sandy and her children – At the time Sandy W. entered the PSH program, she was living in a homeless shelter and had a long history of homelessness.  She was a victim of domestic violence and also has a mental illness, and, while homeless, had lost custody of some of her children.  Her young adult son John has a developmental disability and needed services in order to remain in the community.  Sandy has now been in the PSH program for a year, and her four children – who were previously living in state-funded foster care – have been reunited with their mother.  John is now receiving the help he needs, and Sandy has gone back to Junior College and is also seeking employment.

Andrew and Stephen – Andrew and Stephen are brothers in their early 30s.  Both have developmental and severe physical disabilities and Stephen uses a wheelchair.  They spent their entire childhood in Louisiana’s foster care system.  Before moving into PSH, they were living in a small rented trailer that was in terrible condition and not wheelchair accessible.  Their health and safety were seriously compromised as a result of their living situation, and they were both at-risk of being placed in a nursing home.  Andrew and Stephen now each have their own accessible PSH unit in a new rental housing development in Lake Charles, they are receiving daily community-based supports, and are thriving in their new homes.

Implications for National PSH Policy

The creation of these PSH opportunities in a post-disaster environment is a noteworthy achievement that extends far beyond the boundaries of Louisiana.   The four core elements of Louisiana’s PSH approach are now influencing PSH efforts underway in other states and as well as federal PSH policy:

• Targeting the most vulnerable populations with disabilities within one PSH initiative including people who are homeless or at-risk of homelessness, as well as people living unnecessarily in institutions or at-risk of institutionalization;
• Utilizing a highly replicable rental housing production approach that creates small set-asides of PSH units in every new federal Low Income Housing Tax Credit property;
• Creating a Local Lead Agency (LLA) regional system that moves PSH beyond the provider driven model.  The LLA approach ensures referrals to owners of available PSH units and coordinates the delivery of all PSH services;
• Developing a cross-disability Housing Support Team service model that focuses on the housing-related service needs of PSH tenants through a coordinated approach that also encompasses the clinical and medical needs of people with the most intractable disabilities.

Several states have already adopted or are seriously evaluating Louisiana’s cross-disability and integrated PSH approach and/or LLA model.   It should be noted that Louisiana officials and national PSH experts are indebted to State of North Carolina housing and human services officials, who were bold enough to first envision this approach and have demonstrated its feasibility and effectiveness across their state over the past eight years.

Bi-partisan federal housing legislation (H.R. 1675 and S. 1481, The Frank Melville Supportive Housing Investment Act) modeled from the North Carolina and Louisiana PSH set-aside approach is also moving quickly through Congress and will reform and re-invigorate an important HUD PSH program – the Section 811 Supportive Housing for Persons with Disabilities program.  Once enacted, this legislation will initiate PSH Demonstration programs in 15-20 or more states interested in expanding their PSH approach beyond the provider-driven PSH ‘project’ model.  National organizations that are working on behalf of people with disabilities are attuned to getting this model up and running. 

Although Louisiana’s PSH initiative has had its challenges, the state’s integrated, cross-disability approach through the Local Lead Agency model, implemented by agencies like the Jefferson Parish Human Services Authority, provides a vision for creating PSH systems in states and localities across the country.  It also creates a new paradigm and models for emerging PSH policy at both the state and federal level.  This comes at an opportune time as new leadership in Washington, including Secretaries at the U.S. Department of Housing and Urban Development (HUD) and the U.S. Department of Health and Human Services (HHS) have a deep understanding of the value of the PSH model and are actively seeking new ideas and new partnerships to take PSH to scale.  When President Obama announced the “Year of Community Living” on June 22, 2009 to commemorate the Americans with Disabilities Act and the U. S. Supreme Court’s Olmstead decision, it included a commitment of new housing choice vouchers for non-elderly families with disabilities along with new HHS resources to enable them to live in the most integrated community settings, signaling that this type of initiative was going to be a priority. 

At the state level, pressure is high to reduce the growth in Medicaid, particularly the high cost of unnecessary nursing home placements and sub-standard Adult Care Homes/Board and Care facilities.  States are under enormous pressure to comply with the 1999 U.S. Supreme Court’s Olmstead decision which has triggered successful class action lawsuits in a number of states.  In an important Olmstead case recently decided, a federal District Court Judge ruled that New York City’s Adult Homes – large for-profit residential care facilities licensed and funded by the state and Medicaid – are “segregated institutional settings that impede integration in the community and foster learned helplessness.”  The Court held that virtually all 4,300 residents of these adult homes could benefit from the PSH approach at no additional cost to the state.  Several other states (Illinois, New Jersey) have similar cases pending or have negotiated settlement agreements that will require thousands of new PSH units to be created in the next few years.

This demand for ‘scaling up’ Olmstead-related PSH activities must be merged with efforts to end the national disgrace of chronic homelessness among the most vulnerable people with disabilities.   As has been tested successfully in Louisiana, merging these two policy goals at the state level can incentivize states to adopt more uniform housing and support services policies and funding mechanisms that not only represent evidence-based and promising practices but also make sense financially. 

A PSH Vision for the Future

Louisiana’s PSH initiative arose from the Katrina/Rita disasters at a time when – with the notable exception of expanded funding for chronically homeless people – federal policies were constraining rather than expanding opportunities for innovative approaches to PSH.  We are now at a more opportunistic moment when a new partnership between HUD and HHS is focusing on important PSH issues and when states – under increasing pressure from Olmstead-related lawsuits and the burden of high-cost facilities – have more political will to explore and adopt new approaches and models.

Federal housing and Medicaid imperatives are highly likely to encourage and incentivize new strategies, at both the federal and state level, which will require policy and program development efforts very similar to the work underway in Louisiana.  Some of this activity will emerge from the broader federal policy agenda on health care reform as well as more immediately from several HUD-HHS initiatives.  While it is not yet clear the extent to which the new HUD-HHS partnership can provide a policy framework for taking PSH to scale, key lessons learned from Louisiana’s PSH initiative are already being successfully applied in other states that have recognized the importance of this innovative PSH model.  What is now clear is that ‘taking PSH to scale’ is not just about more money but instead is about creating the policy and systems framework that allows government to achieve a number of critically important policy goals.  At the end of the day, it’s also not about doing PSH one project at a time or with only one model.  It is about a variety of different housing approaches (PSH projects, set-asides of units, Housing Choice Vouchers, etc.) that can all be linked systematically to sustainable best-practice community supports and services for people with disabilities living in the community.

About the Author

Ann O'Hara is co-founder and Associate Director of the Technical Assistance Collaborative, Inc. (TAC).  Ms. O'Hara is a national expert on policies and practices to expand affordable housing opportunities for people with disabilities and in implementing supportive housing approaches for people who are homeless or at-risk of homelessness.