According to the US Department of Housing and Urban Development (HUD)’s annual nationwide study, in 2017 there were an average of 553,742 people experiencing homelessness, out of which, 86,962 (15.70%) were chronically homeless. When speaking of homeless individuals among service and housing providers, the term “chronically homeless” is often a part of the conversation. The term is a way to differentiate those whose homeless experience is accidental, short-lasting or a one-time incident, in contrast to those whose homelessness is long-lasting, with repeated episodes or prolonged by a disability, “chronic”.

The separation is needed as it allows social services to know which housing interventions to implement. For example, a single mother that recently lost her job, causing her family to become homeless, would gain the most benefit from Rapid Re-Housing, providing quick temporary housing until she can get back on her feet. On the other hand, a homeless individual that has been chronically living in the streets for twenty years, with a diagnosis of schizophrenia, would benefit the most from Permanent Supportive Housing (PSH), allowing them to live indefinitely in income-based housing with ongoing case management and support services. It is cases like the latter that tend to be the hardest and most expensive to treat. Many of the chronically homeless may deal with untreated mental health and substance abuse issues, service resistance or physical disabilities, consequentially making them the least likely to obtain services.

It was this realization in 2004 that drove President George W. Bush to shift focus to this underserved subpopulation when he made the promise to end chronic homelessness by 2012. The goal was sequentially adopted by every presidency since then, and today, housing the chronically homeless remains one of HUD’s main long-term goals. The goal is carried out today by mandating that PSH only be allocated to individuals who are chronic, in the process creating a definition of what is means to be chronically homeless. This definition must be met in order to qualify for PSH. The term struggled to have a clear criterion until HUD’s final ruling in 2015, which defined chronically homeless as the following:

An individual who can be diagnosed with one or more of the following conditions: substance use disorder, serious mental illness, developmental disability, post-traumatic stress disorder (PTSD), cognitive impairments resulting from brain injury, or chronic physical illness and disability; and Lives in a place not meant for human habitation [such as the streets, shelter, or public park, a safe haven [such a domestic violence program] or in an emergency shelter; and Has been homeless for at least 12 months, or on at least 4 separate occasions in the last 3 years as long as the combined occasions equal at least 12 months and each break in homelessness separating the occasions included at least 7 consecutive nights. Stays in institutional care facilities [such as hospitals, jails or rehabilitation facilities] for fewer than 90 days will not constitute a break in homelessness.

Such intricate criterion requires cities to train their service providers across their continuum of homeless services in order to administer an assessment. If a homeless individual doesn’t meet the requirements housing can be denied under the moral guideline that they are not vulnerable enough. If housing providers do not comply, their HUD funding is jeopardized. While the consensus agrees that PSH should be allocated to those whom we have classically looked at as chronically homeless, those who work directly with the population know the intricate criterion­­ creates a gap among chronically homeless who are unable to meet the definition due to technicalities yet still in need of PSH.

For example, under the current definition, if Joe, a homeless man with a disability, states during assessment that he has been homeless for five years uninterrupted, he would qualify for PSH because he has been continuously living outside for 12 months. However, if he states he has been homeless for five years continuously, but two months ago he stayed with a friend for 15 days during winter before going back to the streets, he would not meet chronically homeless status and would be denied. The five years he lived outside would count as one episode; him staying with a friend would be a break in homelessness (since it was over seven days); and the remaining time outside would be another episode. This would mean that, at the point of assessment, he has not been continuously living outside for 12 months, nor has he had at least 4 episodes in the past 3 years adding up to 12 months, because he technically has only had two episodes.

In another case, Mary, a woman with a severe intellectual disability, could be continuously living outside for 35 years, at which point she meets the status requirements, but then she encounters a church who pays for an 8-day hotel stay. Upon going back to the streets, unbeknownst to the church, she would lose her status for the same reason as the prior case and would be denied future housing based on an eight day “break” in homelessness.

In another scenario, Kevin, a blind man with brain damage and PTSD, meets chronically homeless status by living continuously outside for 10 years and is offered housing. Before he signs housing paperwork, he gets hit by a car and is hospitalized for 90 days. Upon being discharged to the streets, he would lose his status and housing because, according to HUD, an institutional stay (hospital, jail, rehabilitation) over 90 days is a break in homelessness. If Kevin had only stayed 89 days he would still be able to move in to the housing that was previously offered.

Now, imagine Tameka is outside for 25 years, using a wheelchair and living with severe bipolar disorder, schizophrenia and alcohol abuse. She meets the chronically homeless status and moves into PSH; receives mental health treatment; becomes sober; and overall is a responsible neighbor and tenant. Three years into PSH her physical heath deteriorates. Her housing is very far away from her mental health provider and public transportation for the disabled is inefficient in the city, so she has difficulty receiving treatment for her mental health diagnoses. The lack of medication and infective case management leads her to begin drinking again. She finds herself in an argument with a neighbor, breaking one of the rules of the housing provider, and is evicted to the streets. She seeks the help of her old outreach worker who originally got her into housing only to find out she no longer meets the criteria for chronically homeless, since she was housed for three years. She will have to live outside for another year before she qualifies again.

These gaps do not go unnoticed by those working directly with the population, yet criticism never seems to reach policy makers. “Every time I bring it up in city meetings they deflect the subject” says an anonymous Atlanta service provider. “They always respond with ‘I don’t think this is going to be the place where we can change HUD policies’”. This pattern of dismissal repeats itself in other cities as stated by an anonymous social worker in Boise, Idaho — “Rumor has it there are changes coming to fill the gap, but the city is very secretive towards service providers. We never seem to know the details. We feel pretty powerless. How do you say to a client ‘sorry but you just got to be homeless for a bit longer to qualify for housing. Check with us in the near future as there might be other options. But I actually don’t know what those are’”.

This disservice is further intensified by the fact that many of the cases previously mentioned are often unsuccessful with interventions offered to the non-chronically homeless. Not functional enough for rapid rehousing, rent vouchers nor independent living, and in dire need of PSH, yet not properly chronic on paper to qualify, these individuals often fall through the gaps of the system. This leaves many services providers with an ethical dilemma, advocating for clients the only way possible — by going rogue — as expressed by an anonymous Chicago social worker:

“The problem I come into most often is that people who are the most vulnerable generally can’t stand to be in a shelter [to be assessed] and are paranoid, so they don’t want service providers to see where they stay. This means that you have to basically commit fraud to verify their homeless status. Sure our city takes advocacy letters for special cases, but the problem is systematic. Every case would require a special letter”.

Ironically, avoiding this gap in service was the original driving force that caused HUD to shift focus to the chronically homeless almost two decades ago with “the original argument that targeting resources to chronically homeless people would ‘free up’ resources to serve other homeless populations”. Nevertheless, after 18 years of chasing the original goal of housing the chronically homeless, neither HUD nor the United States Interagency Council on Homelessness has successfully freed up resources for ‘other’ homeless populations, including students, veterans, families, and chronic individuals unable to meet the definition.

Despite all of this, cities across America report every year that their chronically homelessness population is in decline. In 2018, 20% down in Boston; 18% down in L.A.; and an amazing 52% down in Asheville. These numbers, however, are a misrepresentation of the “chronically homeless”, as only those that fit the strict definition are counted in these statistics. Ignoring an unaccounted portion of the chronic population, the voices of those not lucky enough to qualify for PSH, yet unable thrive without it, continue to be unheard as cities proclaim their victories in housing their “chronically homeless” year after year based on an arbitrary definition.