Housing Options for People with Mental Illnesses

1
Housing Options for Peoplewith Mental Illnesses

• Prepared for the MHHC meeting
• April 26. 2009

2
Why are we here?

• Did you know that one third of the 60,000
  adults living in the community and served by RSNs
  may be homeless or living in substandard housing?
• Is recovery or even stability possible without
  safe decent housing?

3
Goals for Presentation

• Define the universe of housing options for MHHC
  consideration.
• Provide just enough information to spur interest.
• Offer links to more information about models,
  financing, best practices, etc.

4
Presenter Bias

• Without stable housing, few individuals are able
  to benefit from mental health services
• In old language least restrictive alternative
• In new language promote recovery
• The continuum of options is essential AND most
  people served in the public mental health system
  have the greatest success living in permanent
  supportive housing

5

• Housing Continuum

Least Independent Most Restrictive Highest
Level of Support Services Needed
Medium Independent Medium Restrictive Support
Services Required As Needed
Independent Least Restrictive Least Level of
Support Services As Needed

• Adult Family Home
• Licensed AFH
• Maximum of 6 residents
• State established Medicaid rate
• Support for ADLs
• May offer Medication administration
• Personal allowance
• Mostly senior residents

• Market Rate Rental Housing
• May or may not include rent subsidy
• No services related to housing stability

• Adult Treatment Facility (ATF)
• Licensed residential treatment facility
• State established Medicaid rates
• 24/7 staffing
• Mental health services
• Medication administration
• Personal allowance

• Permanent Supportive Housing
• Community based permanent rental housing
  requiring tenant lease
• Services are voluntary, flexible- adjusted to
  meet current needs, and focused on housing
  stability
• On site staffing may range from 0 to 24/7.

• Housing Retention Programs
• Services designed to assist people to stay in
  their housing
• Model programs for elders
• Homeless prevention programs for individuals and
  families

• Large Congregate Care Facility
• Licensed board home
• State established Medicaid rates
• Offer meals, snacks, laundry, housekeeping,
  activities
• Personal allowance
• May offer med administration

• Transitional Housing
• Community based rental housing
• Time limited residency
• Time limited supporting services focused on
  stabilizing family and securing jobs, benefits,
  permanent housing
• Tenant lease or service contract

• Home Ownership
• May qualify for down payment assistance
• No services related to housing stability

6
Licensed Facilities Adult Treatment Facilities

• Licensed by the State Department of Health to
  provide residential treatment services 24/7 to
  persons requiring care for a mental disorder
• Combine full range of residential services plus
  treatment services
• Require licensed health care staff including LPN,
  supervising RN, other licensed professionals as
  needed to manage individual treatment plans
• Medicaid rates established by DSHS
• Personal care allowance for residents

7
Licensed Facilities Congregate Care Facilities

• Licensed by State Health Department as a boarding
  home
• Medicaid rate established by DSHS for operator
• Small personal care allowance for resident
• Offer housekeeping, laundry, meals, snacks, group
  activities
• May offer support with activities of daily living
  
• May offer limited mental health services and/or
  medication administration

8
Licensed Facilities Adult Family Homes

• Licensed by the State Department of Health as
  Adult Family Home
• DSHS establishes Medicaid rates for owner
• Residents receive a small personal allowance
• Owner must live in the home or employ a qualified
  staff person 24/7
• May house no more than 6 residents
• Provide room and board and support for ADLs
• May offer some basic health services

9
Transitional Housing

• Owned by private landlords, non profits, or
  housing authorities
• Time limited rent subsidy from federal, state, or
  local sources like THOR, TBRA, document recording
  fees (2163, 1359, 2060) new homeless prevention
  stimulus funds
• Time limited supporting case management services
  provided by a non profit that may or may not be
  well coordinated with mental health services.
  Case management focused on stabilizing family,
  securing job, benefits, and permanent housing

10
Permanent Supportive Housing

• Housing
• Permanent Not Time Limited
• Deeply Affordable To People with Disabling
  Conditions
• Independent Tenant Holds Lease or Sub-Lease
  with Normal Rights and Responsibilities
• Services
• Flexible Responsive to Tenants Needs
• Voluntary Participation Not Condition of
  Tenancy
• Independent Focus on Housing Stability

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Permanent Supportive Housing contd

• Can be units leased from private landlords
• Can be units developed specifically by non
  profits or housing authorities to remain as
  affordable housing stock for people with
  extremely low incomes for 40-50 years.
• Supporting services typically a mix of onsite and
  offsite and well coordinated with treatment
  services
• Case managers are available 24/7 to tenants and
  landlords

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Permanent Supportive Housing contd

• Housing types
• Small to large apartment buildings dedicated
  exclusively for supportive housing
• Moderate to large affordable apartments with some
  supportive housing tenants
• Set-aside units within moderate to large
  apartment buildings
• Single family homes including shared housing
  environments

13
Housing Retention Programs

• Supporting services that assist people to
  maintain their housing
• Housing may be owned by consumer, by private
  landlord, by non profit, or housing authority
• Best practice examples
• retention of housing for elders
• homeless prevention programs

14
Independent Subsidized Rental Units

• Owned by private landlords or housing authorities
• Usually apartments in multifamily buildings
• Rent subsidy supplements tenant rent
• Most common sources of rent subsidies are Section
  8 or public housing operating subsidy
• No supporting services, little connection between
  tenant treatment services and housing/landlord

15
Independent Market Rental Units

• Owned by private landlords
• Usually apartments in multifamily buildings but
  can be single family homes
• Tenants pay the market rent
• Tenant incomes often limit choice to substandard
  units or unsafe neighborhoods
• No supporting services, little connection between
  tenant treatment services and housing/landlord

16
Home Ownership

• Homeownership is a real option for some people in
  recovery
• Condominiums are most often chosen
• The HomeChoice second mortgage program is a Down
  Payment Assistance Second Mortgage loan for
  people with disabilities or who have a family
  member with a disability living with them

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Additional Options

• Other types of housing/housing programs?
• Subsets of housing types targeted to RSN
  consumers who are
• Homeless
• Elders
• Young adults, 18-24
• Exiting jails, prisons, MH courts
• Exiting state hospitals

18

• Housing Continuum

Least Independent Most Restrictive Highest
Level of Support Services Needed
Medium Independent Medium Restrictive Support
Services Required As Needed
Independent Least Restrictive Least Level of
Support Services As Needed

• Adult Family Home
• Licensed AFH
• Maximum of 6 residents
• State established Medicaid rate
• Support for ADLs
• May offer Medication administration
• Personal allowance
• Mostly senior residents

• Market Rate Rental Housing
• May or may not include rent subsidy
• No services related to housing stability

• Adult Treatment Facility (ATF)
• Licensed residential treatment facility
• State established Medicaid rates
• 24/7 staffing
• Mental health services
• Medication administration
• Personal allowance

• Permanent Supportive Housing
• Community based permanent rental housing
  requiring tenant lease
• Services are voluntary, flexible- adjusted to
  meet current needs, and focused on housing
  stability
• On site staffing may range from 0 to 24/7.

• Housing Retention Programs
• Services designed to assist people to stay in
  their housing
• Model programs for elders
• Homeless prevention programs for individuals and
  families

• Large Congregate Care Facility
• Licensed board home
• State established Medicaid rates
• Offer meals, snacks, laundry, housekeeping,
  activities
• Personal allowance
• May offer med administration

• Transitional Housing
• Community based rental housing
• Time limited residency
• Time limited supporting services focused on
  stabilizing family and securing jobs, benefits,
  permanent housing
• Tenant lease or service contract

• Home Ownership
• May qualify for down payment assistance
• No services related to housing stability

19
Contact Us

• Lynn Davison, Executive Director
• lynnd_at_commongroundwa.org
• Common Ground Seattle
• [phone]
• Common Ground Spokane
• [phone]
• www.commongroundwa.org