From homelessness to stability: The types of accommodation that make a difference

The Bottom Line

  • Homeless adults are at risk of illness, poverty, isolation, mental health issues, substance abuse and discrimination.
  • They have difficulty finding affordable housing, either because of financial constraints or because of the prejudices and stigma surrounding homelessness.
  • There are a multitude of approaches to alleviating and preventing homelessness. In addition to housing, several types of accommodation provide services and support in other spheres of life.

Around the world, nearly 1.6 billion people do not have adequate housing. In Canada, whether because of inflation or "renovations" (meaning an eviction that is carried out to renovate or repair a rental unit), many seniors are victims of the housing crisis and find themselves on the street and having to go to homeless shelters, often for the first time in their lives. Nearly a quarter of people sleeping in shelters are 50 or older.

Access to safe, stable and adequate housing is recognized as a fundamental human right and is essential to create the conditions for people to live healthy, safe and happy lives. Unfortunately, getting a temporary bed for the night is not enough: homeless adults need additional support and services to get their lives back on track, access the resources they need, especially related to their health, and achieving financial and housing stability.

What are the most effective accommodation approaches to breaking the cycle of homelessness?

What research tells us

A high-quality systematic review published by the Campbell Collaboration looked into this question. This review analyzed the results of 28 studies (combining 13,128 participants and divided into 51 articles) on the effectiveness of different accommodation approaches and their effects, in particular on housing stability and health.

A variety of programs and types of accommodation exist: the "housing first" approach, the "treatment first" approach (housing program conditional on abstinence, for example) or a combination of housing and case management programs. In other words, a bed can be offered for a short or long term period, with or without conditions such as the obligation not to consume drugs or alcohol or that of finding a paid job quickly. In addition to a bed, some types of accommodation offer a continuum of services ranging from referral to external resources to provide comprehensive and intensive care for people.

For example :

- the Housing First program offers housing with few constraints, as well as support and services. Social integration into the local community and engagement in positive activities are encouraged.

- rapid rehousing aims to provide housing as quickly as possible. Staff find available accommodation, assist with application, rent and move-in, and facilitate access to other services.

- the hostel is a short-term accommodation with strict rules. Support varies according to the resources available and consists mainly of practical assistance, for example in filling out forms or obtaining government documents.

- the homeless shelter is temporary accommodation where a bed is provided for the night according to certain requirements. Hot meals may or may not be offered. Staff can sometimes help to establish links with other services.

- supported housing combines accommodation and services. Housing may be permanent or temporary, with or without abstinence conditions, in staffed group homes, in the community or in a private unit. The services are individual and personalized: helping people with mental health or addiction problems, facilitating access to health services and social benefits, helping to pursue studies or seek employment, etc.

What works best?

Despite great variability in the quality of the evidence, the review reveals that:

- Individualized support without conditions is a winning formula for improving housing stability and health. Indeed, this type of approach reduces drug addiction, the number of days spent homeless, the number of emergency room visits and hospitalization days, and improves income.

- In fact, all types of accommodation that offer support, with or without conditions, are more effective than basic accommodation without conditions.

- Studies also show that providing only the basics, such as a bed and food, is sometimes worse than providing nothing at all.

Staff, financial resources and time have the most influence on the implementation of accommodation programs. Get involved, whether by joining the Canadian Alliance to End Homelessness, supporting local shelters or volunteering your time.

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Author Details


  1. Keenan C, Miller S, Hanratty J, Pigott T, Hamilton J, Coughlan C, Mackie P, Fitzpatrick S, Cowman J. Accommodation-based interventions for individuals experiencing, or at risk of experiencing, homelessness. Campbell Systemativ Reviews. 2021 May 18;17(2):e1165. doi: 10.1002/cl2.1165.

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