Post on 16-Jul-2015
transcript
Housing First
Does it really save money? Concrete experiences from
Finland
Virpi Sillanpää
Tampere University of Technology
Finland
1
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Motivation for the research
Finnish government’s program to reduce homelessness (2008 –
2011)
Shift towards Housing First principles in Finnish social policy
Benefits of Housing First (in the literature)
• Reduce of the costs in health, social and legal services
• Positive impacts on the quality of life
What is the situation in Finnish context?
The aim of the research:
To create a model to evaluate cost-effects of Housing First
To evaluate cost and benefits of HF
2
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Framework for evaluating costs and benefits of HF unit
3
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Service Use: amount and
costs
• Health care
• Police
• Special services for
homeless (shelters etc.)
• Institutions
General negative impacts of
homelessness
• Problems in the city center
• Criminality
• Social problems
(individuals, family
members)
• Inhuman conditions, etc.
Homelessness
Costs related to living in the
unit
- Rents in the HF unit
- Costs of support in HF unit
Service Use: amount and
costs
- Health care services
- Police etc.
Qualitative impacts
• related to individuals/
residents: improved qualify of
life, etc.
• other stakeholders
• family members
• environment
Living in the Housing
First Unit
Cost related to living
(independently)
Independent living
Service Use
Qualitative impacts/benefits
• related to individuals/
residents: improved
qualify of life, etc.
• other stakeholders
• family members
• environment
Financial benefits
• For individuals: increased
income
• For the society: increased
tax revenue
Research data
Two case studies: Case Härmälä, Case Pitäjänmäki
Residents’ use of 1) health, 2) social and 3) legal services was
traced for a certain period before moving to the HF unit and for a
period during occupancy of the unit
Data on service utilization of individuals was obtained from client
data bases administrated by different authorities
The qualitative impacts of living in the HF unit were assessed by
interviewing residents
Themes of the interviews:
• Benefits and downsides of the unit
• Changes in life after the move to the unit (in health, relationships to
friends and family, personal financial situation)
• Aspirations for the future
4
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Case A: Housing First unit Härmälä
Operated by a third sector organization, the City of Tampere
purchases services
All residents have own flats and tenancy agreements
The unit was opened in June 2009, it has 22 apartments (22
residents), 5 employees
15 of the residents participated the research that was carried out
in 2010, six residents were interviewed
All residents have a history of long-term homelessness, alcohol
abuse, mental problems
Residents have moved to the HF unit either from the street,
institutions or shelters
Unit offers help and support in everyday life, assistance in
rehabilitation and guide residents to preventive services
5
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Case A:
Service use and costs during homelessness
6
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Service use and costs during
homelessness (5 months before
moving to HF unit) 155 884 €
Amount of
services
used
Number of
people
using
services
Institutional care, shelters, welfare
services for alcohol abusers 121 357€ 1540 days 13
Health care 30 016 €
GP visits 2 119 € 21 8
Visits to nurse 278 € 8 3
Hospital care (days) 20 849 € 45 days 6
Emergency room visits 3 473 € 5 5
Visits to specialized health care 2 236 € 7 5
Ambulance 1 061 € 12 6
Arrests by police 4 512 € 24 4
Case A: Service use in the HF unit and
comparison to the time of homelessness
7
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Service use and costs in HF unit: 95 987€
Amount of services used
Change, qty
Change, -59 897 €
Number of people using services
Institutional care, shelters, welfare services for alcohol abusers 3 374€ 16 days - 1524 days - 117 983 3
Health care 5 690 € - 24 325
GP visits 2 220 € 22 + 1 + 101 8
Visits to nurse 452 € 12 + 4 + 174 7
Hospital care (days) 0 0 - 45 days - 20 849 0
Emergency room visits 1 962 € 6 + 1 - 1 511 3 Visits to specialized health care 526 € 2 - 5 - 1 710 2
Ambulance 530 € 6 - 6 - 530 5
Number of arrests by police 376 € 2 - 22 - 4 136 2 Cost of support in the HF unit 52 797 € + 52 797 15
Rents in the HF unit 33 750 € + 33 750 15
Case A: Changes in costs
Cost savings were 59,897 € 38%, over a five-month period, which
indicates 143,753 € cost reduction per year for 15 people (rents in
the unit are included)
roughly 9,600 € savings per person per year
If rents are not included to comparison, cost savings were 93 647
€ 60 %, over a five-month period, 224 753 € per year
roughly 15, 000 € savings per person per year
Costs related to other services (i.e. health care, police)
During homelessness 34 528 €, in the HF unit 6 066 €
Cost savings for 15 people was 28 462 €, which indicates 68 308 € cost
reduction per year, about 4 600 € per person a year
8
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Case A: Qualitative results
Residents were more satisfied to their lives after moving to the
unit compared with the situation before the move
Benefits and downsides of the unit
• Benefits: privacy, location near services, comfortable new homes,
support from personnel
• Downsides: expensive rent, resembles institution
Effects to residents’ lives
• Health effects: decrease in alcohol consumption, better access to
regular health services and rehabilitation, peace of mind
• No major changes in relationships with friends and family members
• Most of interviewees were fairly content with their personal financial
situation
Aspirations for the future
• Decrease in alcohol consumption, independent living, building
connection with family members again (children), new hobbies,
finding a job
9
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Case B: Housing First unit Pitäjänmäki
Operated by Salvation Army, the City of Helsinki purchases
services
All residents have own flats and tenancy agreements
The unit was opened in February 2011, it has 111 residents, 24
employees, personnel is on duty 24/7
Unit offers help and support in everyday life, assistance in
rehabilitation and guide residents to preventive services,
organized work daily 9 am to 3 pm
Residents have a history of long-term homelessness, substance
abuse (alcohol and/or drugs), mental problems
Residents have moved to the HF unit either from the street,
institutions or shelters
23 residents participated the research
10
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Case B: Service use and costs during
homelessness
11
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Service use and costs (one year) 307 359 €
Amount of
service use
Number of
people
Accommodation and services:
Institutional care, shelters
Detoxification centers (longer-term)
135 335 €
82 813 €
52 522 €
4 993 days
311 days
20
6
Health care 162 488 €
GP visits (in health centre) 5 353 € 54 18
Emergency room visits 9 439 € 28 10
Visits to nurse 2 760 € 69 15
Home calls by visiting nurse 2 150 € 43 2
Visits to mental health clinic 4 422 € 17 5
Visits to detoxification centers (short-
term) 5 842 € 24 8
Hospital care (days) 96 862 € 373 days 8
Visits to specialized health care 6 482 € 26 10
Visits to clinic for abusers of
intoxicants 29 138 € 303 4
Arrests by police 9 576 € 94 12
Case B: Service use in the HF unit and
comparison to the time of homelessness
12
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Service use and costs in HF unit 658 138 €
Service
use
Change,
qty
Change, €
+ 350 799 €
Housing and support:
- Housing (rents)
- Cost of support
Detoxification centers
524 388 €
169 968
340 204
14 216
8 395
56 days
+ 3 402
+ 8 395
-255
+ 389 053 €
+ 87 155 €
+ 340 204 €
- 38 306 €
Health care 131 407 € - 31 041 €
GP visits (in health centre) 2 800 30 -24 - 2 553 €
Emergency room visits 17 451 27 -1 + 8 012 €
Visits to nurse 2 537 59 - 10 - 223 €
Home calls by visiting nurse 388 8 - 35 - 1 762
Visits to mental health clinic 1 577 8 - 9 - 2 845 €
Visits to detoxification centers
(short-term) 1 416 € 6 - 18 - 4 426 €
Hospital care (days) 37 580 € 77 - 296 - 59 282 €
Visits to specialized health care 6 469 € 19 - 7 - 13 €
Visits to clinic for abusers of
intoxicants 61 189 € 657 + 354 + 32 051 €
Number of arrests by police 2 343 € 23 - 71 - 7 233 €
Case B: Changes in costs
Total costs increased by 350 800 €, 15 300 € per person
The major increase relate to support provided by the HF unit, 340 000 €,
14 800 €/person
Participants were former long-term homeless people, who had lived on
streets/with friends or in shelters - > low costs during the homelessness
Costs related to use of health services declined by 20 %
Amount of hospital days declined by 80 % and costs by 60%
Use and cost of withdrawal increased substantially (more than
doubled)
Short term visits to detoxification centers and number of arrests by
police declined both by 75 %
13
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Benefits and downsides of the unit
• Benefits: own apartment, privacy, freedom to move around,
professional personnel and their support, location, organized
work/workshops
• Downsides: permitted use of alcohol, not enough common activities
Effects to residents’ lives
• The most of interviewees (6) reported increased well-being and
decrease in alcohol consumption
• Daily workshops was a focal change in everyday life for 5 persons, 4
had become more active with hobbies
• Relationships with family: no major changes, slightly more intense
than before, new neighbours
• Personal financial situation had improved
Aspirations for the future:
• Rehabilitation, decrease in substance abuse, finding a job or
continue with studies
14
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Case B: Qualitative results
Comparison of cost effects
Total costs
In Case A cost savings were 38%, in case B costs doubled
Effects to use and costs of other services
Health care services
Declined in both cases, in case A savings was 80 %, and in case
B 20 %
• cost of hospital days declined in case A by 100%, and in case B by
60%
Other services
Arrests by police declined in both cases, in case A by 90 %, in
case B by 75 %
Use of other “crisis services”
• in case A use of ambulance declined by 50 %, in case B use of short-
term detoxification center declined by 75%
15
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Conclusions and limitations of the research
Contradictory results
Cost savings in case A, substantial cost increase in case B
Why?
• Differences in costs of housing support in HF units
• Different types of residents
• Research focuses on changes
Service use and cost during the homelessness was at different
level in cases A and B: in case A average cost/person a year was
24 900 €, in case B it was 13 400 €
In both cases HF unit had positive effects on clients’ quality of life
Limitations
• Limited number of participants: 15 in case A, 23 in case B
• Costing principles in units and services may differ
• Research was conducted shortly after opening the unit
-> longer-term effects?
16
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015
Literature
Laihonen, H. & Sillanpää, V. (2014), What is the Role of Knowledge
Management in Establishing the Effectiveness of Public Welfare
Services?, Knowledge and Process Management, Vol. 21, No. 2, pp.112-
121.
Sillanpää, V. (2013), Measuring the impacts of welfare service innovations,
International Journal of Productivity and Performance Management, Vol.
62, No. 5, pp. 474-489.
Asunnottomuuden vähentämisen taloudelliset vaikutukset
Ympäristöministeriön raportteja 7/2011, 114 s. URN:ISBN:978-952-11-
3848-5. ISBN 978-952-11-3848-5 (PDF).
• Report (in Finnish)
Asunto ensin yksiköiden kustannusvaikuttavuus – vertailussa
mielenterveys- ja päihdekuntoutujien yksiköt
• Report available in the web site of Ministry of Environment (in
Finnish) http://www.ym.fi/download/noname/%7B13F1333B-9C45-
438D-B9BD-59D0BEE62339%7D/77950
17
- The 15th National Homelessness Conference, 6th November 2014 - 13.2.2015