10th Decile Project Focusing on High Utilizers in Los Angeles Featured in Scaling What Works Initiative

We’ve long known that many chronically homeless individuals have high rates of chronic health conditions that stem from or are exacerbated by homelessness. These conditions include heart disease, hypertension, diabetes, tuberculosis, kidney and liver problems, HIV/AIDS, serious mental illness, and addiction and substance use disorders. Chronically ill homeless individuals continually bounce in and out of high-cost services, yet health outcomes do not improve. We know that most homeless frequent users of crisis services present complex, co-occurring social, health and behavioral health problems, yet are not adequately served by mainstream systems of care. These individuals demand more comprehensive interventions encompassing medical and behavioral healthcare, housing, and intensive case management.

Research strongly suggests that providing these individuals with supportive housing—providing an integrated package of affordable housing, care management, and coordinated primary and behavioral health care—can help these individuals permanently exit homelessness and improve in health status, while reducing public costs. In California, research showed that providing both case management and supportive housing to frequent users resulted in a 59% decrease in emergency department (ED) charges, and a 69% decrease in inpatient charges after 2 years. ED visits decreased by 61%, inpatient visits decreased by 64% after 2 years.  As individuals became stable in housing, their health began to stabilize as well.

Coordinating care and supportive housing is a win-win solution, resulting in stabilization of our most chronically ill homeless patients, reduction of ED and inpatient readmissions, and realization of substantial cost savings. It is this promise of improving health at lower cost that drove CSH to launch a new national demonstration project piloting and testing integrated models of housing and health targeted at the highest-need, highest-cost homeless individuals with chronic health conditions. Made possible through a $2.3 million Social Innovation Fund grant from the Corporation for National and Community Service, CSH is awarding a total of $1.4 million a year to teams of organizations in four communities—San Francisco, Los Angeles, Ann Arbor, and Connecticut—to pilot these models. 

In Los Angeles, CSH, The Economic Roundtable, and a large group of homeless service providers, hospitals, and FQHCs are working together to coordinate care and supportive housing for the “10th Decile”  –i.e., chronically homeless individuals comprising the highest-cost and highest-need 10% of the county's homeless population.

Nearing the end of our first grant year with our local partners, CSH is working with Grantmakers for Effective Organizations (GEO) to demonstrate the impact that the Social Innovation Fund has made thus far.  To do this, GEO, through the Scaling What Works initiative, and the Corporation for National and Community Service are collecting stories that showcase the work of Social Innovation Fund grantees.

CSH is thrilled that GEO has selected Scotty’s story and the work of the Economic Roundtable in Los Angeles to highlight the impact CSH’s SIF initiative is having not only on reducing high costs but in transforming people’s lives.  Read Scotty’s full story here.

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