photo by: Kim Callahan/Journal-World

The Amtrak homeless camp is pictured early Wednesday, Oct. 16, 2024.

Shelter stays, jail beds, ambulance rides and ER visits: Homeless people in Douglas County used more than $5 million of these types of emergency services in 2023, and the average per-person cost may have been above $7,000.

That’s according to a report released in October that the county compiled for the Kansas Housing Advocacy Network. It looks at records like jail bookings and hospital stays to try to determine how many people in those situations were homeless, and it also takes other factors into account, such as the Lawrence Community Shelter’s expenditures.

“The idea is that people may not realize that the homeless folks do use a lot of emergency services, and that those are costs that may not necessarily be borne if those individuals had permanent housing,” Douglas County data analyst Matt Cravens told the Journal-World. “It’s not guaranteed, but it’s probably a pretty good guess.”

To measure the impact of homelessness in the county, you sometimes have to be comfortable with “a pretty good guess.” It’s sometimes challenging to identify whether an individual using emergency services is actually homeless, and the report warns that there’s some imprecision in its cost estimates.

But advocates in Douglas County and elsewhere in the state say this is a step toward better understanding the costs — and eventually doing something to reduce them.

A look at the numbers

According to the county’s report, the range of costs of all emergency services used by homeless residents in Douglas County in 2023 was between $5.08 million and $5.88 million.

There’s an $800,000 gap between those two numbers, of course, so it might help to look at how the report does its calculations. The report notes that there is “significant uncertainty” in its estimates and that they “should not be interpreted as precise expenditures for unhoused individuals.”

First, we need the number of homeless people. The report assumes that 751 unique individuals were homeless in Douglas County at some time in 2023; that number comes from the county’s Homeless Management Information System and includes all people who moved in and out of homelessness throughout the year.

Then, county staff had to estimate how many uses of emergency services could be attributed to someone who was homeless.

To do this, the county used the addresses in service providers’ record management systems. But these can differ from one agency to another, and identifying homeless individuals in these records can be challenging.

For example, if someone is booked into the Douglas County Jail and reports their address as the Lawrence Community Shelter, that person is considered to be homeless for that booking. But if that same person instead provided a family member’s address to the booking officer, their jail stay wouldn’t be included in the estimates of emergency services used by homeless people.

Even with these obstacles, the county was able to determine ranges of costs for several emergency service providers.

The largest category of emergency expenses in the study was shelter services. These came from two main sources: the Lawrence Community Shelter, which spent $1.5 million on shelter services in 2023, and the Willow Domestic Violence Center, which operates two shelters for domestic violence victims and had expenses totaling $533,000 in 2023.

After shelter services, the next-biggest categories of expenses were ambulance costs and jail beds.

Ambulance costs for homeless individuals are listed at $1.31 million for 2023, and homeless individuals accounted for 11.3% of the total costs of ambulance services for all Douglas County residents that year.

Meanwhile, homeless individuals accounted for between 14.5% and 17.5% of all jail bed-days in Douglas County in 2023, and the total cost of these jail bed-days was estimated to be between $1.26 million and $1.51 million.

The report also lists cost estimates for emergency department visits and law enforcement arrests. These are in the six-figure range; the emergency department costs are between $331,788 and $808,894; and the costs of the arrests was between $148,992 and $214,528. Homeless residents made up between 1.4% and 3.4% of ER visits, but they were anywhere from 8.4% to 12.1% of people arrested in Douglas County.

With all of those costs factored in, we can get a range for the average cost of emergency services per homeless resident in Douglas County in 2023: between $6,767 and $7,831.

Reducing the need

At the same time as it was studying emergency service costs for the homeless, the county was also putting together a separate report about a nonprofit that’s helped lower those costs over the last five years: Artists Helping the Homeless, or AHH.

AHH provides an array of services to homeless individuals across multiple Kansas counties, including Douglas County. Here, it operates transitional and supportive housing options called Kairos House and Meraki House. The goal of these projects is to provide safe, sober living environments for people who had been homeless and help them meet needs like food, medication and transportation.

With these types of services to support them, Cravens said, the program participants spent less time in jail — meaning less money was spent to hold them there.

“Programs like Artists Helping the Homeless were found to reduce the average number of jail bed-days for the program participants by (nearly) 15 per year,” Cravens said. “That was comparing them to a control group of all the homeless people in the jail who didn’t go into (AHH).”

According to the report, although the AHH clients did not experience a meaningful decline in the average number of jail bookings per year, they did spend less total time in jail than homeless individuals who weren’t in the program. Clients of AHH who stayed at one of the houses for more than 30 days spent, on average, “14.9 fewer days in the Douglas County jail each year following the program,” according to the report. This reduction in jail time saves between $257,735 and $417,558 in jail costs annually, the report says.

Additionally, clients of AHH were expected to use fewer ambulance resources, for savings of between $78,328 and $132,072. On average, they had almost one fewer ambulance incident each year than homeless individuals released from the jail who did not participate in AHH.

“If you provide a housing opportunity like AHH, they are using less services, and that’s just better for their own mental health and well-being and also for the community,” Cravens said.

A statewide concern

The data on emergency service costs will be used by the Kansas Housing Advocacy Network, which is a partnership of organizations that work to address homelessness and housing instability in Kansas. It’s led by United Community Services of Johnson County and the Kansas Statewide Homeless Coalition, which facilitate homeless services in Johnson and Douglas counties.

Assistant Douglas County Administrator Jill Jolicoeur told the Journal-World that the network was advocating around the state for things like “housing investments, affordable housing, supportive housing” and “an alternative to spending money on emergency services.”

“Their hope is to use the analysis for Douglas County as an example of how these costs are showing up in one community in Kansas,” Jolicoeur said.

Christina Guidry, director of policy & planning at United Community Services of Johnson County, said her initial hope was to collect the emergency service cost data on a statewide basis. She said there are coordinated efforts in other states to help lower the cost of emergency services for the homeless.

“I was hoping that we could do something similar in Kansas, and we’re just not there yet,” Guidry said. ” … We have approached some other areas, and it’s just a ton of work for them to try to collect that data.”

Two projects that Guidry cited as examples of this kind of work were in Philadelphia and Denver.

In 2011, Philadelphia experienced a surge in opioid-related deaths, especially among homeless drug users, and in 2016 it launched a pilot program that placed chronically homeless individuals struggling with opioid addiction into supportive housing. After a year, 100% of the participants were still in stable housing, and over five years, 85% had maintained housing.

And Denver launched the Denver Supportive Housing Social Impact Bond Initiative to improve housing stability and reduce jail time for chronically homeless individuals who are frequently in the criminal justice system. The initiative targeted those with eight or more arrests over three years, offering them permanent supportive housing, rental subsidies and intensive services. After three years, 77% of participants remained stably housed.

“It’s something that we’re going to continue to work on, but we don’t have an easy answer the way that several cities have (nationwide,)” Guidry said.