“I Don't like It but It's Okay”: An Ethnographic Investigation of Tenants Living in Permanent Supportive Housing

Background and Purpose: Permanent supportive housing (PSH) is an effective intervention to address homelessness. The majority of research that has investigated the process of transitioning from homelessness to PSH has been based in East Coast cities such as New York, Philadelphia, and Washington, D.C. There has been more limited investigation of tenant experiences on the West Coast.  Los Angeles, in particular, has the largest unsheltered homeless population in the U.S. and the highest geographical concentration of homelessness in Skid Row, which is exacerbated by the city’s decentralized urban infrastructure. Nevertheless, since 2011 Los Angeles County (LAC) has provided PSH to over 25,000 individuals. This study used ethnographic methods to better understand residents’ experiences as they transition from homelessness to housing in LAC. Specific areas of inquiry included how housing type and location, along with support services, affected residents’ experiences in PSH.

Methods: Thirty people who were living in PSH were recruited for ethnographic shadowing of their typical day and daily routines. All participants were part of a larger longitudinal study of adults transitioning from homelessness to PSH. Purposive sampling of the 421 participants of the larger study was used to ensure maximum variation of residents with different health risk behaviors upon entry into and three months after moving into PSH. Trained interviewers conducted over 90 hours of fieldwork with selected participants, using field notes and observation as the primary source of data collection. Synthesized field notes were used to create individual case summaries that were entered into a case summary matrix to facilitate thematic analyses (Miles and Huberman, 2011).

Results: Two dividing themes (i.e., geospatial and gendered differences) emerged in the analyses along with three unifying themes (i.e., family reunification, social isolation, and negative provider perceptions).  The geospatial theme refers to differences in the housing experiences between those who were provided an apartment in Skid Row versus elsewhere, with variants in experience due to housing type (scattered site vs. congregant). Gendered differences refer to a theme in which women tend to experience the transition into housing differently then men, specifically in terms of their view of self and self-improvement. A cross cutting theme of social isolation and how participants cope with isolation emerged as relevant to the majority of participants.  Family reunification refers to a strong desire by most participants to reunify with their family of origin once housed. Finally, a near universal theme of negative provider perceptions entailed a general disengagement and distrust of PSH providers once housed.

Conclusions and Implications: The themes that emerged suggest that PSH is a model that must be tailored based on factors such as housing location and type, individual health, mental health, and behavioral needs, and the occupant’s gender.  Specifically, perceptions of providers by participants may suggest a need for additional provider training or decreased caseloads in order to maintain better engagement and retention in care. Increased attention to social isolation and a renewed focus on community integration can help support residents in their transition from homelessness to PSH.