In November 2018, Health-Tech Consultants Inc. issued a report outlining the findings of a statewide pilot initiated by Florida Housing Finance Corporation. The study assessed the efficacy of providing Permanent Supportive Housing (PSH) – affordable housing linked with individualized support services – to “high utilizers” of crisis services. Following is a summary and the key findings of the Solution That Saves pilot.
Florida Pilot: Adding to the Evidence Base
In 2012, Florida Housing Finance Corporation hosted a Supportive Housing Forum. In attendance were community stakeholders and representatives from the Agency on Health Care Administration, Agency for Persons with a Disability, Department of Children and Families, Department of Elder Affairs, and the Governor’s Office. One outcome of the forum was to develop a statewide pilot to assess the Florida specific cost benefit of providing PSH to “high utilizers” of crisis services.
Through a competitive process, three pilot sites were selected in Duval, Miami-Dade and Pinellas Counties. Each site received a special funding appropriation from Florida Housing Finance Corporation to construct a PSH community and conduct an analysis to determine the impact PSH has on the utilization of publicly funded systems of care.
Duval Pilot Site
Ability Housing led the implementation of the Duval County pilot, with Health-Tech Consultants as the evaluator. A supportive housing workgroup led by Florida Housing Finance Corporation and comprised of state agencies approved the pilot’s methodology, selection criteria and evaluation team. Pilot participants were identified by community organizations in the healthcare, criminal justice, and crisis services systems. The evaluation consisted of a single group pre/post with PSH as the intervention; it examined two time periods – two years pre-housing and two years post-housing.
The housing consisted of a 43-unit apartment complex on Jacksonville’s Westside, Village on Wiley, and 49 units scattered at properties throughout the community that are owned or leased by Ability Housing. Originally, 92 participants enrolled in the study. At the end of two years, 77 were still housed and 68 were stillenrolled in the pilot. The final evaluation includes data on these 68 participants.
The evaluation consisted of a cost benefit analysis to determine the change in healthcare and community service costs. Data was provided by:
Agency for Health Care Administration
|Jacksonville Sheriff’s Office|
|Baptist Health System||Memorial Hospital|
|Changing Homelessness||Mental Health Resource Center|
|City of Jacksonville Fire and Rescue Department||St. Vincent’s Health Center|
|Department of Children and Families||Sulzbacher Center|
|Gateway Community Services||UF Health Jacksonville|
While the focus of the evaluation was on the cost benefit of providing PSH to “high utilizers”, the evaluation also assessed quality of life and mental wellness of participants to determine any change in stability. Data was collected using the MINI International Neuropsychiatric Interview (M.I.N.I.) and Ferrans and Powers Quality of Life Index (QLI).
All pilot participants were extremely low-income and “high-utilizers” of crisis services for whom homelessness and housing instability were contributing factors. “High utilizer” refers to persons with chronic health conditions who frequently cycle through costly publicly funded systems of care. These include emergency rooms, hospitals, shelters, jails and prisons, and psychiatric facilities. Of the total 92 participants initially enrolled in the study, 90 had at least one documented disability and were formerly chronically homeless.
Of the 92 participants initially enrolled in the study, 77 remained in housing at the end of the two-year evaluation. This represents a housing stability rate of 90%. Two persons deemed ineligible for the pilot, three persons that were deceased and one person for whom data could not be found were not included in this calculation.
Moving into PSH provided access to insurance. Prior to moving into housing, 32 participants (47.1%) did not have health insurance.
Moving into PSH reduced interaction with the criminal justice system. Arrest and jail data were gathered from the Jacksonville Sheriff’s Office.
Hospital costs decreased by 57.6% from $6,458,809 incurred during the two years prior to housing to $2,741,425 incurred during the first two years in housing. This represents a $3,717,384 decrease in total costs to hospitals.