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THE AGING HOMELESS RIVERSIDE COUNTY Homeless Management Information System Five Years in Review 2015 to 2019

Published December 2020 Pictured Above: Riverside County Adult Services Case Worker Melissa Torres assists client, Edwina Cockrell, with housing and other services in downtown Riverside.

ABOUT The Homeless Management Information System (HMIS) is an information collection tool that enables localized Continuum of Care (CoC) agencies to collect quantitative data on homeless individuals. Data collected includes demographic, subpopulation, and provision of housing and services. The HMIS system is updated throughout the year. This report summarizes five years of data (2015-2019) collected from Riverside County’s HMIS in the homeless subpopulations age 55 and older.

RIVERSIDE COUNTY

AGING AND HOMELESS

Solutions First

AGING INTO POVERTY Riverside County Rises to Meet the Need

AGING AND CHRONICALLY HOMELESS PAGE Aged Homeless Rely on Temporary Programs GENDER Trauma Widespread Among Homeless VETERANS Serving Those Who’ve Served AGING AND CHRONICALLY HOMELESS Aged Homeless Rely on Temporary Programs RACE & ETHNICITY Black and Brown Disproportionate Among Aging Homeless SUCCESS STORY

Operation Roomkey Unlocks Success

SERVICES FOR VETERANS Addressing Complex Needs

WHERE DO THEY GO More Stable Affordable Rentals Needed for Seniors SOLUTIONS

13 14

Teams Head Off Risks

SUMMARY

Partnerships Strengthen Data Sharing

RIVERSIDE COUNTY 2

AGING AND HOMELESS Solutions First

The face of Riverside County’s homeless population is growing older. The increase of elder homelessness locally and nationally is widely attributed to the aging of existing chronically homeless and those who are experiencing homelessness for the first time later in life. The complexity of their circumstances requires that planners and policymakers adopt multifaceted short and long-range solutions to address the medical, social, emotional and economic needs of those who are aging and homeless. The needs of the aging in our local communities are quickly mounting. In coming decades, the over-60 population in Riverside County is expected to burgeon by 250%, placing Riverside in the top five California counties with the largest older-adult population. Sustained economic uncertainty, a falling away of social supports and shrinking supply of affordable housing are putting a growing number of aging County residents at risk of homelessness. Those who have access to financial and emotional support are more likely to successfully transition from homelessness to a permanent housing situation. An Individualized and Comprehensive Service Plan from approved service providers—one that recognizes the unique interactions between chronic, co-existing age-related health conditions and the inherent trauma caused by homelessness and living on the streets is essential and must include: Integration of community-based healthcare that provides linkages to stable, permanent housing Access to specialized aging services that include crisis assistance, substance-use treatment and community-based services supported by a strong network of partners that understand the need for individualized, one-on-one engagement and service provision Multidisciplinary service teams that can identify underlying issues and help homeless individuals navigate ‘one stop’ access that promotes completion of necessary treatments and programs Financial support and access to nutritious meal services, daily living activities, transportation, employment and community-based activities to increase social engagement and reduce isolation. Housing support that allows tenants to ‘age in place’ to overcome barriers of signifi- cant challenges related to personal care assistance, limited mobility, or cognitive decline, to reduce the incidents of first-time homelessness due to these causes. By adopting short-term and long-term solutions now, Riverside County is positioning itself to head off a looming and costly public health crisis, serving as a national leader in solutions for the aging homeless and—most importantly—extending a vital lifeline to valued members of our communities.

One in 10 aging residents of Riverside County is impoverished. For each person age 50 and older experiencing homelessness, another is struggling to keep a roof over their head. The tolls of poverty, aging and homelessness are difficult to calculate in one life let alone thousands: each with a unique and complex story to tell. Risks of death and chronic disease accelerate by two decades in people living on the streets. A chronically homeless woman in her 50s, for example, is likely to suffer the same maladies as a woman in her 70s. More than half of the aging homeless population in Riverside County reports having at least two or more chronic medical conditions. Adults 50 and older who are homeless have mortality rates four times higher than the general population. Undertreated conditions such as hypertension, diabetes, and other comorbidities in the homeless are straining local health systems and costing the nation in excess of $5 billion annually. Their needs are growing and DPSS and our partners are uniquely positioned to serve the needs of the aging. One in four enrollments into Riverside County’s Homeless Management Informa- tion System (HMIS) between 2015 and 2019, was by a person age 55 or older. Ten percent of HMIS enrollments by the aging came through street outreach. When calculating the high costs of housing and healthcare, the poverty rate for River- side County seniors is at least five percent higher than the national average, according to the U.S. Census Bureau. A network of multidisciplinary service teams is addressing the trajectory of the County’s aging homeless through a multipronged approach that tailors services to the unique needs of each person. Recent successful initiatives such as Project Roomkey and Gov. Newsom’s 100-Day Challenge brought permanent housing and services to 108 homeless and at-risk seniors. However, the greatest challeng- es are ahead. Statewide, only 21 housing units are available for every 100 very-low income individuals. A dwindling supply of affordable housing and the arrival of the global coronavirus pandemic in March, have heightened housing insecurity and increased economic vulnerability for thousands of seniors in one of the nation’s most populous counties By keeping seniors at the forefront and participating in a network of comprehensive services, Riverside County-DPSS and our partners are ensuring long-term stability and safety for the aging and vulnerable. The five-years of data collected specifically about unique homeless individuals who accessed programs through Riverside County’s Homeless Information Manage- ment System (HMIS) cast a spotlight on the housing-related needs of a fast-grow- ing population. AGING INTO POVERTY Riverside County Rises to Meet the Need 3 RIVERSIDE COUNTY

1,495 people age 55 and older represented 16% of all the chronically homeless who sought housing support services in Riverside County between 2015 and 2019: chronically homeless is defined by the federal Department of Housing and Urban Development as being unsheltered for a year or more with a physical disability, substance use disorder, or serious mental illness. Virtually all the chronically homeless age 55 and over (98%) reported at least one disabling condition. While the aging and chronically homeless enrolled into permanent supportive housing with 15% more frequency than their non-chronically homeless counterparts, a majority still relied on temporary programs. Nearly two out of five were served most often at emergency shelters, followed by permanent supportive housing interventions, and then street out- reach. Mental health and professional service providers throughout the county are teaming up to conduct street outreach to those who are most reluctant to accept services. Drop-in-centers and peer-to-peer outreach programs also serve an important role in linking the chronically homeless to long-term services and housing solutions. AGING AND CHRONICALLY HOMELESS Aged Homeless Rely on Temporary Programs

FILTER TOTAL VS OVERALL HMIS Filter Total 2019 AGE 55 AND OLDER

Overall HMIS 10,213

HMIS Unique Clients HMIS Enrollments

2,046

14,046

3,656

Average Age

441

618

Chronically Homeless Disabling Condition

1,000

279

4,769

1,263

1,274

595

Veterans

VA Medical

713

352

2019 Data

RIVERSIDE COUNTY 5

Service and mental health providers are addressing multiple challenges of helping older men, and all genders, get off the streets and into permanent housing. Males made up about 70% of the senior homeless population in 2015, with their proportion decreasing to 66% of all aging individuals enrolled in HMIS programs by 2019. Social norms make it difficult for men of all ages to talk about their experiences, or to acknowledge the circumstances that contribute to their homelessness. Many are in denial about underpinning addiction and mental health issues. Service providers, medical, and behavioral health experts are advanc- ing trauma-informed care through comprehensive services for those who are wrestling with homelessness and housing insecurity. Recognizing and addressing emotional trauma is a critical important toward helping individuals with complex needs find a stable and healthy path forward. GENDER Trauma Widespread Among Homeless

Percent of Total

2017 Count

2019 Count

2018 Count

2015 Count

2016 Count

GENDER

1147

69.3%

1365

66.8%

1269

68.0%

Male

980

70.0%

1174

70.5%

505

30.5%

678

33.2%

596

31.9%

Female

491

29.9%

419

29.5%

0.2%

0.0%

0.1%

Transgender

Total

1656

100%

2044

100%

1867

100%

1401

100%

1594

100%

RIVERSIDE COUNTY 6

VETERANS Serving Those Who’ve Served

VETERANS VETERANS

626

Aging Riverside County veterans represented nearly one of every five unique individuals who enrolled into HMIS programs over the past five years. In 2018-2019 the number of veterans receiving medical care fell by 15%, indicating fewer homeless veterans are accessing health services. Ensuring veterans have access to permanent housing is a longstanding priority of the Board of Supervisors and Continuum of Care. In 2016, the County of Riverside achieved ‘func- tional zero, a recognition by the U.S. Department of Veterans Affairs that a well-coordinated and efficient community system is in place and that no veteran is forced to live on the streets. Locally, the Veterans Administration Loma Linda is working in collaborating with the Housing Authority of the County of Riverside, the Homeless Street Outreach Team and others in the Continuum of Care to assist homeless veterans off the streets and into permanent supportive housing.

587

596

532

481

2015

2016

2017

2018

2019

VA MEDICAL VA MEDICAL

414

375

353

241

148

2015

2016

2017

2018

2019

RIVERSIDE COUNTY 7

The Department of Veterans Affairs offers a continuum of services that include: outreach to veterans living on streets and in shelters who otherwise would not seek assistance; clinical assessment and referral to needed medical treatment for physical and psychiatric disorders, including substance abuse; long-term sheltered transitional assistance, case management, and rehabilitation; employment assistance and linkage with available income supports; and supported permanent housing. 1-877-424-3838 (VA’s toll-free hotline) Web http://www.va.gov/homeless

RACE & ETHNICITY Black and Brown Disproportionate Among Aging Homeless

RACE RACE

71.6%

1,465

White

21.8%

447

Black

American Indian/ Alaska Native

2.0%

Unknown

1.3%

Black, multiracial, Hispanics/Latinxs are more likely to experience homelessness than whites, according to the National Alliance to End Homelessness. Blacks and African Americans make up just 7% of Riverside County’s overall population, yet they accounted for one in every four unique aging individuals who accessed HMIS services over the past five years. In 2019, almost one in every four Aging Homeless Individuals in HMIS identified themselves as Hispanic or Latino, repre- senting a significant increase from one in five in 2015. Poverty is a strong predic- tor of the ability to maintain housing stability. More than one in five Black residents of Riverside County live in poverty. The 2020 coronavirus pandem- ic heightened health, economic and employment disparities in Riverside County’s communities of color. The Board of Supervisors responded in August by declaring that systemic racism causes persistent discrimination and disparities in housing, education, employment, transportation, criminal justice and health outcomes. Community builders, faith-based leaders, civic and nonprofit partners are developing culturally sensitive programs to address the diverse needs of local communities of color.

1.7%

Multi-Racial

0.9%

Asian

Native Hawaiian/ Pacific Islander

0.7%

ETHNICITY

1,562

76%

472

23%

Hispanic

Unknown

Non-Hispanic

RIVERSIDE COUNTY 9

Count Change

28 1 -2 7 -1 8 170 2017-2018 Count Change

Count Change

Percent Change

2019 Count

RACE

2017 Count

2018 Count

RACE

1142 2016 Count

2015 Count

16 0 9 -2 6 -12 161 2018-2019

-1 1 4 8 -2 -11 -8 2016-2017

72 1 4 0 0 18 170 2015-2016

White

3.7% 0.0% 36.0% -10.0% 66.7% -31.6% 12.3%

6.9% 2.5% -7.4% 53.8% -10.0% 26.7% 15.0%

-0.7%

17.5%

1465

1304

1134

972

404 39 23 5 12

332

447 41 34 18 15

431 41 25 5 12

-0.2% 2.6% 17.4% 160% -16.7% -26.8%

403 40 27 13 10

21.7% 2.6% 21.1% 0% 0% 78.3%

Black

American Indian/ Alaska Native

Multi-Racial

Asian

Native Hawaiian/ Pacific Islander

Unknown

2046

1868

1657

1666

1401

Total

Count Change

Percent Change

ETHNICITY ETHNICIT

472 2019 Count

391 2018 Count

305 2017 Count

291 2016 Count

264 2015 Count

81 2018-2019

86 2017-2018

14 2016-2017

27 2015-2016

Hispanic/ Latino

28.2%

20.7%

10.2%

4.8%

1354

-1.4%

-19

1562

9.5%

100

1335

127

6.8%

1127

Non-Hispanic/Latino

20.1%

227

1462

10 1401

15 1868

-4

Unknown

110.0%

-3

-2

21 1666

17 1657

12 2046

-11.8%

-20.0%

-19.0%

Total

2019 Data

RIVERSIDE COUNTY 10

SUCCESS STORY Riverside County launched Project Roomkey in April 2020 to rapidly shelter homeless individuals and help slow the spread of the coronavirus. The coordinated effort between state and local governments to house vulnerable residents in hotel and motel units brought lessons to providers countywide. Members of the Continuum of Care (CoC) helped house more than 700 at-risk individuals in the first weeks of the coronavirus pandemic as part of Project Roomkey. In May, Riverside County became one of just four California communi- ties to answer Governor Newsom’s 100-Day Challenge to transition dozens of vulnerable seniors from the emergency hotel and motel program into permanent housing, while providing wraparound services. Teams from DPSS, the Office on Aging, RUHS Behavioral Health HOPE Collabora- tive, and the Department of Housing, Homelessness Prevention and Workforce Solutions joined with CoC providers to transition more than 100 seniors into per- manent housing in the first 100 days. The collaboration continued and a total of 108 seniors have been permanently housed by the end of November, moving toward the goal of permanently housing all seniors identified in Project Roomkey. Communication, cooperation and collaboration have been the framework for Project Roomkey, enabling public and private agencies to develop a seamless and effective client-centered approach. Across the county, service providers are work- ing on agreements to streamline information and resource sharing to better serve clients in crisis. The project’s success led to a recent $10.5 million grant to contin- ue permanent housing solutions for individuals considered most at risk. Project RoomKey Unlocks Solutions

RIVERSIDE COUNTY 11

Riverside County housing, service and health providers are developing solutions that support the complex needs of the aging, economically vulnerable and those who’ve been chronically homeless. Between 2018 and 2019, enrollment into shelters by those age 55 and older increased by 60%. In 2019, four of every five enrollments into Homeless Prevention resulted in the senior client obtaining rental assistance. Nearly half of the seniors who exited Rapid Re-Housing did so for a rental by the client. By demonstrating innovation and data-supported decision making, Riverside became one of four California counties in 2020 to participate in the Governor’s 100-Day Chal- lenge to End Senior Homelessness: 108 seniors were placed in permanent housing by November’s end. The success positioned Riverside County for a $10.5 million grant from Project HomeKey, another initiative from the Governor’s Office, to devel- op housing for diverse populations including the aging LGBTQ communities. A net- work of providers countywide is strengthening and expanding the provision of com- prehensive services to help individuals live independently in apartments, boarding residential and skilled-nursing facilities that support their needs and conditions. Providers Collaborate for Solutions WHERE DO THEY GO?

RIVERSIDE COUNTY 12

Service Only 4% 55 Rapid Re-housing 4% 150 Homelessness Prevention 3% 114

Permanent Supportive Housing 17% 611

Transitional Housing 1% 41

HMIS Enrollment Entry By Project Type

Street Outreach 10% 372

Emergency Shelter 60% 2,210

362 2017-2018 Count Change

Count Change

-393 2016-2017 Count Change

45 266 4 -12 29 -23 -81 2015-2016 Count Change

Percent Change

PROR JAECCET ENROLLMENT

2018 Count

2019 Count

2017 Count

1408 2016 Count

1489 2015 Count

833 2018-2019

Emergency Shelter

35.7%

60.5%

-27.9%

11.8% 71.5% 2.4% -11.4% 100% -39.7% -5.4%

1377

2210

1015

Permanent Supportive Housing

426 638 171

16.1% 15.3% -18.0% -17.1% 42.0% 68.2%

-6.9% -44.0% 0.0%

381

611 372 150 41 155 117

656 664 150

-45 -292 0 -27

565 576 183

32.6% -9.7% 7.0% -11.8% -13.8% -25.7%

139 -62 12 -11

91 88

Street Outreach

372

Rapid Re-Housing

167

-33 -14

105

68 71 74

Transitional Housing

93 58 35

82 50 44

-39.7% 118.3% 58.1%

84 43

-8 -9

21 30

Services Only

Permanent Supportive Housing

3656

3060

2515

2829

2601

Total

RIVERSIDE COUNTY 8 I I 13

SOLUTIONS Multidisciplinary Teams Head off Risks

A growing number of Riverside County’s 2.5 million residents are at risk of becoming homeless. Poverty impacts one in every ten older adults, and one in five disabled adults between 18 and 64, according to the U.S. Census Bureau. These fragile populations represent a growing number of cases for DPSS Adult Protec- tive Services (APS). Without immediate solutions that include affordable, long-term housing tailored for the aging, their ranks in Riverside County will continue to grow. DPSS-APS is working with our partners to head off these crises. Collectively, we are strengthening housing supports and the safety net for our aging and disabled communi- ties. The new APS Crisis Response and Intervention Services (CRIS) unit plays an import- ant role by serving APS clients who are determined to be experiencing homelessness or at-risk of becoming homeless at time of referral. The APS-CRIS unit supports clients when traditional APS social workers determine that homelessness or housing instability are at the root of the crises they’re experiencing. APS-CRIS social workers offer clients intensive and targeted short-term interventions to prevent evictions. They help stabilize clients and offer short-term case management and housing stabilization. The APS-CRIS unit links clients with longer-term needs to providers and partners who advocate and expedite services on their behalf. A comprehensive multidisciplinary team (MDT) approach is crucial to providing solutions in short-term complex cases of home- lessness. DPSS also implemented the County’s Homeless Focused Curtailing Abuse Related to the Elderly (CARE) Team comprising of county partners in housing and home- lessness; coordinated entry systems; justice and law enforcement; behavioral health and others. The panel accepts referrals of complex cases to review and develops solutions that focus on best outcomes. We are forging innovative solutions with partners such as Office on Aging, Riverside University Health System and others to meet the needs of a population that has been made more vulnerable by the coronavirus pandemic ensuing economic instability and social isolation. While we are working to strengthen the safety net for these at-risk members of our communities, it is necessary to create a coordinated system of service delivery that focuses on long-term engagement, assistance, and support to seniors to address both immediate conditions and future medical and cognitive decline.

RIVERSIDE COUNTY 14

SUMMARY A Homeless Management Information System (HMIS) is the technology platform used by a local Continuum of Care (CoC) to collect, analyze and share service and housing data about individuals and families who are homeless or at risk of becoming homeless. The federal government uses HMIS data to target program funding and benchmark local progress toward the national goal of ending homelessness. Civic, faith-based and nonprofit partners in Riverside County’s Continuum of Care rely on HMIS data to determine the provi- sion of services and plan for future needs and advocate for funding for solutions. The CoC is a network of private and public sector organizations and providers that work closely to improve coordination and integration of services for those who are experiencing or are at-risk of becoming homeless. Three years ago, Riverside County and the Continuum of Care collaborated with UC Riverside Computer Science and Engineering Department to establish the Riverside County Health Informatics led by Dr. Paea LePendu. The project began as an effort to enhance data collec- tion for the annual Point in Time count. The partnership improved the quality of data and reporting on homelessness and this five-year summary of HMIS data is an outgrowth of that information and ongoing partnership. In spring of 2020, the Department of Public Social Services transferred responsibility of the CoC and the HMIS to the new county department of Housing, Homeless Prevention and Workforce Solutions: a one-stop shop for the homeless and those experiencing housing insecurity. DPSS continues as a committed partner in the CoC and as a strong safety net for families and adults. Our hope is that the five years of data reflected in this report will keep a sharp focus on the plight of thousands of Riverside County residents who are aging into poverty. We are grateful to all who continue to help meet the needs and strengthen services and supports for this vulnerable population. Thank you to our partners and stakeholders in the Riverside County Continuum of Care, RUHS Behavioral Health, Office on Aging, who continue to help stabilize individuals and families. Our special appreciation goes to Professor Le Pendu and the Riverside County Health Informatics Team at UCR, especially to recent graduate Ulyana Tkachenko, who served as lead in developing the HMIS Aging Homeless Dashboard outlined in this report. We look forward to the next decade of service to our senior population as we find solutions to the growing challenges of poverty and homelessness in our vulnerable aging. Partnerships Strengthen Data Sharing and Solutions

RIVERSIDE COUNTY 15 Together we are strengthening the safety net for these at-risk members of our communities. This report focuses on HMIS data limited to the Homeless Population aged 55+. For a broader scope of the data, highlights describing the combined 2015-2019 Homeless Aging Population to comparing with the overall HMIS population, regardless of age, are briefly listed below. 5,030 HMIS Unique Clients (11% of all HMIS Unique Clients) 1,493 Chronically Homeless (16% of all Chronically Homeless Clients in HMIS) 3,349 Disabling Condition (13% of all HMIS Clients with Disabling Condition) 1,370 Veterans (19% of all Veterans in HMIS) 764 Veterans Assistance Recipients (23% of all HMIS Clients receiving Veterans Assistance) 14,661 HMIS Enrollments (25% of all HMIS Enrollments) 7,499 Emergency Shelter Project Enrollments 2,639 Permanent Supportive Housing Project Enrollments

2,622 Street Outreach Project Enrollments 821 Rapid Re-Housing Project Enrollments 389 Transitional Housing Project Enrollments 363 Service Only Enrollments 328 Homelessness Prevention Enrollments

RIVERSIDE COUNTY SERVICES Dept. of Public Social Services www.DPSS.co.riverside.ca.us 24 Hour Adult Protective Services Hotline: 800.491.7123 CONTACT US

Dept. of Housing, Homelessness & Workforce Solutions www.harivco.org 1-800-498-8847 Office on Aging www.rcaging.org 951-867-3800

@rivcoDPSS

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