Supportive housing combines permanent, affordable housing with services that help people live more stable, productive lives. Supportive housing is developed by packaging together housing that is affordable to persons with very low or extremely low incomes with flexible supportive services that are designed to meet the special needs of an individual or family. When targeted effectively, supportive housing can be cost-effective for communities. Creating supportive housing involves partnerships and collaboration. Please refer to CSH’s publication Not a Solo Act for more information about putting together a supportive housing project.

Who does supportive housing serve?
Supportive housing is typically targeted to individuals or families who are experiencing homelessness and who would have difficulty maintaining permanent housing without ongoing supports. Supportive housing is designed primarily for people with long histories of homelessness due to persistent obstacles like serious mental illness, substance use disorders, or chronic medical problems. Compared with other very low-income people, these men and women disproportionately use shelters, emergency health care and public mental health services—often cycling rapidly through various public institutions at great cost to taxpayers. Supportive housing can break this cycle by providing affordable housing and the services that these individuals or families need to remain stably housed.

Supportive Housing is distinguished from affordable housing with resident services in that households who need supportive housing are often described as persons who:

• without supportive services cannot access and maintain stable housing in the community, and
• without affordable housing cannot access and make effective use of treatment and supportive services in the community.

From CSH’s perspective, supportive housing is effective for a wide range of people who are homeless or at risk of becoming homeless. CSH has focused on working with partners to create supportive housing opportunities for people—men, women, youth and families with children—who meet the following criteria:

1. They are poor, with most earning 20% of area median income or less.
2. They have chronic health conditions that are at least episodically disabling, such as mental illness, HIV/AIDS and substance use issues or other substantial barriers to housing stability (domestic violence, trauma, a history of out-of-home placements).
3. They are not able to obtain or maintain housing and do not live in appropriate and stable housing in the community.
4. They would not be able to retain stable housing without tightly linked services.

This group includes people who may be homeless (for any length of time) or are at risk of becoming homeless and those who may be leaving other systems of care without a place to live, such as young people aging out of foster care, people with mental illness or other disabilities, leaving jail or prison, and some elderly people.

Within this target group, CSH has stepped up efforts to ensure that supportive housing is delivered to a priority population consisting of a subset of those defined: people who have been homeless for long periods and have experienced repeated (three or more times) or extended (a year or more) stays in the streets, emergency shelters or other temporary settings, sometimes cycling between homelessness and hospitals, jails or prisons.

What are the benefits of supportive housing?
Research shows that supportive housing has positive effects on housing stability, employment, mental and physical health, and school attendance.

Supportive housing is also a far more cost-effective response to homelessness than many of the institutions where many people without housing spend large amounts of time. Cost studies in six different states and cities found that supportive housing results in tenants’ decreased use of expensive homeless shelters, hospitals, emergency rooms, jails and prisons. People who are housed in supportive housing significantly reduce their use of these more expensive interventions. Some examples follow:

• Emergency room visits decline by 57%[i]
• Use of emergency detoxification services decline by 87%[ii]
• The rate of incarceration declines by 52%[iii]
• More than 83% stay housed for at least one year[iv]

These reductions result in direct public system savings. For example, in New York, reductions in service use resulted in an annualized savings of $16,282 per unit, which amounts to 95% of the cost of providing supportive housing. In Portland, the annual savings per person amounted to $24,876, whereas the annual cost of housing and services was only $9,870. 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.[v]

What are the Characteristics of Quality Supportive Housing?
CSH’s Dimensions of Quality for Supportive Housing set the standard for development and operation of supportive housing throughout the country. Our assessment tools and trainings are designed to help you leverage the Dimensions of Quality in your programs and projects. The Dimensions of Quality clearly articulate what makes quality supportive housing. They strengthen and sustain the supportive housing industry by driving better outcomes for tenants, especially those with multiple barriers to housing stability. They help ensure that existing resources for supportive housing are used as efficiently and effectively as possible. For more information, please click here.

Aligning Supportive Housing with Needs
Supportive housing is a critical and effective tool for ending homelessness, but targeting this intervention is very important. Supportive housing is designed to serve those who would not be able to stay housed without a wide range of supportive services. People living in supportive housing usually have a long history of homelessness and often face persistent obstacles to maintaining housing. Supportive housing is generally not intended for people who are experiencing homelessness due to a short-term economic crisis or who appear likely to get back on their feet simply with a housing subsidy.

As you begin or expand your work to end homelessness, it is important to discuss with homeless service providers (and possibly outside experts) how you will ensure the right people receive the right resources, and whether or not your community wants to target scarce resources to any particular sub-populations. For example, if addressing homelessness due to foreclosures is the focus of your local initiative you’ll likely want to consider a less intensive program that focuses on getting people re-housed and increasing their incomes. On the other hand, if your community is determined to address street homelessness and those with persistent mental illness, or perhaps a problem with homeless families with a disabled head of household, supportive housing is likely a more cost effective option.

Over the past ten-plus years, federal policymakers have directed more resources towards permanent housing and addressing persistent, long-term homelessness. There are many reasons to address long-term homelessness through supportive housing, including: the high cost to taxpayers when people cycle for long periods of time between emergency systems; wanting to address street homelessness particularly in business districts; reducing the number of long stays in shelters to create space for those with short-term needs; and perhaps most importantly, the moral reason of wanting to help people who have suffered on the streets the longest. That said, homelessness is a broad problem with varied solutions based both on individual levels of need, as well as local housing conditions and other factors. The bottom line is to be sure that the intervention your community is working on truly matches the needs of the population you are seeking to help.

What are the most common models of supportive housing?
Supportive housing is found in diverse locations and neighborhoods across the country and the design of the housing itself reflects that diversity. Models of supportive housing include:

Single Site Housing
This is generally an apartment building, townhouse or single family home that exclusively provides housing to formerly homeless families or individuals. Project-based vouchers are the primary PHA tool used in single site housing, which is generally owned by nonprofit landlords.

Integrated Housing
This model generally refers to market-rate apartment complexes that have a dedicated percentage of subsidized units that provide housing to formerly homeless families or individuals. Project-based vouchers are the primary PHA tool used in integrated housing.

Scattered Site Units
This model enables households to lease apartments from private landlords using a rental subsidy. This rental subsidy might be designated to the tenant (tenant-based) or to the organization assisting them (sponsor-based.) A sponsor-based model allows providers to master lease apartments from landlords and sublet them to people who cannot otherwise pass landlord screening. Scattered site models can be particularly effective in quickly creating units of supportive housing in markets with vacancy in the existing rental housing stock. Tenant-based Housing Choice Vouchers are the primary PHA tool used in scattered site supportive housing.

Long-Term Set-Asides
Set-asides are dedicated units that provide housing to formerly homeless families or individuals within a building that may or may not be subsidized. The subsidized supportive housing units in integrated housing are often referred to as set-asides. Set-asides can also be established in buildings financed with public funding, Low Income Housing Tax Credit buildings and public housing.

What are the features of the housing?
While the physical configuration may vary, supportive housing generally shares the following common features:

Apartments are dedicated.
Units are intended and designated for individuals or families who are homeless, at-risk of homelessness and who have multiple barriers to independent living.

Tenants hold leases and pay rent.
Tenants ideally pay no more than 30% of household income toward rent and utilities. The tenant has a lease with no limits on length of tenancy related to the provision or participation in supportive services.

Housing and services are coordinated.
Agreements exist between the housing owner, the property manager and the supportive services providers. Service and property management strategies are coordinated to address issues that may threaten housing stability.

Supportive services are flexible and engaging.
All members of the tenant household have easy, facilitated access to a flexible and comprehensive array of supportive services designed to assist the tenants to achieve and sustain housing stability. Service providers proactively seek to engage tenants in on-site and community-based supportive services, but participation in such supportive services is not a condition of tenancy. For more information, go to the section of this toolkit on supportive services in supportive housing.

Go to the next section to learn about supportive services.

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