Resolving Poverty

Sources 16-20:

We can end the homelessness crisis (March 2018)

By stabilizing people through shelter, moving them into permanent housing, and implementing assistance programs to keep them in their housing, we can not only reduce, but eliminate, homelessness in New York City.

Since modern homelessness began more than thirty years ago, research and experience have overwhelmingly shown that investments in permanent housing are extraordinarily effective in reducing homelessness — as well as being cost-effective.

Many of the most successful housing-based policies designed to address the homelessness crisis — in particular, permanent supportive housing for individuals living with disabilities and other special needs — were pioneered in New York City and have been replicated throughout the country. 

Numerous research studies have consistently confirmed that long-term housing assistance not only successfully reduces homelessness — it is also less expensive than shelter and other institutional care. 

Proven housing-based policies include:
•Federal housing assistance: Federal housing programs are one of the most successful housing-based solutions to reduce homelessness. The two largest federal housing programs are public housing and federal housing vouchers, known as Housing Choice Vouchers or Section 8 vouchers. Housing vouchers allow low-income households to rent modest market-rate housing of their choice and provide a flexible subsidy that adjusts with the family’s income over time. Studies show that public housing and federal housing vouchers are highly successful at reducing family homelessness and in ensuring that these families remain stably housed out of the shelter system.

•Permanent supportive housing: Pioneered in New York City in the 1980s, permanent supportive housing has now proven to be a successful and cost-effective solution to the homelessness crisis. The supportive housing model combines affordable housing assistance with vital support services for individuals living with mental illness, HIV/AIDS or other serious health problems. Moreover, numerous research studies have shown that permanent supportive housing costs less than other forms of emergency and institutional care. The landmark 1990 City-State “New York/New York Agreement,” which has been renewed twice, is the premier example of a permanent supportive housing initiative that successfully reduced homelessness in New York City and saved taxpayer dollars that would otherwise have been spent on costly shelters and hospitalizations.

(Next column)

•“Housing first”: Another proven solution developed in New York City and replicated nationwide is the “housing first” approach to street homelessness, which builds on the success of permanent supportive housing. The “housing first” approach involves moving long-term street homeless individuals — the majority of whom are living with mental illness, substance abuse disorders and other serious health problems — directly into subsidized housing and then linking them to support services, either on-site or in the community. Research studies have found that the majority of long-term street homeless people moved into “housing first” apartments remain stably housed and experience significant improvements in their health problems. Much like permanent supportive housing, the “housing first” approach is far less costly than emergency and institutional care, such as shelters, hospitals and correctional facilities.

The fundamental cause of homelessness is the widening housing affordability gap. In New York City, that gap has widened significantly over the past decades, which have seen the loss of hundreds of thousands of units of affordable rental housing. At the same time that housing affordability has worsened, government at every level has cut back on already-inadequate housing assistance for low-income people and has reduced investments in building and preserving affordable housing. Finally, the weakening of rent regulation laws, which help keep around half of all rental apartments in New York City affordable, has accelerated the loss of low-cost housing. 
To address New York City’s wide housing affordability gap, the Federal, State and City governments must significantly increase investments in affordable rental housing, with a significant portion targeted to homeless families and individuals. Similarly, strengthening rent regulation laws would preserve affordable housing and protect tenants, allowing them to keep their homes.
Supportive Housing and Housing First (September 2018)

Many people with mental health and substance use conditions lose access to housing because of poverty and disruption of personal relationships related to their disability, and about 27% of homeless people have serious mental illnesses.
According to the Office of National Drug Control Policy, 67% of people experiencing chronic homelessness have a primary substance use disorder or other chronic health condition.
Housing First is a proven approach in which people experiencing homelessness are offered permanent housing with few treatment preconditions, behavioral contingencies, or other barriers.

A respected 2004 study found that:
“The Housing First program sustained an approximately 80% housing retention rate, a rate that presents a profound challenge to clinical assumptions held by many Continuum of Care supportive housing providers who regard the chronically homeless as ‘not housing ready.’ 
Given that all study participants had been diagnosed with a serious mental illness, the residential stability demonstrated by residents in the Housing First program—which has one of the highest independent housing rates for any formerly homeless population—indicates that a person’s psychiatric diagnosis is not related to his or her ability to obtain or to maintain independent housing. Thus, there is no empirical support for the practice of requiring individuals to participate in psychiatric treatment or attain sobriety before being housed.”

Tsemberis and Eisenberg reported the effectiveness of a five-year Housing First program on people with severe psychiatric disabilities and addictions in New York City. During that time, the program provided "immediate access to independent scatter-site apartments for individuals with psychiatric disabilities who were homeless and living on the street." With an 88 percent housing retention rate, the program achieved substantially better housing tenure than did the comparison group.

Permanent Supportive Housing
Substantial literature, including seven randomized controlled trials, demonstrated that components of the model reduced homelessness, increased housing tenure, and decreased emergency room visits and hospitalization. Consumers consistently rated this model more positively than other housing models.

According to the U. S. Inter-agency Council on Homelessness (ICH),: "Housing First yields higher housing retention rates, reduces the use of crisis services and institutions, and improves people's health and social outcomes."

Components of the Model includes the following elements:
•   Emergency shelter, street outreach providers, and other parts of the crisis response system are aligned with Housing First and recognize that their role encompasses housing advocacy and rapid connection to permanent housing. Staff in crisis response system services believe that all people experiencing homelessness are housing ready.
•   Strong and direct referral linkages and relationships exist between crisis response system (emergency shelters, street outreach, etc.) and rapid rehousing and supportive housing. Crisis response providers are aware and trained in how to assist people experiencing homelessness to apply for and obtain permanent housing.
•   The community has a unified, streamlined, and user-friendly community-wide process for applying for rapid re-housing, supportive housing, and/or other housing interventions.
•   The community has a coordinated assessment system for matching people experiencing homelessness to the most appropriate housing and services.
The community has a data-driven approach to prioritizing highest-need cases for housing assistance, whether through an analysis of lengths of stay in Homeless Management Information Systems, vulnerability indices, or data on utilization of crisis services.
•   Policymakers, funders, and providers collaboratively conduct planning and align resources to ensure that a range of affordable and supportive housing options and models are available to maximize housing choice among people experiencing homelessness.
•   Policies and regulations related to supportive housing, social and health services, benefit and entitlement programs, and other essential services do not inhibit the implementation of the Housing First approach. For instance, eligibility and screening policies for benefit and entitlement programs or housing do not require the completion of treatment or achievement of sobriety as a prerequisite.
•   Every effort is made to offer a tenant a transfer from one housing situation to another, if a tenancy is in jeopardy. Whenever possible, eviction back into homelessness is avoided.
•   Permanent supportive housing programs differ from other living arrangements by providing a combination of flexible, voluntary supports for maintaining housing and access to individualized evidence-based support services, such as assertive community treatment (ACT). ACT is an interdisciplinary team approach that supports people in recovery in the community with intensive services. ACT teams include social workers, nurses, psychiatrists, and vocational and substance abuse counselors who are available to assist 7 days a week 24 hours a day. But variants on the ACT model are essential to success in practice. The team must have sensitivity to and knowledge of housing issues and available funding.  Just having an ACT team is not enough.  It takes a lot of “behind the scenes” work to keep people housed.

The Call to Action lists the required case management services, but it is worth stressing assistance with personal care, housekeeping and cleaning, and pest control, which are essential to avoid eviction, and individual counseling and de-escalation when eviction is threatened. These are the interventions stressed by the practitioners interviewed for the preparation of this position statement. The aim is to maintain permanent housing by interventions that go beyond treatment of the underlying general and mental health and substance use issues to deal with behavioral issues that threaten tenancy.

As noted by the Corporation for Supportive Housing:
“Supportive housing is not affordable housing with resident services. It is a specific intervention for people who, but for the availability of services, do not succeed in housing and who, but for housing, do not succeed in services. The housing in supportive housing is affordable, permanent, and independent. The services are intensive, flexible, tenant-driven, voluntary, and housing-based. The services in supportive housing are tenancy supports that help people access and remain in housing. Supportive housing is also a platform from which health care services can be delivered and received.”

The 2014 review, which specifically focused on housing for people with mental health conditions, used a slightly more refined definition of permanent supportive housing:
•   Tenants have full rights of tenancy, including a lease in their name; the lease does not have any provisions that would not be found in leases held by someone without a mental disorder.
•   Housing is not contingent on service participation.
•   Tenants are asked about their housing preferences and provided the same range of choices as are available to others without a mental disorder.
•   Housing is affordable, with tenants paying no more than 30% of their income toward rent and utilities.
•   Housing is integrated; tenants live in scattered-site units located throughout the community or in buildings in which a majority of units are not reserved for individuals with mental disorders.
•   House rules are similar to those found in housing for people without mental disorders.
•   Housing is not time limited, so the option to renew leases is with the tenants and owners.
•   Tenants can choose from a range of services based on their needs and preferences; the services are adjusted if their needs change over time.

(Next column)

The success found by the 2014 review researchers was based on:
Reduced homelessness
Increased housing tenure over time
Reduced emergency room use
Reduced hospitalizations
Increased consumer satisfaction

The Corporation for Supportive Housing summarizes the three benefits of supportive housing demonstrated by the research:
1) “Supportive Housing Improves Lives. Research has shown that supportive housing has positive effects on housing stability, employment, mental and physical health, and school attendance. People in supportive housing live more stable and productive lives.

2) Supportive Housing Generates Significant Cost Savings to Public Systems. Cost studies in six different states and cities found that supportive housing results in tenants’ decreased use of homeless shelters, hospitals, emergency rooms, jails and prisons.

3) Supportive Housing Benefits Communities. Further evidence shows that supportive housing benefits communities by improving the safety of neighborhoods, beautifying city blocks with new or rehabilitated properties, and increasing or stabilizing property values over time.”

Shelters are rarely equipped to provide adequate supports to qualify as supportive housing and are transitional responses to get people off the streets. Group living facilities and psychiatric hospitals are needed by some people experiencing mental health crises, but are also transitional, since most people cannot tolerate indefinitely the degree of supervision inherent in such residences. 
Thus, shelters, group homes, and clinical facilities, while necessary, should be de-emphasized as much as possible in favor of development of scattered-site supportive housing that is fully integrated into the community and permanently available to its residents, so that the people living there can identify it as their home.

It is not uncommon that people start out only wanting housing and not services. Housing First accepts such people, rejected in the past, and provides the services they need to help them keep their housing, while offering to increase services as the need becomes apparent. Case managers meet people where and as they are and start building trust, which, in practice, works much better than insisting on providing services as a condition of providing housing.   

The greatest ongoing difficulty encountered in Housing First programs is in maintaining enough vacant units to minimize waiting periods while guaranteeing ongoing availability of permanent housing to people already being served. This requires ongoing development of new housing, which in turn requires surmounting funding and zoning barriers. 
Denver and Salt Lake City are examples of communities that have had greater success than others in increasing housing options for people with mental health and substance use disorders.

Supportive housing requires a substantial investment by state and local governments, which bear the burden of funding housing, with some support from the federal government, particularly through the “Section 8” program that provides rental assistance. Most rental assistance is federally funded, yet only one in four eligible low-income households receives assistance. 
In addition, programs like the Low-Income Housing Tax Credit (LIHTC) should be expanded, which provide incentives for real estate developers to invest in housing that is accessible to low-income individuals.
Communities should review zoning, transportation, and related policies to ensure that low-income housing developed in inclusive and promotes economic mobility for individuals with mental health conditions.

Significantly, the federal Medicaid program, which matches state funds for mental health and substance use treatment, pays for licensed facilities but is prohibited by statute from funding other forms of housing. 

However, in recent years, the Center for Medicare and Medicaid Services (CMS) and SAMHSA have stressed the availability of Medicaid funding for the ancillary services required for supportive housing. For example, a bulletin detailed how Medicaid funds could be used for “(1) Individual Housing Transition Services – services that support an individual’s ability to prepare for and transition to housing; (2) Individual Housing & Tenancy Sustaining Services - services that support the individual in being a successful tenant in his/her housing arrangement and thus able to sustain tenancy; and (3) State level Housing Related Collaborative Activities - services that support collaborative efforts across public agencies and the private sector that assist a state in identifying and securing housing options for individuals with disabilities, older adults needing LTSS, and those experiencing chronic homelessness.”

A 2014 SAMHSA-funded Corporation for Supportive Housing (CSH) white paper, “Creating a Medicaid Supportive Housing Services Benefit: A Framework for Washington and Other States,” is the best blueprint of the policy changes needed. 
See also, CSH’s 2015 “A Quick Guide to Improving Medicaid Coverage for Supportive Housing Services” The Center for Budget and Policy Priorities’ 2016 white paper, “Supportive Housing Helps Vulnerable People Live and Thrive in the Community,” and CMS’ 2015 Informational Bulletin, “Coverage of Housing-Related Activities and Services for Individuals with Disabilities.”

The 1915i State Plan Amendment for Home and Community-Based Services offers the opportunity to implement supportive housing services state-wide (no geographical limits are permitted), without limits on the population to be served so long as all are served who meet needs-based criteria. People being served need not be at risk of institutionalization. Thus, the 1115i waiver does not require that implementation be “cost neutral” to the federal government. Independent evaluations are required to demonstrate outcomes. The CSH white paper discusses the pros and cons of alternative CMS waiver strategies.

It is also critical that public benefit design and administration, such as Social Security Insurance, reinforce Housing First approaches. Benefits must be sufficient and accessible enough to support an individual in supported but independent and permanent housing. They must take into account additional costs related to any rent and upkeep of housing in that geographic market, and must be coordinated with Housing First programs to ensure that the full benefits are received when first needed. During transitions in housing or after a period of institutionalization, such as hospitalization or incarceration, public benefits should immediately consider the full costs of housing and avoid any “look back” that disadvantages Housing First.
Benefits administration should be coordinated with institutions to ensure that benefits immediately consider changes in living situation when an individual returns to the community.

Call to Action
It is imperative that mental health and substance use treatment providers expand their reach to include permanent supportive housing, whether as part of clinical community support outreach and ACT programs, or in partnership with housing providers. To accomplish this, federal, state and local funding policy must be changed.

Based on the current estimates of the unserved need, federal rental housing assistance should be quadrupled, and states and localities should recognize the imperative to develop a robust array of government-sponsored housing alternatives to respond to the nationwide epidemic of homelessness. 
Part of this will also need to include concomitant increases in programs like the Low-Income Housing Tax Credit to ensure the availability of low-income housing options in different communities, and review of zoning, transportation, and other policies that promote inclusive development.
Solving homelessness — obvious if not easy (June 2016)

The obvious solution is that we must keep people on the verge from becoming homeless, because once on the streets they experience a dehumanizing and costly downward spiral. 
Job loss, long-term unemployment, lack of affordable housing options, and gentrification are all contributing factors to homelessness.
In San Francisco only 10 percent of the substantial funds spent on the homeless is focused on keeping people housed.
The answer is that we must build more supportive housing (housing with social services) for the homeless. This solution takes money, political will, focus and coordination.

Public and elected officials in some U.S. cities are willing to tackle the problem and spend money.
San Francisco now spends nearly a quarter of a billion dollars on homelessness each year. That works out to nearly $35,000 per homeless person, given the latest count. The problem is how the money is spent and how programs are coordinated.

I would characterize the current approach as scattershot (random and haphazard). The underlying causes of homelessness are so varied, and the homeless population so diverse, that a myriad of programs have emerged in an attempt deal with the entire spectrum. 
San Francisco now has 400 separate contracts for services with over 70 different nonprofit community groups. These community organizations provide mental health services, addiction programs, employment training, emergency housing and more.

‘Housing first’
It is common knowledge among experts and practitioners in the homeless field that supportive housing – permanent housing with social services on-site – is the best approach and is where public money should be focused. 
As far back as 2002, research by Dennis Culhane at the University of Pennsylvania revealed that the cost reduction for social services, hospital visits and emergency responses is so great, when homeless are instead housed, that the latter plan more than pays for itself. 
This strategy, known as “housing first,” is not only the most humane approach, it’s also the most economical one. 

Why is “housing first” successful?  When you are homeless, survival is your goal. Finding a meal, a safe place to sleep and a toilet are your priorities, not health care, mental health treatment, substance abuse programs or job training.

Malcolm Gladwell’s 2006 article in The New Yorker, “Million-Dollar Murray,” describes the case of Murray Barr, a homeless ex-marine who was on the streets of Reno for a decade. Murray was an alcoholic, and while he underwent several treatment programs, he would inevitably relapse and return to the streets, and eventually to the local emergency room. Between police interventions, emergency services and hospital stays, Murray had cost Nevada an estimated $1 million. Had there been “housing first” perhaps Murray would have lived longer and better, and cost the state far less.

The underlying reasons for homelessness are many, and rarely is the individual at fault — so everyone must be viewed as equally worthy of housing.
Mental illness is prevalent among the homeless, and we have failed as a society to provide community mental health strategies after California, and then the nation, retreated from centrally funded treatment centers in the late 1960s through the early 1980s.

We incarcerate many and provide little to help those released to re-enter society. Many become homeless. 
Drugs are prevalent, cheap and quickly destructive, often leading to homelessness and acute health problems.
A large and growing segment of the homeless population is very young or very old. 
•Many of the young are aged out of foster care and have few options. 
•Others may have been in abusive homes and escaped. 
•Many of the old have severe physical disabilities, little social security and are not employable.

Even were the public perception of the homeless to change (from being those at fault, to being those at risk), providing housing for them in established neighborhoods is a hard sell. Residents of south Berkeley are enraged at the notion of the Claremont Hotel adding 45 condominiums on its property, each of which is likely to sell for $2 million. Imagine the resistance, were there a proposal for supportive housing anywhere in the area.

The first time I designed an adult shelter it was within a warehouse, a poignant example of “warehousing the poor.” Locals still objected, as it was next to a cemetery and they didn’t want homeless near the grave sites of their loved ones.

SOLUTIONS - Here then are a few solutions.
Institute anti-snob zoning
California needs a tougher “anti-snob” zoning law, similar to the one enacted in 1969 in Massachusetts. That law not only streamlines the regulatory process for development, but may also allow for variances in local zoning codes, to facilitate affordable housing projects. A more conservative approach would simply disallow appeals to city councils, and lawsuits by opponents, if a project abides by current zoning laws. This would reduce the cost of the housing by negating drawn out litigation, and by providing assurances that pre-development funds will result in a building.

(Next column)

Toughen housing-element plans
Every city in California is required to have a housing element — a development plan that includes affordable housing, shelters and supportive housing. There is, however, little recourse against a city if it fails to enact such a plan. The threat of not receiving funds for affordable housing is ineffective if the municipality sees such housing as a low priority.
Furthermore, the plan requires that a city identify locations where shelters may be created without a discretionary review. All other locations require the same type of review as any other project. Because of the opposition to housing for the homeless, this in essence precludes such housing outside of the specially designated district. Similarly, supportive housing must be treated like all other projects, and therefore without a stronger anti-snob provision, these too will be restricted.

Build smaller projects 
While we need more housing, any one project should be modest in scale. Projects of 30 to 40 units are large enough to achieve an economy of scale both for construction and the operation of on-site services, yet small enough to avoid an institutional quality while enabling a cohesive sense of community.  Projects of this scale are also more likely to be acceptable to a community. Larger projects, while more economical to building and operate, will encounter increased community resistance and, once occupied, more likely stigmatize the residents.

Use existing buildings
It is not necessarily true that rehabilitating existing buildings is less expensive than new construction, but there can be advantages. If an existing building is viewed by the community as a blight or a nuisance, any upgrade may be acceptable. In Los Angeles both nonprofit and private developers are buying and then converting “nuisance” motels into 500 units of permanent supportive housing. The city will issue vouchers to support rent and services at these sites.

Manage projects well
In 1994, a motel was converted into affordable housing for formerly homeless and those of very low income. Community opposition was long, bitter and litigious, but the project prevailed. The project is now an integral part of the neighborhood, in part because it is well managed and well maintained. It is difficult to counter neighborhood fears that unsavory occupants will lead to lower property values and a deteriorating neighborhood. Only by building more successful projects can the reality overcome the perception.

Shelters are a necessary albeit unsatisfactory solution. We must have the beds, bathrooms, meals, healthcare and treatment programs where they are accessible and available. But shelters are difficult places — seen as unsafe, unhealthy, noisy, institutional and restrictive — and oftentimes people would rather stay on the street than use them.
Just as housing projects can be too large, so, too, can shelters. Shelter design needs to evolve from huge rooms with hundreds of beds to something less intimidating. The dilemma is how to create a sense of privacy for the occupant while enabling the staff to provide security and control. In the shelters I have designed, there are no more than 10 to 20 beds in a cluster. A cohesive group formed on the street for support and security could occupy a small dorm, something not currently allowed in most shelters. This is only one of many strategies that can make shelters less institutional and more welcoming.

Tent encampments on public streets are dangerous and unhealthy, both for the homeless and those who live nearby. They do nothing to counteract the underlying causes of homelessness. But we cannot force people to use shelters, and if they view encampments as the only option, many will remain on the streets by themselves.
Some encampments are better than others. Several cities have set aside land for groups of homeless to settle. For some time there was a community of 26 people living in geodesic domes under a freeway near downtown Los Angeles. Portland, Oregon had a self-governing encampment called Dignity Village on city property. Among the advantages are a sense of community and self-determination, both of which are often lacking in shelters or when people are living on the streets alone. In addition, the relative concentration of homeless people in such encampments makes it easier for outreach teams to connect them to the services they need.
But these group encampments are also often not clean or safe. While local authorities sanction some, there are rarely infrastructure improvements such as paving, lighting and sanitary sewers. If there are to be encampments, there should also be such improvement, as well as meals, social services and security. Such monitored encampments would be more economical than rousting people from sidewalks on a recurrent basis, and then cleaning up after their eviction — only to have them settle elsewhere or return. And they would be far more effective in connecting people to services.

Tiny houses
There has been much discussion of the “small house” solution; the idea is that we can manufacture very small dwellings for the homeless. But where would these mini dwellings go? How are they connected to the city infrastructure? The implication is that it is only the lack of shelter that makes someone homeless. But someone with mental illness, isolated in a tiny dwelling, is not likely to be able to live independently.
Were these small dwellings aggregated in a community then there is both the security and independence of a home, but also the support and services that can help them stay in that home. 
This is the basis of a recent project I designed in Sacramento. The tiny dwelling units are clustered into groups of 10 houses around a court. These courtyard clusters are then connected by a main pedestrian street to the community building that includes social services.

Achieving ‘housing-first’ solutions to homelessness
The goal must be to build supportive housing — housing with social services — and this will take continued political will and money in order overcome neighborhood resistance to such housing. It will also take time. While we work toward this goal, we should improve shelter design, convert existing buildings in marginal use and continue programs already in place, but with renewed efficiency, and evidence-based evaluation of these programs.
Utah found a brilliantly effective solution for homelessness (February 2015)

The entire state of Utah has fewer than 300 homeless people and will likely eliminate chronic homelessness by the end of the year.

"We did it by giving homes to homeless people," Lloyd Pendleton, director of Utah's Homeless Task Force, told "Daily Show" correspondent Hasan Minhaj in January.

Since 2005, the state has reduced the number of people living on the streets by almost 75% by giving them access to permanent housing, no strings attached.

The strategy, called Housing First, gives homeless people the stability that's lacking in temporary solutions like shelters and halfway houses. The tactic began as a test by New York University psychologist Sam Tsemberis in 1992.

"I thought, they're schizophrenic, alcoholic, traumatized, brain damaged," Tsemberis recalls. "Why not just give them a place to live and offer them free counseling and therapy, healthcare, and let them decide if they want to participate?"

Tsemberis tested his theory on 242 chronically homeless people in New York City. Five years later, 88% were still living in their apartments at a lower cost to taxpayers and the state government. The idea caught on in other places like Seattle, Denver, and the state of Massachusetts. The experiment in Utah is likely the most successful Housing First program.

The Housing First project began in Utah as a 10-year project with the goal of eliminating homelessness entirely by the end of 2015. While state legislators were reluctant to support the plan at first, they eventually embraced the idea, albeit cautiously.

(Next column)

And the housing is, indeed, permanent. People get to keep their state-provided apartment even if they keep abusing drugs or alcohol. In this way, Housing First has been more effective at keeping people off the streets than transitional housing, which requires that homeless people get a job and get sober before they are given more permanent options.

"If you move people into permanent supportive housing first, and then give them help, it seems to work better," Nan Roman, the president and CEO of the National Alliance for Homelessness, told The New Yorker. "It's intuitive, in a way. People do better when they have stability."

Initially, critics feared Utah would lose tons of money by giving the homeless permanent housing, and that doing so would just "incentivize mooching," as Minhaj put it. However, state officials found Housing First actually saving the government money over time, especially as it encourages people to become more self-sufficient sooner.

Moreover, Housing First homes are not free: New tenants have to pay $50 or 30% of their income to rent each month (whichever amount is greater).

Between shelters, jail stays, ambulances, and hospital visits, caring for one homeless person typically costs the government $20,000 a year. Providing one homeless person with permanent housing, however — as well as a social worker to help them transition into mainstream society — costs the state $8,000, The New Yorker reported in September.

"Perhaps the most potent question raised by the program's success is how safety nets, including a home to which people return each night, impact people," Utah newspaper Deseret News wrote in an editorial last year. "There are two possibilities: first, safety nets undermine personal responsibility, or, alternatively, safety nets allow for mitigated risk-taking - and which can lead to real growth."
How a Canadian City Ended Homelessness With a Simple Idea (February 2017)

...Giving every person living on the streets a home with no strings attached.

While traditional housing programs ask that prospective participants get clean and seek psychological treatment before being admitted into the system, the Housing First approach doesn't make any of these demands. Whoever is in need of a permanent place to stay will get help, no matter what their circumstances are. 

"We take the stance that people are worthy of a home and it is a fundamental human right to have shelter and a roof over one's head," Jamie Rogers, who ran the Housing First program in Medicine Hat told the BBC. 
"Of course it is recovery-oriented, and we help and support people in making different choices in their life, but we don't withhold housing because of who they choose to be."

(Next column)
Housing First also brought with it a number of unexpected positive effects. Emergency room visits and run ins with police have dropped while at the same time court appearances went up. Once people felt that somebody cared about them, they mustered up the necessary motivation to begin dealing with their past in a positive way. 

Medicine Hat didn't just implement Housing First (which is also being used in other cities with varying levels of success) but rather changed its whole approach to homelessness. Rather than building, or relying only on subsidized housing, the city built a relationship of trust with landlords, property management companies, and local communities as a whole. 
Fear and prejudice towards the homeless was replaced by the realization that they are simply people down on their luck and nowadays landlords call up city hall to offer their apartments to the program.

Medicine Hat's inspiring success proves to us all that if we put aside our fears and differences and instead come together as a community, nothing is impossible.