Service-enriched housing

Service-enriched housing is permanent, basic rental housing in which social services are available onsite or by referral through a supportive services program or service coordinator (Sturtevant 2015). Housing and services can be provided by nonprofit, private, or government organizations; housing options can be unsubsidized, government assisted, mixed income, or a combination. Programs often support low income families, seniors, people with disabilities, or veterans (, Sturtevant 2015, Brown 2013b). Some service-enriched housing programs also assist families or individuals experiencing homelessness; programs that support households experiencing homelessness are often referred to as permanent supportive housing (NASEM 2018).

Expected Beneficial Outcomes (Rated)

  • Reduced homelessness

  • Increased housing stability

  • Reduced hospital utilization

Other Potential Beneficial Outcomes

  • Improved health outcomes

  • Improved mental health

Evidence of Effectiveness

There is some evidence that service-enriched housing reduces homelessness (, Fitzpatrick-Lewis 2011, Sturtevant 2015, ), increases housing stability (, NASEM 2018, , Fitzpatrick-Lewis 2011, Sturtevant 2015, ), and reduces hospital utilization for participating individuals and families (, , , Fitzpatrick-Lewis 2011, ). Programs are particularly effective among individuals experiencing homelessness (NASEM 2018, , , Fitzpatrick-Lewis 2011, ). Additional evidence is needed to confirm effects.

Participation in service-enriched housing programs can reduce anxiety (Urban-Popkin 2010). Programs with strong case management can stabilize physical (NASEM 2018, Fitzpatrick-Lewis 2011) and mental health conditions for formerly homeless individuals with HIV (Fitzpatrick-Lewis 2011). Long-term supportive housing can reduce HIV risk behaviors, new HIV infections, and the costs associated with managing HIV (Lee 2018a). Supportive housing programs for youth aging out of foster care have been shown to increase housing stability and reduce sexually transmitted infections (STIs) (Lim 2017). Service-enriched housing programs may improve the health of seniors by reducing preventable risk factors () and provide support to allow seniors to age-in-place (). Service-enriched housing may reduce chronic homelessness and improve health outcomes among individuals who are chronically homeless (NASEM 2018). Programs which include peer support workers, who have also experienced homelessness, mental illness, or addiction, can improve physical and mental health and reduce psychological distress for participants with serious mental illness (). In one study, service-enriched housing has been associated with increased maintenance of sobriety (Collard 2008).

There is a demonstrated need for service-enriched housing among the elderly (, ), veterans (Sturtevant 2015), individuals with chronic mental illness and substance abuse problems (, Fitzpatrick-Lewis 2011, Culhane 2002), and chronically homeless families and individuals (NASEM 2018). Tailoring service-enriched housing to meet the specific needs of older veterans, female veterans with children, or young veterans, can increase effects on housing stability and mental health or substance disorders, and ease the transition from military service to civilian workplaces (Sturtevant 2015).

States may facilitate partnerships between behavioral health and housing providers and provide intensive behavioral health services via Medicaid for supportive housing participants ().

Service-enriched housing may be a cost-effective mechanism to achieve stable housing for vulnerable families and individuals (Urban-Popkin 2010, ); additional research is needed to assess cost-effectiveness and potential health care savings (NASEM 2018). Decreased emergency care utilization and hospitalizations may offset some program costs (, Fitzpatrick-Lewis 2011, Brown 2013b, , ).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Service-enriched housing programs for low income or homeless families and individuals are in place throughout the United States. Programs may be implemented across a region, as by the LINC Housing Corporation in California and the Colorado Coalition for the Homeless, or in individual communities as in Bridgeport, CT via the PT Barnum Partnership (PT Partners) (LINC Cares-Resident services, CCH-Housing, PT Partners 2014). PATH Making It Home and Mercy Housing are two additional examples of service-enriched housing programs in local communities (PATH, Mercy Housing). Programs can also be implemented by faith-based non-profits as in Washington DC’s Jubilee Housing (Jubilee Housing).

There are many veteran-specific service-enriched housing programs. The HUD-VA Supported Housing (HUD-VASH) program, a service-enriched housing program for homeless veterans with psychiatric or substance abuse disorders, includes rental assistance vouchers from the US Department of Housing and Urban Development (US HUD) with case management and clinical services provided by the US Department of Veteran Affairs (VA); 93,000 vouchers have been awarded and approximately 150,000 homeless veterans have been served by HUD-VASH since 2008 (HUD-VASH, HUD-VASH 2018). The Mayors Challenge to End Veteran Homelessness, an additional partnership between the VA and US HUD, uses permanent supportive housing with added mental health services along with concepts from rapid re-housing and Housing First to serve homeless veterans (US ICH-Veteran homelessness).

Some programs also focus on the needs of specific groups. Family Service Communities, for example, provides service-enriched housing to low and middle income seniors in five senior-living complexes in Rochester, NY (Family Service Communities). The Road Home Dane County in Madison, WI provides service-enriched housing for families that are chronically homeless and include a disabled adult (RHDC-PSH). In Minnesota, the Volunteers of America provide service-enriched housing in one complex which includes families and seniors and in five senior-living complexes (VOA-Service-enriched housing).

Implementation Resources

US HUD-ALCP - US Department of Housing and Urban Development (US HUD). Assisted Living Conversion Program (ALCP): Grant program to convert private, non-profit housing developments to service-enriched housing or assisted living facilities for elderly residents aging in place.

Housing Hope - Housing Hope. Housing and services.

Partnering for Change - Partnering for Change. Service-enriched housing.

US ICH-Supportive housing - United States Interagency Council on Homelessness (US ICH). Supportive housing: Core components and featured tools. 2018.

LHS - Local Housing Solutions (LHS). To enhance local affordability and foster inclusive communities. New York University Furman Center and Abt Associates, Inc.

Furman Center-Neighborhood conditions - Furman Center for Real Estate and Urban Policy. Research area: Neighborhood conditions. New York University Furman Center.

Citations - Evidence

* Journal subscription may be required for access.

Cohen 2004* - Cohen CS, Mulroy E, Tull T, White C, Crowley S. Housing plus services: Supporting vulnerable families in permanent housing. Child Welfare. 2004;83(5):509-28.

Golant 2010* - Golant SM, Parsons P, Boling PA. Assessing the quality of care found in affordable clustered housing-care arrangements: Key to informing public policy. Cityscape: A Journal of Policy Development and Research. 2010;12(2):5-28.

Fitzpatrick-Lewis 2011 - Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, et al. Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health. 2011;11:638.

Collard 2008 - Collard CS, Larkin R. Supportive housing: Implications for its efficacy as intervention with special needs low-income African Americans. Journal of Public Management & Social Policy. 2008;14(2):69-83.

Castle 2008* - Castle NG. Service enriched housing and the senior living enhancement program. Journal of Housing for the Elderly. 2008;22(3):263-78.

Urban-Popkin 2010 - Popkin SJ, Theodos B, Getsinger L, Parilla J. Supporting vulnerable public housing families: An evaluation of the Chicago Family Case Management Demonstration. Washington, DC: Urban Institute; 2010: Brief No. 1.

Montgomery 2013* - Montgomery AE, Hill LL, Kane V, Culhane DP. Housing chronically homeless veterans: Evaluating the efficacy of a Housing First approach to HUD-VASH. Journal of Community Psychology. 2013;41(4):505-514.

Castle 2016* - Castle N, Resnick N. Service-enriched housing: The staying at home program. Journal of Applied Gerontology. 2016;35(8):857–877.

Bamberger 2015* - Bamberger JD, Dobbins SK. A research note: Long-term cost effectiveness of placing homeless seniors in permanent supportive housing. Cityscape: A Journal of Policy Development and Research. 2015;17(2):269–277.

Brown 2013b - Brown RT, Thomas ML, Cutler DF, Hinderlie M. Meeting the housing and care needs of older homeless adults: A permanent supportive housing program targeting homeless elders. Seniors Housing & Care Journal. 2013; 21(1), 126–135.

Sturtevant 2015 - Sturtevant L, Brennan M, Viveiros J, Handelman E. Housing and services needs of our changing veteran population. Washington, DC: National Housing Conference and Center for Housing Policy; 2015.

Rog 2014* - Rog DJ, Marshall T, Dougherty RH, et al. Permanent supportive housing: Assessing the evidence. Psychiatric Services. 2014;65(3):287-294.

Culhane 2002 - Culhane DP, Metraux S, Hadley T. Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing public service reductions associated with placement of homeless. 2002;13(1):107-163.

NASEM 2018 - National Academies of Sciences, Engineering, and Medicine (NASEM). Permanent supportive housing: Evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. Washington, DC: The National Academies Press; 2018.

Mathematica-Kleinman 2017* - Kleinman R, Kehn M, Siegwarth AW, Brown J. State strategies for coordinating Medicaid and housing services. Psychiatric Rehabilitation Journal. 2017;40(2):225-232.

Crisanti 2017* - Crisanti AS, Duran D, Greene RN, et al. A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population. Psychological Services. 2017;14(2):141-153.

Lim 2018* - Lim S, Singh TP, Hall G, et al. Impact of a New York City supportive housing program on housing stability and preventable health care among homeless families. Health Services Research. 2018;53(5):3437-3454.

Lee 2018a - Lee CT, Winquist A, Wiewel EW, et al. Long-term supportive housing is associated with decreased risk for new HIV diagnoses among a large cohort of homeless persons in New York City. AIDS and Behavior. 2018;22(9):3083-3090.

Lim 2017 - Lim S, Singh TP, Gwynn RC. Impact of a supportive housing program on housing stability and sexually transmitted infections among young adults in New York City who were aging out of foster care. American Journal of Epidemiology. 2017;186(3):297-304.

Gutman 2017* - Gutman SA, Raphael-Greenfield EI. Effectiveness of a supportive housing program for homeless adults with mental illness and substance use: A two-group controlled trial. British Journal of Occupational Therapy. 2017;80(5):286-293.

Citations - Implementation Examples

* Journal subscription may be required for access.

Mercy Housing - Mercy Housing. Live in hope.

PATH - PATH Making It Home. Find your PATH home: helping individuals, families, and communities end their homelessness.

US ICH-Veteran homelessness - United States Interagency Council on Homelessness (US ICH). Mayors challenge to end veteran homelessness: Criteria and benchmarks for ending veteran homelessness.

PT Partners 2014 - Partnership for Strong Communities. Affordable housing, community development, supportive housing: Making public housing work for families. Fairfield County Community Foundation and PT Barnum Apartments (PT Partners); 2014.

Jubilee Housing - Jubilee Housing. Affordable housing and family services in Washington DC.

LINC Cares-Resident services - Limited Income Communities (LINC) Housing Corporation. LINC Cares: Resident services.

CCH-Housing - Colorado Coalition for the Homeless (CCH). Housing: Affordable housing and support services for low income or homeless families and individuals.

HUD-VASH - US Department of Housing and Urban Development (US HUD). Veterans Affairs Supportive Housing (VASH): HUD-VASH Vouchers.

HUD-VASH 2018 - US Department of Housing and Urban Development (US HUD). HUD and VA announce additional support to help homeless veterans find permanent homes: Second round of HUD-VASH vouchers to provide housing for veterans and their families. HUD Public Affairs, press release; December 11, 2018.

Family Service Communities - Family Service Communities. About Family Service Communities: Enriched housing & assisted living in Rochester, NY.

VOA-Service-enriched housing - Volunteers of America, Minnesota and Wisconsin. Service-enriched housing: Affordable apartment living for families and seniors in Minnesota.

RHDC-PSH - The Road Home Dane County (RHDC). Permanent supportive housing (PSH).

Date Last Updated

Mar 4, 2019