Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed. Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.

There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.

The U.S. Department of Housing and Urban Development (HUD) is pleased to present this second national report to Congress on homelessness in America. The first Annual Homeless Assessment Report (AHAR) was submitted in February 2007. These reports were developed in response to a series of Congressional directives beginning with the FY 2001 HUD Appropriations Act. In that year, Congress directed the Department to assist communities to implement local Homeless Management Information Systems (HMIS) and required every jurisdiction to have client-level reporting within three years. Senate Report 106-410 noted that HMIS data could be used to develop an unduplicated count of homeless people and to analyze the use and effectiveness of homeless assistance services. To that end, Congress further charged the Department with collecting and analyzing HMIS data from a representative sample of communities in order to understand the nature and extent of homelessness nationally.