A Report to the Nashville Metro Homelessness Commission By Courte C.W. Voorhees, Scott R. Brown & Douglas D. Perkins
The costs of homelessness, in terms of services and systems of care, must be understood to better inform policy-making. Currently those costs are generally unknown because they are spread across many public and private agencies that do not readily share cost and budget information or do not separate costs for serving the homeless population; some may be difficult to quantify; mostly costs of homelessness are elusive because people experiencing homelessness themselves tend to be “hidden.” Also, the methods and resources to track, analyze and report costs have not been standardized or made transparent and regularly reported.
This study aims to shed light on the economics of homelessness in Nashville. We draw on, and where possible try to improve upon, the data sources and analytic approaches of similar studies in other cities across the U.S. In addition, for comparative purposes, we estimated the costs of providing permanent housing for homeless persons, both including and not including supportive services, and the differences in expenditure for all options to provide a cost-efficiency analysis.
Methods. Six trained Vanderbilt students conducted interviews with homeless people, service providers, and outreach workers throughout Nashville. Archival data were also used to construct costs directly and to estimate unavailable figures. Homeless participants were only excluded from the study if they were under 18 years old, were unable to understand the consent form, or did not speak English. Once the initial convenience sample was gathered, an effort was made to make the final sample (n = 105) as demographically representative of the 2,227 homeless persons identified in the 2008 Nashville Homelessness Count as possible. Respondents were, on average, 45 years old; had lived in Nashville an average of 35.5 years (median 12 years); 75% were male; 62% self-identified as African-American; almost all were single, divorced or widowed. Only 2.7% were veterans of the armed forces, which likely under-represents the adult homeless veteran population. Median income for respondents was $2,800 (mean $4,641); 71.4% of participants had been homeless for one year or more prior to the interview; participants had spent an average of 3-5 years on the streets or in shelters; 52% met the criteria for chronic homelessness. We believe this percentage in the sample to be representative of the Nashville count, regardless of some estimates that chronic homelessness makes up about 10% of homelessness nationally. Participants were interviewed at shelters, on the street, and in advocacy centers.
Key informants (n=17 outreach and service workers, program administrators) were interviewed (by phone, email or in person) to determine or help estimate costs of providing services for people experiencing homelessness in Nashville. Service costs were sought for addiction treatment, advocacy, case management/referrals, child care and education, clothing, communications, counseling, documents, education, emergency care/transport, financial services, food, health care, housing/shelter, incarceration, job training, laundry, legal/courts, mental/behavioral health, pastoral care, personal care items, and transportation. Unavailable costs were estimated based on existing data or excluded from the total.
Three semi-structured interview protocols were used in this study (See Appendix). One asked service providers about their services, costs, numbers served, and their record keeping. The second protocol was a long-form interview of homeless persons to determine whether they are chronically homeless, which services they use and how often, and demographic information. This protocol was pilot tested with 8 homeless persons and then modified based on feedback. Long form interviews were recorded and transcribed. Homeless participants were paid $10 as compensation. The third protocol was a shortened version of the long-form interview.