What Would it Take to End Homelessness?

The answer requires a multi-modal approach – spanning housing planning, community development resources, and personalized team-based plans of behavioral health care


Before the COVID-19 pandemic, more than half a million Americans were experiencing homelessness1. According to their January, 2020 point-in-time study, one third were people in families, one in five were chronically homeless, one in six were veterans, and one in six were homeless youth living alone1. Chronically homeless individuals have experienced homelessness for at least one year while also struggling with a disabling medical condition, physical disability, mental illness, and/or substance use disorder2.


Why do people become homeless?

By and large, homelessness is a symptom of poverty. People who cannot make a living wage, lack affordable housing, face an expensive medical emergency, or deal with the daily impacts of racial injustice and discrimination, are all most at-risk of losing stable housing.

MinimumwageCost of atwo-bedroomapartment
The numbers don’t add up

The average worker making minimum wage in America can’t afford a two-bedroom apartment anywhere in America. That is, unless they work 97 hours per week. Rising housing costs only add to the challenge. Monthly rent in many cities continues to rise and yet government funding for affordable housing hasn’t scaled to meet the need.

The burden of social inequalities

Race and ethnicity are significant factors of homelessness. Historically marginalized groups – such as Black and African Americans, Native Americans, Hawaiians, and other Pacific Islanders – are four to 10 times more likely to experience homelessness than white Americans.

Emergencies tip the balance

And, lastly, two-thirds of bankruptcies in the United States are tied to medical emergencies or expensive, chronic conditions. Last year, during the COVID-19 pandemic, 12 million Americans lost employer-sponsored health insurance, further compounding this issue of financial insecurity. 


A visit to the emergency room in 2018 set patients back an average of $2,000, the average outpatient surgery visit costs more than $5,000 – and these staggering health care costs rise substantially each year, according to a report by the Health Care Cost Institute3. People who lack an emergency fund to cushion the financial burden of unexpected health emergencies are at-risk of accumulating debt and, eventually, being unable to afford basic needs, including rent and food.

“We are patching up a leaking ship” 

That’s what Dr. Margot Kushel, a leading researcher on homelessness, said in a 2020 New York Times article, about providing homelessness services while ignoring the financial, housing market, and systemic racism that persist in society on a fundamental level4. 

Other factors, including behavioral health problems, domestic violence, and substance use disorders, also increase the risk of homelessness.

There is not a one-size-fits-all approach to ending homelessness. So, how do we prevent, and end, the complex, multi-faceted issue of homelessness?

From housing and employment, to behavioral healthcare and social supports – ending homelessness requires a full work-up of services that spans government agencies and departments. 

First and foremost, stable housing must be secured. Efforts to increase minimum wage and decrease housing costs for at-risk populations can help close the gap. But while homelessness is predominantly driven by economic forces, free or subsidized housing won’t necessarily solve the problem. Education, training, childcare, the availability of nutritious food, and access to well-paying jobs will help individuals and families sustainably avoid homelessness. 

Many people experiencing homelessness also face health challenges that require often-expensive medical treatments. Substance use disorders, mental health challenges, and chronic diseases, such as diabetes, obesity, and heart disease, deplete an individual’s ability to continue working and being able to afford stable housing.

Every person facing homelessness has a matrix of factors to consider and address. Each case requires a personalized plan of care that addresses long-term goals of self-sufficiency.

Wraparound behavioral and mental health care plans are intensive, team-based, and rely on a community of professional and natural supports. The care plan is often driven by individual perspectives from the individual, or their family members, and requires a high level of coordination among the case manager, individual, care team members, clinicians, and partner agencies – each playing an important role in a matrixed, goal-oriented care plan.

What Would it Take to End Homelessness?

How CaseWorthy helps agencies confronting homelessness:

At CaseWorthy, we believe that homelessness cannot be tackled in a silo. Taking a matrixed approach to building individualized homelessness care plans is essential — and we are here to help your organization manage complex cases with multiple variables.

Our HMIS software tracks individual clients and the services they receive through a continuum of care network – linking all of these variables together in one place for transparency, accountability, and ease of access. 

Want to learn more about CaseWorthy? Schedule a demo or talk to one of our case management experts today!

  1. Nationwide Point-in-Time Count. National Alliance on Ending Homelessness.  (2020)
  2. Defining Chronically Homeless Final Rule. U.S. Department of Housing and Urban Development (HUD). (2015)
  3. Health Care Cost and Utilization Report. Health Care Cost Institute. (2018)
  4. What would it take to end homelessness? New York Times. (2020)

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