Satisfaction with Housing and Services Among Formerly Homeless Permanent Supportive Housing Residents

Background: Permanent Supportive Housing (PSH) is a function of affordable housing and supportive services for adults experiencing homelessness. PSH has demonstrated successful retention and improvements in health, yet disparities in housing tenure and unmet need for health services remain. Satisfaction with PSH is associated with housing and service outcomes, however there is little empirical information regarding what aspects of housing and services residents are satisfied with, or not.

Methods: Surveys were conducted with PSH residents (N=386) living in PSH in Los Angeles County for one year. A short answer, open ended response question asked residents what housing or service related aspect of PSH they found most satisfactory and a separate question asked what aspect they found least satisfactory. A directed content analysis approach was used whereby open-ended responses were initially reviewed to identify themes. An inductive coding process was used to allow for expected and novel thematic categories. Three coders with experience in PSH settings separately coded and co-coded each response to confirm thematic categories. Frequencies for thematic variables were conducted using Stata 14.  

Results: Regarding housing, residents were most frequently satisfied with “the apartment itself.” An apartment offered a source of safety and security, which meant residents were “off the streets” and no longer faced with the “chaos of homelessness”, including the stress of securing housing and dangers of street life. The autonomy that accompanied an independent apartment brought “peace of mind,” allowing participants to live on their own terms, and come and go as desired, which was not possible while homeless. Although a physical space was unanimously satisfactory, residents were frequently dissatisfied with their buildings and building locales. Within the building, cleanliness and pests, inattention to maintenance issues such as “elevators that keep breaking down,” safety concerns surrounding neighbors’ risky behavior and “lack of building security” frequently reflected dissatisfaction. Building locales hindered access to services and loved ones, and increased tendencies to stay inside to avoid “all the crime in the neighborhood.” Regarding services, residents were satisfied with staff/providers, specifically those that demonstrated “they really care” by addressing residents’ service and maintenance needs. Staff/providers that were available and “reach out often,” improved residents quality of life and “boosted morale.” Although some residents were satisfied with PSH staff/providers, many participants were dissatisfied with them. Residents described staff/providers as disrespectful, confrontational, insensitive to their racial and cultural identities, untrustworthy, and “frequently changing.” These perceptions often negatively impacted residents’ service linkages and utilization, subsequently increasing unmet service needs.

Conclusion: Findings suggest a physical space to call home can serve as a meaningful solace and launching pad for PSH residents. Yet results also highlight the importance of offering safe spaces to adults experiencing homelessness, who have high rates of trauma and tendencies to isolate, as unsafe housing environments may exacerbate these issues. Results warrant training PSH providers in cultural competence and ethical service delivery, managing provider caseloads, prioritizing PSH building care and security, and decreasing the systemic practice of locating PSH units in marginalized, high crime neighborhoods.