Organizations working to support homeless individuals can improve their effectiveness by partnering with other service groups, according to a recent study from Rutgers University.
"Our paper describes how homeless services and health care providers are working together to tackle the challenge of providing healthcare to the unhoused," said Joel Cantor, director of the Rutgers Center for State Health Policy and Distinguished Professor at the Edward J. Bloustein School of Planning and Public Policy. He is also coauthor of the paper published in The Milbank Quarterly.
"With the right organizational and financial arrangements, organizations are demonstrating that it is possible to make effective use of limited resources," Cantor added.
The study comes amid concerns about potential delays in federal assistance for people experiencing homelessness. Advocates have warned that such delays, along with changes in harm reduction strategies, could impact approximately 770,000 people nationwide who are unhoused, including around 14,000 in New Jersey. People without stable housing face higher risks for infectious diseases, injuries, overdoses, violence, and premature death.
Although the research was conducted before recent federal policy changes took effect, Cantor believes it can guide organizations seeking ways to adapt their approaches.
There has been little academic focus on how housing and health care organizations work together to serve those without homes. To address this gap, Cantor and Michael Yedidia—also a research professor at the Center for State Health Policy—conducted structured interviews with 14 administrators and 10 frontline providers across eight New Jersey programs that combine housing and health services. These interviews were carried out between October 2023 and July 2024.
Programs included in the study had to show significant involvement from both health and housing organizations. Participants were identified through extensive outreach efforts. Each interview lasted about 75 minutes and covered topics such as motivations for collaboration across sectors, strategies for maintaining partnerships, operations management, and funding mechanisms used across institutional boundaries.
Cantor explained that while only 24 interviews were conducted overall, "the participants are representative, not in a statistical sense, but in a qualitative sense of what's going on in this field."
Analysis revealed several successful approaches for overcoming differences between organizations' cultures, missions, and financing structures. Collaborations worked best when they matched client preferences with realistic options; maintained frequent interaction between partners; or offered co-located health care within housing facilities.
Meeting clients where they are proved effective as well. "Asking someone who hasn't been able to shower for weeks to come to a clinic isn't going to work," Cantor said. "Having nurses available in shelters is far more effective."
Partnerships often arose from recognizing how much housing affects health outcomes—and from seeing that treating medical needs without first addressing homelessness is costly and less effective. As one hospital program director stated: "There's not much you can do if someone doesn't have a place to live as they're struggling with their own depression or anxiety or serious mental illness."
Despite these insights into what works well when coordinating services across sectors, challenges remain—including ongoing shortages of affordable housing due to restrictive zoning policies or community resistance (sometimes called NIMBYism).
"The availability of affordable housing is a longstanding and growing problem for a variety of reasons—from restrictive zoning and affordability to the NIMBY factor – people not wanting facilities for the homeless in their neighborhoods," Cantor said.
Changing perspectives within healthcare itself poses another hurdle: "Health care providers are used to dealing with people who are deeply focused on their health," he noted. "If I don't have a place to sleep or enough to eat, how can I possibly think about seeing a doctor?"
Cantor concluded that continued collaboration will be crucial as resources become more limited: Effective partnerships help organizations stretch what they have while better meeting patients' needs where they actually are located.
