Wait Time Disparities in Receiving Permanent Supportive Housing and Rapid Re-Housing Among Individual Adults Experiencing Homelessness: A Competing Risk Survival Analysis

Introduction: On any given night, an estimated 568,000 people experience homelessness in the United States. Individual adults experiencing homelessness (IAEH) are vulnerable to multiple adverse health and mental health outcomes. Considering that there are far fewer housing resources than people experiencing homelessness, innovative efforts at the community level are needed to end homelessness locally. The current community-based Continuum of Care coordinated entry system aims to end homelessness by connecting IAEH with local stable housing in a timely manner. Although homelessness service providers have raised concerns regarding potential housing prioritization disparities based on IAEHs’ protective characteristics (e.g., race and sexual orientation), correlates of wait time under the current coordinated entry system for IAEH to receive housing resources remain understudied. Using administrative data, this study aims to explore correlates of IAEH’s wait time to receive two major housing programs: permanent supportive housing (PSH; permanent housing with comprehensive services) and rapid re-housing (RRH; short term housing with supportive services).

Methods: We used deidentified Homeless Management Information System (HMIS) administrative data from 16 communities across the United States to gain a greater understanding about PSH and RRH wait times among IAEH. A total of 25,741 IAEH entered into the HMIS between 2015 and 2018. Wait time is defined as time between the date of IAEH’s housing eligibility assessment date and the date one exits homelessness via PSH and RRH. We used the competing risk survival analysis approach to investigate potential disparities (e.g., race and ethnicity, gender identity, and sexual orientation) in PSH and RRH wait time separately, while taking into consideration the presence of other potential competing homeless exits (e.g., family reunification and self-resolution), as an IAEH can only exit homelessness via one exit during any given episode of homelessness.

Results: This study identified wait time disparities to receive PSH and RRH among IAEH based on gender identity and race/ethnicity. Specifically, when taking into account the possibility of other competing homelessness exits, female IAEH (compared to male IAEH) have a lower probability of exiting homelessness via PSH and RRH over time. Additionally, compared to White IEAH, Black IEAH have a lower probability of exiting homelessness via PSH and RRH over time, while Multiracial IEAH have a lower probability of exiting homelessness via PSH over time. Study findings also suggest that highly vulnerable IAEH, IAEH aged 50 or older, and those whose current episode of homelessness lasted at least a year have a lower probability of exiting homelessness via PSH but are less so via RRH over time.

Conclusion and Implications: Consistent with community homeless service providers’ concerns, our findings suggest apparent disparities based on gender and race/ethnicity in the current PSH and RRH prioritization practices targeting IAEH. Female and minority IAEH are waiting longer period time to receive critical housing interventions, such as PSH and RRH after entering the homeless service system. Future housing prioritization strategy targeting IAEH may need to investigate and address potential housing assignment disparities identified in the study to address homelessness in an efficient yet fair way.