CRAIG STEVENS

11th in a series

During my short time working at the Middlebury Office of the Vermont Department of Health, much of my exposure to homelessness has focused on what is most visible — what I see downtown, what I hear of disruptions, what urgent issues are discussed at meetings. When asked to write a small reflection on homelessness, I chose to concentrate on some of the hidden elements, the people, their health, some of the costs that we, as the public, incur that might not be seen, and the research on solutions. 

According to the 2021 Point in Time Count, which obtains a one-day count of those experiencing homelessness, there are 117 homeless individuals representing 80 households in Addison County. Another more recent estimate by Charter House put it at 146 individuals, The Middlebury Campus reported this past Oct. 26. Of those cited in the Point in Time Count, 16% of those households included children, 10% were fleeing domestic violence, 27.5% were chronically homeless, and 38.8% were first time homeless. 

Behind these numbers is a larger and perhaps unknown pool of individuals who are at risk and vulnerable to homelessness. A significant percentage of first-time homeless, 38.8% — or 4 out of 10 — underscores the precarious environment for individuals and families in Addison County. Whether these individuals and families have a long-term experience with homelessness, transient or one-time, research demonstrates a significant cost to health including treatment and hospitalization, as well as impacts on early childhood development. 

Poor health can be a significant contributing factor of homelessness, according to the National Health Care for the Homeless Council (February 2019), particularly for individuals who have a major health incident that isn’t covered by insurance or may inhibit their ability to work. And it can be cyclical, in that being homeless, and the context of homelessness, can further degrade and worsen health conditions. Chronic diseases such as diabetes, asthma, cardiovascular disease and the lack of proper food and medications can highly impact individuals. Silent contributors like lack of bathing, getting proper rest and sleeping conditions continue a spiral of illness. Unsurprising conditions can co-occur; for example, people with diabetes often have co-occurring depression, which can spiral for a homeless individual. 

Not surprisingly, people most at risk for homelessness share many of the same precipitating health indicators as those who are homeless. A 2021 study published in the Journal of Health Care for the Poor and Uninsured conducted an analysis of electronic medical records that showed both homeless and at-risk-for-homelessness individuals, as compared to not at-risk individuals, have elevated incidence of chronic pulmonary disease, hepatitis, liver disease, hypertension, obesity, diabetes, deficiency anemia, congestive heart failure and depression among others. 

The cost of homelessness is multi-factorial and includes hospitalization and medical treatment. For example, a report in the New England Journal of Medicine showed homeless people spend longer days hospitalized at an extra cost of $2,414. People who are homeless interact with the prison system more frequently, specifically for overnight stays. A University of Texas survey of homeless individuals showed that each person cost taxpayers $14,480 per year for overnight jail incidences. 

So, what levers can be pulled to curb the costs associated with homelessness and continue to move forward in our mission to serve this vulnerable population? In an article by the National Alliance to End Homelessness: “Ending Chronic Homelessness Saves Taxpayer Money,” the alliance puts forth a “proven solution to end chronic homelessness: permanent supportive housing.” Permanent Supportive Housing, or PSH, pairs affordable housing with case management and auxiliary services to reduce emergency department and inpatient stays, improve health and wellbeing, while also helping individuals achieve long-term housing stability. 

Cost studies were conducted across 22 PSH sites to document the reduction in services, such as hospital stays, emergency room visits as well as crisis services and jail. According to the study, a chronically homeless person costs an average of $35,578 per year in taxpayer dollars across all study sites. Costs on average were reduced by 49.5% with PSH while expenditure for supportive housing averaged $12,800 resulting in almost $5,000 less expenditures for the intervention compared to no intervention. The value presents itself in the societal impact and reduced pressure on health care and jails, however challenges in funding often originate in who funds these dollars because the benefit is distributed across the health and welfare system.

For citations and links to these studies email [email protected]

Craig Stevens is the director of the Vermont Department of Health Middlebury District Office. For more than 30 years, he has worked closely with consumers, community leaders, health and human service organizations, and government representatives to help them develop solutions to their outstanding public health issues.