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.

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.

Affordable Housing Preservation in Washington, DC uses the case of Washington, DC to examine the past, present, and future of subsidized and unsubsidized affordable housing through the lenses of history, governance, and affordable housing policy and planning. Affordable housing policy in the US has often been focused at the federal level where the laws and funding to build new affordable housing historically have been determined. However, as federal housing subsidies from the 1960s expire and federal funding continues to decline, local governments, tenants and advocates face the difficult challenge of trying to retain affordability amid increasing demand for housing in many American cities. Now, instead of amassing land, financing and sponsors, affordable housing stakeholders must understand the existing resident needs and have access to the market for affordable housing. Arguing for preservation as a way of acknowledging a basic right to the city, this book examines the ways that the broad range of stakeholders engage at the building and city levels. This book identifies the underlying challenges that enable or constrain preservation to demonstrate that effective preservation requires long-term relationships that engage residents, build trust and demonstrate a willingness to share power among residents, advocates and the government. It is of great interest to academics and students as well as policy makers and practitioners internationally in the fields of housing studies and policy, urban studies, social policy, sociology and political economy.