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.

For as long as statistics record, housing conditions in the United States have been improving. Housing that only the rich once enjoyed is commonplace today; by today's standards, most of the population was ill-housed at the turn of the century. Amidst this rise, however, inadequate living accommodations for a portion of the population have stubbornly persisted. Many families endure housing deprivations that are severe, even with respect to the norms of earlier years.Development of housing policy requires a blending of technical data, theory, and political and ethical considerations. This study is organized, therefore, around a planning framework. Housing needs and objectives are specified; housing resources are identified; theories of the problem are explored; alternative strategies are reviewed; and one of several possible packages of programs is elaborated in detail. Particular emphasis is placed throughout on the multiplicity of housing and non-housing goals and programs, and on the variety of client groups, which must be taken into consideration in trying to evolve an appropriate role for the public sector in this area of social concern.Specifically, this work begins with a quick sketch of Baltimore and an examination of local problems and policies. This is followed by a description of the dimensions of housing needs. Another chapter studies the low-income market empirically from the perspective of the person whom poor families rely on for housing services - the landlord. An investigation on several theories of slums, decay, and housing abandonment is discussed, and the authors formulate a composite theory that serves as a foundation for policy decisions. The final set of chapters explores in greater detail technical aspects of the proposals contained in the text, and the concluding chapter investigates their political feasibility.