Housing Boston's Chronically Homeless Unsheltered Population: 14 Years Later

Area of Science:

• Public Health
• Social Sciences
• Gerontology

Background:

• Long-term outcomes of permanent supportive housing (PSH) for chronically unsheltered individuals are not well understood.
• This study focuses on individuals with decades of street homelessness.

Purpose of the Study:

• To assess the long-term housing outcomes and survival rates of chronically unsheltered individuals housed in PSH.
• To identify predictors of survival within this population.

Main Methods:

• An open-cohort design was used, enrolling 73 chronically unsheltered individuals directly from the streets of Boston (2005-2019).
• Descriptive, regression, and survival analyses were employed to evaluate housing retention, stability, and survival predictors.

Main Results:

• Housing retention decreased significantly over time, from 82% at ≥1 year to 36% at ≥5 years.
• Nearly half (45%) of the cohort died while housed; trimorbidity (medical, psychiatric, substance use disorders) was common.
• Frequent housing relocations (38% moved ≥5 times) increased the risk of returning to homelessness and death.

Conclusions:

• Permanent supportive housing for chronically unsheltered individuals demonstrated low long-term housing retention and survival.
• Enhanced, flexible, and long-term medical and social supports are likely necessary for improving housing stability in this vulnerable group.