Homeless solutions

WHAT'S CHEAPER: housing the homeless or letting them cycle through shelters, hospital emergency rooms, jails, and the street?

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Too often the question is overlooked. Governments pay for triage. Nonprofit organizations hand out food and services. Passersby offer loose change.

Increasingly, research points to better strategies. Massachusetts legislators should heed these three points:

Patchwork solutions are expensive. Grants from the federal Interagency Council on Homelessness have helped 470 people in 11 cities. They have typically been homeless for three to 10 years, a troubling total of 2,900 years and tens of millions of dollars in hospital, jail, substance abuse help, and other costs, according to Philip Mangano, head of the council.

Housing is cost-effective. Last month the Lewin Group, a Virginia consulting firm, compared the daily costs of services for the homeless in nine cities. In Boston, supportive housing -- units linked with social services -- costs an estimated $33.45 per day. That's less than the daily $40.28 cost for shelters and much less than the daily costs of a hospital stay ($1,770), a mental hospital stay ($541), or prison ($117).

There are good solutions. In 1998, the medical center at the University of California in San Diego studied 15 chronically homeless alcoholics. In one year they took 299 ambulance trips to the hospital's emergency room at a cost of $967,000. Adding in the cost of police response brought the total to $3 million, according to local officials. San Diego responded with the Serial Inebriate Program, uniting the law enforcement and human services communities to break the cycle of substance abuse programs, jails, and emergency rooms. The program steers the homeless away from jail, helps them use services effectively, and helps move them into housing.

In 2003, researchers looked at the Serial Inebriate Program's impact on 18 people. The findings: an 80 percent drop in the use of emergency medical services and a 92 percent drop in emergency room visits. In addition, the hospital's free care costs fell from $468,000 to $82,000. And police arrests of so-called chronic inebriates dropped by almost a third.

The moral: housing the homeless won't end the need for costly care, but it can reduce the demand.

Sadly, Massachusetts has ended its own Individual Self-Sufficiency Initiative. The program started in 2000, created 120 units of housing, and helped 1,300 people leave shelters. Funding was $2.3 million in 2002 but fell to zero in 2004 and 2005. Governor Romney and the Legislature should reinvest in this program. Evidence points to the power of prevention and intervention -- and also to the cost savings.