Permanent Supportive Housing FAQ

Permanent Supportive Housing (PSH) is an approach that offers stable, permanent housing in combination with supportive services. It is an evidence-based best practice that supports people with disabilities who have experienced ‘chronic homelessness,’ meaning they have been homeless for more than a year. PSH is one of many interventions to homelessness on the “housing continuum,” that creates stability by offering long-term support for tenants that need it.

This approach emphasizes working with highly vulnerable individuals and leveraging their strengths to set and reach personal goals while acquiring essential life skills necessary for sustainable community living. Engagement with support staff is optional, but participants must adhere to program guidelines and landlord/tenant regulations. Failure to comply, particularly if there is a risk to the community, would result in corrective actions, up to and including eviction.

Services are tailored toward helping participants gain the skills necessary to manage their needs, recover from harms brought about by an extended period of homelessness, and improve (or at least stabilize) their health. Staff are trained and available to provide one-on-one services.

Staff promote healthy community integration by encouraging participation in community life. Being involved in the community fosters a sense of belonging and reduces isolation, both of which are protective factors to improve individual and community health.

Some PSH programs are designed for tenants who need more support, and those facilities have full-time on-site service staff (including nights and weekends). Other programs have tenants who require lower levels of support and in-person check-ins are conducted during normal business hours with after-hours resources on call.

Staff typically engage with tenants at least once per week, increasing or decreasing visits based on the tenant’s level of need. These services are voluntary. Tenants have the right to decline services, and may stay at the facility as long as they abide by the terms of their lease. The service needs for any given individual will change over time, and their engagement with support staff sometimes happens right away. For some residents, engagement takes time and only becomes possible after trust is developed.

Permanent Supportive Housing (PSH) is a best practice and evidence-based intervention endorsed by both the United States Interagency Council on Homelessness and the Department of Housing and Urban Development. WCHCS believes that this intervention provides dignity to individuals who have faced homelessness or housing instability, particularly those who have experienced extended unsheltered homelessness.

Moreover, for those experiencing homelessness, PSH offers a critical pathway to accessing and effectively utilizing support services aimed at improving health and overall well-being. It is also a more cost-effective solution than allowing someone to remain homeless because people in PSH are less likely to use emergency services or spend time in jail or prison.

In agreement with best practice guidance, WCHCS has seen PSH provide a sustainable, long-term housing solution to hundreds of individuals who would be unable to rent in the open housing market. For people who are unable to navigate congregate shelter settings and access services while unsheltered, it is the only available path to housing and security.

PSH can look different depending on the setting, population being served, and the agency providing the services. There are ten agencies in Whatcom County that manage PSH programs in Whatcom County, and collectively they’re serving hundreds of Whatcom County residents. The entry requirements vary for each program but all limit tenant income to less than 50% or less than 30% of Whatcom’s area median income, they generally only admit individuals exiting homelessness, and they all provide supportive services to increase stability of tenants.

Selected individuals are living with a disabling condition, and are initially identified by outreach teams or emergency shelter staff. While homeless, they are encouraged to apply for services, and an intake system is used to prioritize those with the most immediate needs. Sometimes, PSH units are developed for a specific disability such as serious and persistent mental illness or people living with a developmental disability. Information collected during the intake helps match each individual to the most appropriate program for them.

As of June 2024, Whatcom County’s Coordinated Entry Housing Pool has 747 households. Of those households, 463 have significant enough needs and disabilities that they are candidates for PSH. This represents 62% of people waiting for services in the housing pool.

Placement into PSH units depends on availability through filling vacancies caused by program exits or the creation of new units. These things are happening too slowly to meet the demand for this type of intervention.

Public funding comes from a mix of state, local, and federal sources, and some agencies collect donations from supporters to enhance their services.

Local

Local funds are derived from fees collected at the auditor’s office, property taxes, and sales taxes. Grants provided by the Washington State Department of Commerce also support local projects. Local funds contribute towards capital as well as services and operations.

State

Washington State provides critical support for both operations and capital investments, primarily through the Washington State Housing Trust Fund and the Washington State Department of Commerce.

Federal

Federal funds are passed through state agencies like the Department of Commerce and the Washington State Housing Finance Commission.

All PSH programs that receive funds from Whatcom County Health and Community Services are required to submit quarterly reports. PSH programs that serve high-need populations also submit monthly reports that include information about crisis calls made, lease enforcement activities, staffing levels, and building maintenance needs. Whatcom County staff meets with PSH providers regularly and maintains documentation on all in-person visits.

All PSH programs are subject to inspections from the various agencies that provide ongoing subsidies or who contributed investment funds to develop the building. These annual inspections include overall building safety and security and individual unit inspections.

Additionally, all units are inspected before a new tenant moves into the unit and must pass HUD's basic Housing Quality Standards assessments. The layered subsidies from city, county, state, and federal agencies leads to different types of oversight for the different components of the project and the many costs associated with ongoing operations.

Permanent Supportive Housing (PSH) programs were disproportionately affected by the COVID-19 pandemic and the eviction moratorium from 2020 to 2021. The PSH model relies heavily on outreach from various mental and behavioral health providers and employs lease enforcement to help residents change behaviors that jeopardize their housing stability. Unfortunately, both of these critical tools were severely limited when pandemic restrictions were in place. Clients did not engage at high rates with case managers and wrap around services, and the eviction moratorium kept building management from enforcing lease agreements.  These issues lead PSH programs nationwide to struggle with stability and recovery. The ripple effect of this was felt by residents, staff, and neighboring community members.

The fentanyl crisis took off at roughly the same time, drastically altering regular operations within PSH programs. This increase resulted in higher rates of crisis situations and overdoses among residents. PSH staff, classified as frontline workers, were required to work in person and frequently responded to overdose incidents, significantly impacting their roles. Many PSH workers in Whatcom County left frontline positions for less demanding options, creating challenges in hiring new staff willing to take on these responsibilities during the pandemic.

Permanent Supportive Housing (PSH) is a national best practice because it is proven to be extremely successful in keeping formerly homeless disabled residents housed.

Research has demonstrated that PSH is cost-effective compared to emergency services such as shelters, hospitals, and law enforcement involvement. By providing stable housing and supportive services, PSH reduces the frequency of emergency room visits, incarcerations, and other costly interventions associated with homelessness. PSH models are scalable and replicable across different communities and regions. They can be adapted to meet local needs and resources while maintaining fidelity to core principles, making them a flexible solution to homelessness.

Comparable costs at a glance:

• Avg. annual cost for bed in federal prison: $35,347
• Avg. annual Whatcom jail single bed cost in 2022 estimated at: $45,000
• Typical annual cost of motel/hotel room in Whatcom: $48,000
• One night for uninsured individual at hospital: $9,300 
  • $279,000 monthly
  • $3,394,500 annually
• Avg. annual cost to taxpayers of a low-barrier PSH unit in Whatcom: $25,000 
  • This equates to around $69 per night, significantly more affordable than emergency services or incarceration. 

Stable housing through PSH can contribute to improved physical and mental health outcomes for residents. With access to supportive services, residents can better manage chronic conditions and mental health issues, leading to better overall well-being. For many in Whatcom County, such as individuals that are unable to access emergency shelters, this is the only viable path out of unsheltered homelessness.

No, just like in any other apartment building, illegal substances are not permitted on the properties. Smoking of any kind in the facility, in any housing program, is grounds for lease enforcement or eviction.

PSH participants are tenants with leases, and they enjoy the same protections and rights as other tenants throughout Whatcom County. They cannot be removed from their homes without court approval. Going through the lease enforcement process can take several months and require multiple attempts to notify the tenants of lease violations before a court will review for an eviction.

The eviction process is legally required by landlord-tenant law. It gives the tenant an opportunity to engage with support services and change their behavior to maintain housing. An example of this could be engaging with a case manager to go to detox and begin a path towards treatment. Although eviction is never a preferred solution in PSH programs, it is nonetheless an essential tool needed to protect the rest of the PSH community’s health and safety.

No, there is no evidence that Permanent Supportive Housing (PSH) attracts more homeless people to a city, a specific neighborhood, or to the property itself. PSH is an intervention that effectively lowers the number of people who are homeless within a community by providing a direct solution: a place to call home with the supports needed to sustain their living arrangement. PSH projects exist in many cities in Washington State and in other states throughout the country.

Residents pay 30% of their income towards rent and agree to abide by their lease agreement. Some tenants who are living with a disability pay a portion of their benefits towards rent; while others who can work pay from their wages.

Tenant rents increase proportionately with their income. Some participants will use PSH as a stepping stone, moving on to other housing options in the community. For others, PSH will be a long-term housing option, with community and social service supports helping them meet their goals. The purpose of PSH is to provide stability for those who need it, not to move people out into other living arrangements.

As per Federal Housing and Urban Development guidance, in PSH projects there must be a lease and it must be for a term of at least one year and automatically renewable upon expiration. As long as the tenant meets income requirements and complies with their lease, they can stay indefinitely. Residents can be evicted if they do not pay rent or violate their lease. However, onsite staff work closely with managers and service providers to make every effort to ensure the stability of the residents so that they do not return to homelessness.

Criminal background checks are conducted to determine eligibility for residency. While a criminal record does not automatically disqualify applicants from housing, Permanent Supportive Housing programs have varying criteria regarding background checks. Some PSH programs may disqualify individuals with serious felony charges, but most will accept those with misdemeanors. Programs that accommodate families with children typically have stricter criteria based on background checks than those serving single adults.

Increasing the number of disqualifying factors based on criminal background checks creates additional barriers to entry, thereby limiting housing options and potentially removing PSH as one of the few viable solutions for individuals with no other housing prospects. Individuals leaving institutions with multiple charges on their record often find themselves ineligible for housing in the private rental market, making PSH their primary or only realistic housing option for re-entry.

Residents often work, particularly after they have been stably housed. However, since the typical resident is living with a disability, sometimes receiving SSI/SSDI, there may be a higher volume of individuals who are unable to work living in the PSH program.

The Housing First approach prioritizes stable housing as a first step toward addressing other issues, such as mental health, substance use, medical challenges, and employment. This approach has been widely recognized as effective in reducing homelessness, and for providing a platform from which participants can make better use of community services.

Housing First stands as a critical intervention in homelessness, placing stable and permanent housing at the forefront without demanding prerequisites like sobriety or employment. This evidence-based approach acknowledges that being unhoused is extremely stressful and makes it very difficult for someone to focus on addressing other issues until the uncertainty of daily life and the stress of finding housing is taken care of.

By prioritizing secure housing, individuals gain improved access to essential support services and can focus on goals such as seeking substance use disorder treatment, pursuing employment or education opportunities, ultimately enhancing overall well-being.

• National Alliance to End Homelessness. (n.d.). Permanent supportive housing. Retrieved July 2, 2024, from https://endhomelessness.org/resource/permanent-supportive-housing/
• United States Interagency Council on Homelessness. (n.d.). Permanent supportive housing. Retrieved July 2, 2024, from https://www.usich.gov/all-in
• U.S. Department of Housing and Urban Development. (2023, June 15). Homelessness assistance. Retrieved July 2, 2024, from https://www.hud.gov/faqs/homeless
• Metraux, S., & Culhane, D. P. (2016). Homeless shelter use and reincarceration following prison release: Assessing the individual- and neighborhood-level effects. Social Service Review, 90(3), 339-371. https://doi.org/10.1086/688357
• Tsemberis, S. (2010). Housing First: The pathways model to end homelessness for people with mental illness and addiction manual. Hazelden Publishing.
• Henwood BF, Dichter H, Tynan R, Simiriglia C, Boermer K, Fussaro A. Service use before and after the provision of scatter-site Housing First for chronically homeless individuals with severe alcohol use disorders. Int J Drug Policy. 2015 Sep;26(9):883-6. doi: 10.1016/j.drugpo.2015.05.022. Epub 2015 Jun 7. PMID: 26123896.