John Fallon spent years trying to help a homeless man whom we’ll call patient R, a paranoid schizophrenic and alcoholic who spent 21 years on the streets, in emergency rooms, and in the jails in and around Chicago.

The cost of arresting and re-arresting R, plus the price tag for his care at just two of the hospitals that he frequented, added up to more than $1.6 million. That’s about $72,000 per year.

“He had 26 inches of hospital records,” said Fallon, a program manager for the Corporation for Supportive Housing (CSH).

Supportive housing is supposedly specifically designed to help people like R stabilize their lives—it’s permanent, affordable rental housing mixed with services like drug treatment and mental health counseling. Yet even though he was a perfect candidate for it, R is also exactly the kind of person who often fails to get into supportive housing.

Since the number of chronically homeless people is still much larger than the number of supportive-housing apartments, most communities keep long waiting lists. But people like R move constantly, Fallon said. By the time they reach the top of one of these lists, they are often incarcerated or otherwise unreachable.

Also, some communities won’t accept potential residents who have been to jail or prison. Other supportive-housing developments require residents to be sober for a certain amount of time, a standard that many chronically homeless people are unlikely to meet.

As a result, most supportive-housing communities help chronically homeless people who genuinely need help, but who are slightly more stable than R, and are probably slightly less expensive to taxpayers. These people may have spent years in the shelters, but they are at least able to come to appointments, and when their names come to the top of a list, they can be found.

Fallon would like to change the rules. To help people like R, CSH has started a program called Frequent User Service Enhancement (FUSE). In New York City, FUSE has begun to track people who have both stayed in homeless shelters and been in jail at least four times over the past five years.

The FUSE program has identified nine supportive-housing providers in New York City, including industry leaders like Common Ground Communities, Inc., that are willing to house the people in the FUSE program. CSH followed homeless people like these from the jail on Rikers Island to homeless shelters and to detox programs, and eventually placed 80 of them in supportive housing over the last year.

So far, 73 of the 80 have stayed in the program, a retention rate of 92 percent, according to Ryan Moser, CSH’s program manager in New York.

Through the FUSE program, CSH hopes to show that not only is it possible to effectively target homeless people who have served time in jail, it’s also cost-effective, Moser said. The organization is now working to start FUSE programs in Chicago and Minneapolis.

Chicago nonprofit leads the way

Some supportive-housing providers worry that caring for homeless people fresh from jail is more than they can handle. But Thresholds Psychiatric Rehabilitation Centers, based in Chicago, has been succeeding with this population for 10 years.

“We work specifically with people coming out of jail,” said Jason Fujioka, director of public information for Thresholds.

The organization’s mission is to help people suffering from persistent mental illness. It provides both permanent supportive housing and services to people who have been hospitalized an average of nine times. Many have also spent time in jail.

Thresholds operates two communities that welcome people leaving the criminal justice system and provides services through its Thresholds Jail Program, which refers residents to a variety of housing providers.

The organization does not find that residents who have been to jail are any more difficult to serve than residents who are alcoholics or have mental illness, but have not served time. “We work with a lot of people whose lives have been disrupted,” Fujioka said. “I don’t think that there is one group coming through our system that is somehow different.”

Re-uniting families

New Foundations, a supportive-housing developer based in St. Paul, Minn., also welcomes people with criminal records at its Crestview Community. “They are just going to re-offend if they don’t get help,” said MaLoyce Bell, the nonprofit’s co-founder and program director.

New Foundations aims to help parents with a history of addiction and mental illness stabilize their lives and reconnect with their children, many of whom may have been in foster care.

This population tends to have some kind of criminal record. In fact, New Foundations used to take people straight from prison into its program, until funding sources like the Department of Housing and Urban Development and the Department of Corrections changed their rules to require that the offenders spend some time in homeless shelters before the funders would pay rental subsidies. It’s a rule that gets in the way of helping people, Bell said.

Despite that, New Foundations is still able to aid its residents. The retention rate at Crestview is 70 percent, incredibly high for people that are fighting addiction.

“We meet people where they’re at,” Bell said.

Patient R finally retires

Regardless of the efforts by groups like Thresholds and New Foundations, homeless people like R often don’t get the help they need. Although age and infirmity finally slowed him down enough for the system to catch up to him, R never made it into supportive housing. He now lives in a nursing home. While that’s not quite what Fallon had in mind, it’s still better—and cheaper—than staying on the streets. And Fallon ultimately has hope that he can reach others in time to do them even more good.