This article is part of The Rooftop, a blog and multimedia series from New America’s Future of Land and Housing program. Featuring insights from experts across diverse fields, the series is a home for bold ideas to improve housing in the United States and globally.
When housing professionals talk about innovative solutions to the affordable housing crisis amid the rising tide of homelessness in the United States, we are quick to turn to the development of 3D-printed homes, micro-units, and commercial building conversion. Perhaps it is human nature to look for something new when the problem is so big and current approaches seem to be failing. But if we only focus on new innovations, we risk overlooking small corners of the system where impactful solutions already exist.
This proved to be the case in my first job after moving to Arizona, as the housing stability specialist at a rapid rehousing program for veterans in Phoenix. I later had the opportunity to help design and test a low-cost, high-impact solution that cleared barriers for our most vulnerable community members—people who are homeless and need personalized care. My experience implementing this pilot program taught me not only how tedious and fragile innovation can be, but also that if we can clear the path for existing innovations, and mobilize resources towards them, we can make open units accessible to those who need them the most.
Housing for Higher Care Needs
On the first day of my job in Arizona, I joined a veterans committee meeting of a continuum of care program. On the agenda was a section covering “Veterans Needing a Higher Level of Care.” These were military veterans experiencing homelessness who had care needs that extended beyond the provision of services in mainstream shelter and housing programs. Veterans who fall into this category are commonly experiencing some combination of serious mental illness, cognitive dysfunction, or physical disability that results in the veteran being considered incapable of taking care of basic needs alone.
Having just relocated from my home country of England, I learned in that meeting some hard truths about the U.S. housing system. First, I realized that case managers and other social services professionals in the field are often asked to lead systems-change work, which entails identifying and testing solutions to barriers within the housing and homelessness system—something that is not typically in their job description, capacity, or pay grade. Case managers in emergency shelters and housing programs were not trained in the delivery of health care, nor were the facilities or units set up to support activities of daily living for veterans in need of a higher standard of care.
Second, relocating from a country where shelter and housing are a basic human right, and where there are protections written into law for people who are homeless as long as they meet certain criteria, I had naively assumed that U.S. law would offer something similar. But I learned that there was no immediately accessible housing solution for veterans who fell under the category of having a high care need, despite the availability of financial assistance for these needs individually.
What’s more is that this gaping hole in the safety net isn’t limited to veterans, but exists for anyone who is experiencing homelessness and needs a higher level of care. As senior and chronic homelessness has rapidly increased, so too has the number of people who need nontraditional housing options. These include residential facilities that offer permanent housing, plus help with activities like bathing, dressing, and medication management.
“This gaping hole in the safety net isn’t limited to veterans, but exists for anyone who is experiencing homelessness and needs a higher level of care.”
While nontraditional permanent housing options exist, including assisted living and group homes where specialized care is provided onsite, those who need these options and are homeless, housing insecure, or in financial crisis can face barriers to accessing them. Nationwide, individuals can use Medicaid’s Home and Community-Based Services (HCBS) waiver program to cover the costs of these facilities, and in Arizona individuals can use the Arizona Long Term Care System (ALTCS), a Medicaid program. Veterans may qualify for the Veterans Administration (VA) Aid and Attendance benefit, which provides monthly payment to veterans who need assistance with daily living tasks.
So if short- and long-term services and housing exist, and if federal and state financial assistance is available to cover these costs, why is there still a gap? In short, it’s because it takes a lot of time to navigate the pairing of these benefits, and the application processes of separate programs do not align on timing.
The average processing time is three to six months for VA Aid and Assistance, 36 months for HCBS, and 60 to 90 days for ALTCS. But when case managers are working to secure suitable long-term housing for people with a higher level of care need, such as a room in an assisted living facility, payment for an open unit is required up front. Couple this with the stress of homelessness and the realities of day-to-day survival for someone with a high level of care needs, and navigating this type of housing option can feel impossible. This leaves people caught between mainstream emergency housing that does not meet their needs and financial barriers to accessing the housing that does. Practically speaking, that leaves no option at all.
The Solution: Flexible Funding and Expedited Processing
The stubbornness of this housing gap lingered at our first veterans committee meeting as dedicated community members tried to come up with solutions. What we designed and implemented is a pilot program I believe should be replicated and scaled up. Called Heroes’ Path to Hope, it offers flexible funding and expedited benefit processing to move veterans from unsheltered homelessness and immediately into suitable housing facilities.
It seemed simple enough, but as with most solutions, it required a lot of moving parts and relationship building. We leveraged a relationship with the head of Arizona’s Department of Veterans’ Services (DVS), who was incredibly passionate about finding solutions for veterans experiencing homelessness and also had the power to help us secure funding and expedite claims. This unlocked $150,000 in funding via DVS. Next, we fostered a connection with the ALTCS to build a bridge between the local housing and health systems. In the end, ALTCS offered expedited processing for veterans referred by the pilot. And we built connections to permanent care facilities, including assisted living, which agreed to same-day entry with a promissory note if a check was not available the same day.
Once veterans were in facilities, we engaged a navigation service that agreed to walk alongside the veteran to braid together a financial plan for housing stabilization from the financial assistance and benefit options. Lastly, we had an agreement with a local nonprofit with nimble payment processes to be the fiscal agent and project manager for the pilot. Crucially, partners in local VA healthcare systems agreed to manage referrals to the program, based on their assessment of need. This cross-sector, cross-organization partnership was instrumental in the pilot’s success.
“This cross-sector, cross-organization partnership was instrumental in the pilot’s success.”
Ultimately, the $150,000 served 15 veterans across the state, with up to three months of payment for a long-term facility (housing and care), benefits navigation, and $500 in flexible funding for basic needs like food. The goal was to advocate to the legislature for a standing line item in the state budget to provide annual funding following the pilot. What we found was that most of the veterans didn’t need the full funding. The relationship between partners within the veterans homelessness response system and the health-care system enabled expedited processing, with ALTCS applications getting prioritized and processed sometimes within the same week, meaning veterans were stabilizing into their long-term housing plans much faster than we anticipated. The program also had the potential for fund recycling, with the possibility of reimbursements in ALTCS funding that could have enabled us to serve many more veterans than anticipated with the initial funding.
Unfortunately, the pilot ended, attributable to staffing changes and the loss of core team members who had the will and commitment to establish this solution as a firm system change. This speaks to the fragility of innovation when ad-hoc groups of professionals are trying to build solutions where gaps should not exist. A gap persists across the United States for people who are experiencing homelessness and seeking permanent options that address their care needs. This example from Arizona shows that resources may already exist for the most vulnerable among us, and that solutions are possible—they simply require intention and care.
Editor’s note: The views expressed in the articles on The Rooftop are those of the authors alone and do not necessarily reflect the opinions or policy positions of New America.