Denver homeless program struggles to reduce death rates
By JENNIFER BROWN, The Colorado Sun
DENVER (AP) — When people who had been homeless for years left the streets of Denver to move into apartments, they were much less likely to end up in hospital emergency rooms or locked up in jail .
But they still died at the same rate as those living outside.
That’s the grim finding of a new study by Denver’s Social Impact Bond program, which sends outreach workers to find the biggest users of taxpayer-funded services, including hospitals, drug rehabilitation centers and the prison. Hundreds of chronically homeless people have been housed through the program, which began seven years ago.
Previous research has shown that the first 250 participants cost the government a total of $7.3 million a year as they lived outdoors and in shelters and navigated the health care and criminal justice systems. After they were housed, the researchers found a 40% reduction in arrests, a 30% reduction in prison stays, a 65% decrease in drug addiction services, and a 40% drop in emergency room visits.
The cuts were half the cost of the program, which was launched with $8.6 million from eight private investors as well as local housing resources.
But as these researchers from the Urban Institute based in Washington, D.C., worked on the earlier study, they noticed high levels of mortality among those living in supportive housing, which not only comes with support rent, but also mental health and addiction treatment. .
A second study confirms this: the mortality rate of people living in apartments is the same as that of people living outside.
The institute looked at mortality data from 532 people who had moved into supportive housing from 2016 to 2019, then compared it to 529 people who were homeless and receiving community services through nonprofits and government organizations. .
Around 10% of the housed group – 53 people – had died, a number the researchers called “extremely tragic”. Meanwhile, 9% of those who were still homeless had died. This is despite the fact that program participants had a 155% increase in doctor’s office visits.
The conclusion was that a few years in supportive housing were not enough to reverse the long-term health and stressful effects of homelessness, which often include mental health issues and addictions.
“We just wanted to dig deeper into that number. It’s such a tragic number,” said Sarah Gillespie, the Urban Institute’s associate vice president for metropolitan housing and communities policy. “People were entering the program with very significant health issues.”
Not a single sheltered person died from exposure, while seven people from the homeless group died from exposure, a cause of death often linked to having no shelter during extremely hot temperatures or cold. It was heartening to find that those housed are not freezing to death at least, Gillespie said.
“Dying indoors with access to services is very different from dying on the street,” she said.
Other causes of death for people in both groups varied. Drug overdoses accounted for 2% of deaths, while injuries, liver disease, circulatory disease and alcohol use disorders each accounted for 1% of deaths. Smaller fractions of the groups died from homicide, cancer, COVID, diabetes and alcohol overdose.
The average life expectancy of a chronically homeless person is 54 years, according to the Colorado Coalition for the Homeless.
The death rate for those housed was so high, the researchers concluded, because the program targets people who are most at risk of dying on the streets. The Colorado Coalition for the Homeless, the Denver Mental Health Center and other groups create lists of people who make frequent ambulance rides and regularly spend nights in hospitals and jail. Then, outreach workers visit camps and shelters to try to find them.
Once found, they are offered a place in the program, which is funded by government and private investment.
Denver expanded the program in 2018, and in 2021 the US Treasury Department offered the city $6 million in new federal funding if the program can show lower Medicare and Medicaid billings over the next few years. If the city can keep 125 new people housed, it won’t have to repay the money.
Previous research found that 86% of people in the program were still housed after one year, and 77% were still housed after three years.
The program has provided a wealth of data and potential research on homelessness costs. “We were able to shed some light on common myths,” Gillespie said. “One of them is that people want to be homeless and they choose that.”
Out of hundreds of accommodations offered, only a few said no. It’s also a rare look at how intervention programs can help those who haven’t sought help.
“The project succeeded in targeting the most vulnerable residents – not those who walked through the door and asked for it,” she said.
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