08 | Flexible Housing Pool: Rapid Expansion to Address Regional Homelessness

 The Center for Housing and Health’s unique program, the Flexible Housing Pool, works to address the region’s homelessness through system coordination. Through the Flexible Housing Pool (or FHP), Cook County is able to rapidly house and provide supportive services to some of the region’s most vulnerable populations, including individuals experiencing homelessness who cycle through the criminal justice system and utilize hospital emergency rooms for care.

In this episode, I’m talking with Pete Toepfer, Executive Director of the Center for Housing and Health .

The Center’s mission is to honor every person’s right to a home and health care by bridging the housing and health care systems to improve the lives of Chicagoans experiencing homelessness.  We’ll hear more from Pete about how FHP has expanded in the past three years to meet the growing demand for permanent supportive housing and how the organization is centering racial equity in its strategic priorities. 

Just last week, the Flexible Housing Pool, or FHP, housed its 1,000th resident. Congratulations on this milestone! Can you share more about its significance in the context of serving people in the Chicago region experiencing homelessness?

Kuliva. Thanks so much. As you pointed out, an awful lot has changed since 2019. The least of which was the covid 19 pandemic. For a little context, in the first year of the Flexible Housing Pool, like lots of projects that are starting up, it began fairly slowly. In the first year we housed just under 60 people, and now we’re at 1,000. So as you can tell, the growth has been very, very rapid, but very, very necessary when we’re talking about the tens of thousands of our neighbors who are homeless each year in Chicago. So, for me, the biggest takeaway is that we have dramatically improved the lives of a thousand of our neighbors, and many of those are children. About 350 of those thousand people are minors/children. So those are children who will not have to experience the trauma of living in cars and bouncing between an aunt’s house or grandma’s house, a shelter and that can focus on school, friends and playing. Just like every child should do.

One of the stories that I feel is really fitting around the Flexible Housing Pool is one of the first residents who received housing as a result of the Flexible Housing Pool. Her name is Kayla Wallace, and she was actually one of the residents who was at an early press conference talking about the promise that the Flexible Housing Pool could bring. She was also someone who had been bouncing between hospitals, got seriously injured on the job while working as a tour guide on one of the double-decker buses downtown, and was no longer able to pursue her musical career. Fast forward to today. Kayla is now chair of the Flexible Housing Pool governance council. This is essentially the Board of Directors for the Flexible Housing Pool that makes decisions about where we are going as an overall project that brings together all the community stakeholders. She is representing tenants of FHP, and is facilitating the meetings. It really is a full circle moment for her and for the Flexible Housing Pool.

I think that speaks to one of the points that you brought up about how we’re trying to live out the value of racial equity within the Flexible Housing Pool. That, within that governance council, residents of FHP have, per the bylaws, 40 percent of the seats. These are folks who have experienced homelessness and they have the same voting power as someone who put in six million dollars. They are truly the experts in the direction that we need [to go in].

So I think that one of the other things that’s exciting about where we’ve come is that we have two of the largest managed care organizations in the state who are now investors in the Flexible Housing Pool, because they see it as part of their best interest to help their members maintain health, achieve better health outcomes, and as a managed care organization is charged with doing, control costs. It is not a good investment to continue to have someone get hospitalized for conditions that could be better controlled in primary care settings, but that’s very difficult for people to do if they don’t have a stable place to live, and that’s exactly what the Flexible Housing Pool does. So, with CountyCare and Meridian Health Plan, we talk to them regularly about how we are serving their more complex members who really, but for having a safe and stable home, struggle, and cycle through different, high-cost crisis settings.

In the past, you’re reported chronic disease conditions, serious mental illness, justice system involvement and undocumented status as housing barriers experienced by FHP participants.  Considering the impact of the pandemic, what other barriers are you and your team working to address? 

One of the big ones is that we want to ensure that people joining the Flexible Housing Pool have a meaningful choice in where they want to live. We promote the value of “housing first” along with racial equity and both of those really hinge on self-determination. We want folks to be able to choose the types of neighborhoods they want to live in. That are close to their loved ones, close to transportation, the grocery store, to their health care resources. But what we were finding as we really dug into our data, was that people were being clustered in the same neighborhoods that have historically been red-lined and disinvested for decades and decades in Chicago. We alone as one program aren’t going to solve for that problem but we brought that concern to the larger governance council and the Chicago Department of Housing and said we want people to live everywhere in the city, but we want them to have meaningful choices, and we know that we’re not able to offer the same number of units in certain northside neighborhoods as we are in, say, Austin or South Shore. Continuing to have folks clustered in the same neighborhoods is not ideal. If that’s what people are choosing – wonderful. But we know that without that actual choice, that it isn’t necessarily realistic. So, what we are trying to do is set meaningful and achievable goals for increasing the number of units we have in what we’re calling “opportunity neighborhoods”. Ones that have lower percentages of poverty and lower percentages of violent crime, which generally are also correlating to places that have other types of resources. That’s an effort we have going this coming year, especially as we launch a variety of new programs.

You also mentioned the really disturbing disparity that exists within the homelessness system in Chicago where upwards of 70+ percent of people experiencing homelessness identify as Black, despite only representing about a third of the City’s population.  We’ve been tracking that since day one to ensure that the folks coming to the Flexible Housing Pool are representative of the larger homeless community so that we are starting there but then also throughout their experience in the program that they are not falling off and disparities aren’t developing in different steps in the project.  Like, once we find them, do they actually reach housing?  Do they stay in housing once they enter the program?  And I can say with pride and confidence that we don’t see those disparities developing.  So about 80 percent of participants that we serve that identify as Black or African American, which should be the case based on what we know about the larger demographics of homelessness in the city. 

My understanding is that the program cost is about $125,000 per household per year, which includes:

– Outreach and engagement

– Pre-tenancy supports (e.g., assistance with initial housing assessments and housing applications)

– Tenancy supports (referrals to community-based services, transportation and connect to health and social services)

– A housing subsidy

– FHP Administrative costs

Can you share more on how this represents a return on investment for FHP partners and investors?

A quick point of clarification:  so, you’re about $100,000 too high.  It’s only about $25,000 per household, per year.  Which is still a lot, frankly, given what investors often are typically used to paying especially in the health care space.  But that $25,000 per year, as you mention, does cover a really wide spectrum of needed services from the time that someone is identified as being homeless and needing a housing intervention, all the way through helping someone stay housed.  And just to underscore one important thing, once people enter the Flexible Housing Pool, 98 percent remain stably housed for a year or longer. So once they come into the Flexible Housing Pool, they stay and remain stable, which is hugely, hugely important.   

In that sense, that investment is ensuring that a member or a patient or one of our neighbors has housing stability.  To me, there’s no price on that.  And, we know that we live in an environment where need to look at budgets, priorities, and costs.  And so, a way to think about it, especially, let’s say, for one of our insurance company partners, or managed care company partners; what if someone had 3 or 4 hospital stays over the course of the year?  What would those hospital costs average out [to be] for each stay?  What we hear, is that if someone ends up in the hospital, it can average about $10,000, roughly.  Of course, it can depend on medicines, procedures, things like that.  But, just alone, if we’re able to reduce even one or two of those hospitalizations, then the insurance companies have already saved money on that particular individual because they aren’t going to the hospital, especially for something that may not have been necessary in the first place, a condition that got worse because someone was outside on a day when it was -5⁰F with an additional -10⁰F windchill. Someone doesn’t need to have their toes amputated, and instead of being discharged from the hospital back to a tent, this person is going to their home.  And, potentially being discharged sooner because there doesn’t need to be long-term scrambling and planning for where a discharge can happen.  When someone has a stable address, it’s not hard to know where someone is going home to.   

What other positions (moral or fiscal) does FHP take to persuade institutions and systems to pay greater attention to clients they serve who experience homelessness?

To me the clearest answer to that is that housing is a human right. Everyone, no matter who you are, what you’ve done, where you come from, deserves a safe and stable home. To me that is a very clear moral imperative and one that we can’t say enough until we no longer have any of our neighbors sleeping out on the streets, on the el (elevated trains) or on park benches. To me it also speaks to the larger priorities that we have in society. We find money for an awful lot of things. Be it the City-level or at the national-level. To me the fact that we allow, that we tolerate our neighbors experiencing homelessness is part of a moral re-alignment that’s necessary for how we think about ourselves as individuals, but how, more importantly, we think of ourselves in community, and in community with others. Especially those that have been failed by our systems and have faced oppression, racism, and discrimination.

So the Flexible Housing Pool is here to say, “Come one, come all.  You are welcome here.  We’re going to help you find a home and we’re going to help you stay there, to help you get healthier, to reach your goals and to reach your potential”. 

Tell me what we can expect in scale and scope in 2023? 

So, I think there are three things I’m really excited about. The first is that we’ll be launching a Re-Entry Initiative for some of our neighbors who will be coming home from Illinois’ state prisons. These are folks who will be returning to Chicagoland, Chicago and Cook County, are going to need a place to stay and the Flexible Housing Pool is going to help them find those homes and to get back on their feet, and reconnect to people that they care about and to the places that were once familiar to them.

So that Re-Entry Initiative is going to serve between 50-100 people this year, and we’re excited about that opportunity. It includes a workforce component as well, working with the North Lawndale Employment Network, which has a deep history with the North Lawndale community and also working with folks within the re-entry space.  So that’s one thing that’s exciting. 

The second is in partnering with two of the state of Illinois’ Healthcare Transformation projects that are funded through the Illinois Department of Healthcare and Family Services.  Part of their charge is to think about delivering healthcare in a new way.  Those projects have decided that the Flexible Housing Pool is going to help them achieve that charge.  So, Wellness West, based on the West Side of Chicago and the South Side Healthy Communities Collaborative  are both going to be connecting with the Flexible Housing Pool, identifying members in their collaboratives that are going to be the best fit for the Flexible Housing Pool and working with us in the next year.   

Actually, just last week, when (U.S. Secretary of Housing and Urban Development) Marsha Fudge made a visit to Chicago to announce a $60 million dollar investment in homelessness, the Flexible Housing Pool was one of Chicago’s projects and one of the projects that I think helped our local application be especially attractive and competitive as part of the national review.  And so the Flexible Housing Pool is going to be connecting with a federally-funded program through HUD through the HUD Continuum of Care programs for another 100 households, and leveraging our existing experience and some of the resources we have towards this larger end.  So, a lot happening in this coming year, too, Kuliva.  Lots of exciting things and a lot more people to serve.  

Pete, thank you so much for talking with me today about the role of FHP in addressing homelessness, and improving health outcomes for the most vulnerable in Chicago. The links and resources you’ve provided today will be added to this podcast for our listeners.