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Permanent triage in housing assistance

by Ethan Handelman, National Housing Conference

Less than one-third of those who qualify receive housing assistance.

The Washington Post’s recent story, “For many, D.C. housing waiting list offers little more than hope” made that reality a little more immediate by highlighting how the limited resources and resulting long wait have affected individuals like Ceola Lewis, who has been on the waiting list for 35 years, and Mary Hordge, who is 71, homeless, disabled, and still hoping for housing assistance.

The story also illustrated how perennial lack of resources can tie policy up in knots. To a very limited extent, scarcity of resources can impose discipline, but beyond that point, it leads to painful triage. Year after year of flat or decreasing funding (particularly when compared to rising costs of providing housing) has put housing assistance in a state of permanent triage, continually choosing among lesser evils. Some examples:

  • Absolute need vs. potential help. Triage requires choosing among those who need help. Do we help those whose need is direst, such as the homeless or disabled? Or those who are most likely to become more self-sufficient with a little help, such as employable workers who are temporarily displaced? Or those whose more claim feels undeniable, such as returning veterans? Few of us find refusing help to any of those people an easy choice to make.
  • Competing levels of triage. Federal policy imposes some triage requirements on housing providers, for instance by targeting 75% of housing vouchers to those with extremely low incomes. Local voucher programs also have some choice in creating preferences, for instance, for homelessness, victims of domestic violence, the elderly, or the disabled. Periodically, higher levels of need arise, such as the wave of returning veterans, that prompt calls for even further preferences. The layers get complex very quickly, to the point that “the [D.C.] housing authority can’t provide applicants with numbers, as their spots are constantly shifting on the list, based upon need” according to the Post’s story.
  • Long, complex lines. The continual increase in housing costs relative to incomes creates need much faster than turnover (as current recipients graduate from assistance) frees up assstance. As need continually outstrips available aid, the number of people waiting and hoping for housing assistance gets larger. Some housing assistance providers manage this through short-term waiting lists that open only when assistance is available, forcing periodic scrambles to wait in line or be disappointed. D.C. maintains a long-term waiting list, on which you can find folks like Ceola Lewis, who has been on the waiting list since 1975 but never high enough in priority to receive assistance. There isn’t a magic waiting list policy that can solve the problem—the confusion and complexity result directly from the scarcity of assistance.

Triage is inherently painful. Its only virtue is that it is temporary—at least, usually. For housing assistance, we need to find a way to break through the very loud public conversation on fiscal constraint to make a case for providing enough housing assistance meet the need. Otherwise, if we focus just on triage, we will fragment, focusing too much on narrow preferences and competing moral imperatives and dissipating our political strength.

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