Permanent Supportive Housing as a Solution to Homelessness

Key Findings

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Permanent supportive housing (PSH) is one of the most promising solutions to reducing home- lessness for those with disabling conditions.
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PSH often faces hurdles to implementation because of community opposition and regulatory challenges.
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Engaging with communities around the implementation of PSH is an effective strategy for reducing the cost and time of development.

Homelessness in the United States has grown into a crisis. According to the United States Department of Housing and Urban Development’s 2022 point-in-time count, there were 582,462 individuals experiencing homelessness on a single day in January.1 Those with disabling conditions, such as a physical disability, substance use disorders, or behavioral/mental health disorders,2 are disproportionately at risk. Prior research in Boston found that in three-quarters of shelter stays in the city between 2014 and 2018, the person was recorded as having a disability.3 The susceptibility of this group to homelessness and chronic homelessness is partly because disabilities correlate with lower incomes and job insecurity, which pose a challenge to maintaining long-term housing.4 It is for this reason that permanent supportive housing (PSH)—housing that is paired with supportive services like voluntary counseling, treatment services, or case management5—is one potential solution for people with disabling conditions experiencing homelessness. 

In addition to providing services to residents, the units in PSH developments are intended to be long-term and usually only require tenants to pay no more than 30 percent of their monthly income toward rent.6 Evidence that the model is effective in reducing recidivism rates for shelter is growing: for instance, one study of four cities with PSH units found that after two years, 78 percent of occupants remained housed.7 Given these promising successes, why hasn’t PSH been widely promoted as a solution to chronic homelessness? As with workforce/affordable/lower-income housing, community opposition and structural barriers to development often hinder these kinds of projects’ effective implementation. This brief examines both the successful strategies and the challenges faced in implementing PSH in Massachusetts in the hope that these lessons will further PSH as a solution in other settings.

Permanent Supportive Housing in Massachusetts

The PSH model has been a point of investment in Massachusetts in recent years. In March 2023, the Healey administration announced $63 million in grant funding to support the production of 450 affordable housing units for very low-income people, part of which includes PSH investment.8 These types of awards, usually allocated to nonprofit housing developers, often supplement funding for an ongoing project. This recent award will fund projects that meet the needs of tenants with disabling conditions through case management, job training, childcare, and other supportive services.9 However, implementing this approach will face several barriers, particularly at the local level. 

Recommendation 1. Include people with lived experience in the siting process

To ensure that PSH efforts meet the needs of those they are designed to serve, it is crucial that potential residents are included in planning and decision-making processes (see Box 1). Interviewees who had experienced homelessness suggested that sitting on a service or advocacy organization advisory board ensured their thoughts and opinions were being considered in program development. The value of this group’s insight was also recognized by service providers, who identified such advisory boards as a strength. These kinds of boards empower people with lived experience of homelessness and service providers to create solutions that reflect the needs of prospective tenants.

Apart from the program planning processes, people with lived experience of homelessness should also be intentionally included within public hearing processes, which are often triggered by project proposals like a PSH development. Service providers and community development departments alike identified the efficacy of this strategy in easing local opposition in public hearings, where community members may voice, amongst other concerns, hesitancy to letting people experiencing homelessness in their communities. Humanizing the issue of homelessness and connecting the beneficiaries of a proposed development with community members offers an opportunity to address this conflict. Service providers can encourage people with lived experience of homelessness to testify at a public hearing. Providers can support potential residents in doing so by assisting in crafting a message and communicating what to expect at the public hearing. 

Box 1. Project Methods

In summer 2022, the Massachusetts Housing and Shelter Alliance (MHSA) hired me to work on a project aimed at identifying strengths, challenges, and potential improvements related to the siting process10 for PSH. I worked with the MHSA team to create questions focused on the social, economic, and political factors influencing PSH development at the local level and interviewed stakeholders across different populations, including homeless service providers/PSH developers, community development departments, and people with lived experience of homelessness. For the purposes of this brief, the term service providers includes providers who also act as PSH developers. 

Each of these groups had unique interactions with the siting process and their experiences informed the basis of my recommendations. In total, there were 14 interviewees, composed of five people with lived experience of homelessness, five community development departments, and four service providers. From these interviews, I identified 16 themes and 36 subthemes,11 some directly related to the process of siting PSH and others offering broader insight into shared experiences around homelessness and its solutions. Results of that work were published in an MHSA report, and findings are reproduced with permission here. 

Recommendation 2. Ease processes by building and maintaining community relationships

Given the potential for local-level opposition to slow or disrupt a PSH project, information sharing and relationship building with the community, early and often, play a key role in success. Service providers noted that the process of siting PSH worked best in areas where there was community buy-in and political will to implement such a project. However, service providers noted that this will was the result of sustained engagement and trust-building. Service providers who were active in communities—for example, by going to neighborhood meetings and events—established a presence on which they could rely to avoid outright opposition when it came time to propose a PSH project. Service providers also noted that building relationships with political leadership in the community helped garner support for a prospective project. Engaging with political leaders about homelessness by listening to their concerns and collaborating on potential solutions can create the political will to implement those solutions. This bodes well for PSH development which, when the time comes, may be better supported through the approval process. Establishing relationships with both community members and political leaders can create the environment needed to support PSH development.

Recommendation 3. Prioritize stakeholder collaboration

Service providers and community development departments both identified the importance of collaboration between different stakeholders in the PSH siting process. Interviewees noted that, for example, formal collaboration through a design review process saved time in moving a project through the approval process.12 This process involves the project development team and a local design review board, often composed of volunteers, such as members of the planning board, municipal staff, or elected officials. Communities that have and utilize the design review process with PSH developers can not only ensure that the project complies with local zoning and design regulations, but that the project’s timeline doesn’t extend through design amendments that come up in a project’s consideration process. Utilizing this process ahead of a project’s proposal will ultimately reduce the time it takes to be approved. However, it relies on the engagement and collaboration between community development departments and PSH developers. 

Another related recommendation is to create community working groups that tackle homelessness. These groups can act as a space for a wide range of community perspectives to be shared and can collaborate on local solutions to homelessness, ensuring that solutions holistically reflect the needs and desires of the wider community. Groups are typically initiated by a high-level local leader such as a mayor, who can work with advocacy groups or community. Groups can manifest as a task force, drawing membership from, for example: 

  • Local service providers
  • Representative from the regional Continuum of Care (CoC) 
  • Community organizations, like a Chamber of Commerce or religious organization  
  • Regional Community Action Partnership (CAP) agency
  • Local Housing Authority (LHA)
  • Local Department representatives (e.g., community development or health and human services)
  • Relevant board member representatives (e.g., planning board or ZBA)  

While this is not an exhaustive list, it showcases the wide range of perspectives that can collaborate through working groups in the community. 

Recommendation 4. Enhance regulatory opportunities for PSH

Community development departments highlighted the opportunity for PSH and affordable housing development to grow through revised zoning regulations, like inclusionary zoning ordinances. Inclusionary zoning ordinances, enabled by state legislation,13 mandate that a percentage of units in new housing developments be rented at affordable rates. However, affordability is usually reserved for those with incomes at 60 to 80 percent of the area median income. Units rented at this level are often unattainable for people with very low incomes or fixed incomes. For units rented at or under 60 to 80 percent of the area median income to be affordable, they require an additional state or federal subsidy. Developers leverage this subsidy to provide units that meet the definition of affordable while still earning a profit through market rate units. This dynamic can be seen in mixed-income developments, which the Massachusetts 40B law provides for.14 While these ordinances create opportunities for some, they fail to meet the needs of those with very low incomes. Local ordinances like this must be amended to meet the needs of all income levels, including those who rely on supportive services. 

In addition, regulatory barriers to PSH as multifamily housing developments can be intense. Cumbersome requirements like low-density regulations, excessive parking requirements, or access to public water and sewer must be amended to provide real opportunity for housing development. 

For people experiencing homelessness with disabling conditions, PSH not only offers housing, but the crucial services needed to remain housed. Yet it continues to face social, economic, and political hurdles to its implementation. The recommendations outlined in my full report, Siting Permanent Supportive Housing, aim to address these barriers by translating the experiences of service providers/PSH developers, community development departments, and people with lived experience of homelessness into practice. If we truly want to promote PSH as a solution to homelessness, then it needs to be supported as the promising solution it is. The barriers that exacerbate a project’s cost and timeline are fixable: we must do our part to fix them. 

  1. U.S. Department of Housing and Urban Development (2022, December 6). HUD 2022 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations. HUD Exchange.
  2. Office of the Assistant Secretary for Community Planning and Development (2015). Homeless Emergency Assistance and Rapid Transition to Housing: Defining “Chronically Homeless.” Federal Register, 80(233), 75971–75804.
  3. Hao, H., Garfield, M., Purao, S. (2022). The Determinants of Length of Homeless Shelter Stays: Evidence-Based Regression Analyses. International Journal of Public Health, 66, 1–10.
  4. Beer, A., Baker, E., Lester, L., Daniel, L. (2019). The Relative Risk of Homelessness among Persons with a Disability: New Methods and Policy Insights. International Journal of Environmental Research and Public Health, 16(22), 4304.
  5. Perl, L., Bagalman, E. (2015, December 8). Chronic Homelessness: Background, Research, and Outcomes. Congressional Research Service.
  6. Chiumenti, N. (2018). The Supply of Permanent Supportive Housing in Massachusetts: Comparing Availability to the Chronic Homeless Population. Federal Reserve Bank of Boston, 18(2), 1–31.
  7. Ibid. 
  8. Executive Office of Housing and Economic Development (2023, March 29). Healey-Driscoll Administration Announces Funding for 450 New Affordable Housing Units Across Massachusetts. Commonwealth of Massachusetts.
  9. Ibid. 
  10. From Siting Permanent Supportive Housing: “Siting refers to the social, economic, and political considerations developers must make to build housing. These considerations include having community buy-in, securing funding sources, and meeting local zoning and land use regulations (Scally & Tighe, 2015).”
  11. For a complete list of the themes/subthemes with their descriptions, please see Appendices A, B, & C in Siting Permanent Supportive Housing: Recommendations for Social, Economic, and Political Engagement.
  12. Design review is a tool used by some municipalities to ensure that a project’s aesthetic and structural characteristics comply with the community’s regulations and vision. See Municipal Research and Services Center (n.d.). Design Review. Municipal Research and Services Center of Washington.
  13. Note that not all states allow for this type of mandate; for instance, Massachusetts does, but New Hampshire does not. 
  14. The Massachusetts 40B law is an appeal process that mandates communities ease restrictive zoning regulations if a proposed development includes affordable housing and the community’s housing stock is less than 10% affordable. However, a proposed development only needs to have 20–25% of its units affordable, which creates room for market rate units. 
About the Author

Antonio Serna is a licensed social worker and has a master’s degree in public policy from the Carsey School of Public Policy at the University of New Hampshire. 


The author would like to thank the Massachusetts Housing & Shelter Alliance for supporting the original report on which this paper is based, and for their permission to adapt those findings for publication in this brief. The original paper can be found here. Special thanks to Sarah Wrightsman at New Hampshire Housing for her comments on an earlier draft, and to Ben Savard, Laurel Lloyd, and Bailey Schott at the Carsey School of Public Policy for copyediting, layout, and production support.