The total cost associated with homelessness in Nashville from service provider agencies and archival/provider estimates is $16,784,020.15. This is likely an underestimate, given the omission of externalities such as lost work time, lost potential tax revenue, partial costs of civic projects, survival crime, etc. that are extremely difficult to measure or estimate. The total cost associated with chronic homelessness in Nashville is $10,034,425.68. The per-person estimate for the cost of homelessness in Nashville is $7,536.61 and the per-person estimate for the cost of chronic homelessness in Nashville is $10,624.72. Both of the total cost and per person figures for homelessness and chronic homelessness should be treated as lower bounds for the costs of homelessness in Nashville.
The total cost of homelessness was derived by finding the total cost of these service categories: hospital, clinic, emergency medical services (EMS)/emergency transport, veterans affairs (VA) costs, social services, shelter services, police, jail, courts, drug and alcohol treatment, and advocacy costs. Chronic homeless costs were determined by multiplying the basic per-person cost by the percentage of total use by chronic homeless individuals determined by the survey, then divided by the percentage of chronic homeless individuals relative to the total sample. Slightly different methods were required to calculate the cost of each category, which the following paragraphs will explain in detail.
Hospital costs. 74.28% of respondents use hospital services for physical and mental health, with an average of 9.05(median 2) visits per year. Of those visits, only 28.34% included overnight stays; respondents overwhelmingly felt that being hurried out of the hospital negatively affected their health and likely lead to repeated outpatient visits. Hospital costs were found by multiplying the per-person average cost of providing services to a homeless individual by an estimated count of the number of homeless that used hospital services in the past year. The estimate of the total number of homeless that used hospital services was derived by multiplying the percentage of homeless individuals in our interview survey that reported using hospital services within the past year by an estimate of the total number of homeless in Nashville taken from the count of homeless individuals conducted in January 2008. The average per-person cost for providing health care to people experiencing homelessness is $1,561.49 and the cost for medical care for chronically homeless individuals is $1,875.10. The total estimated cost for providing health care for people on the streets is $3,477,430.55 and for chronically homeless is $2,187,303.81.
Clinic costs. 72% of participants visit a medical clinic for care with an average of 9.24 (median 2) visits per year. Clinic costs were estimated using the same method (multiplying the per-person services cost of clinics by an estimate of the count derived from our interview survey and the 2008 total count). Clinic costs were estimated to be $389.18 per homeless person and $449.36 for a chronically homeless person. This totals $866,703.53 for homelessness and $524,182.29 for chronic homelessness.