Priority Lists, Not Waiting Lists

Let us put an end to waiting lists for housing (or – gulp – shelter for that matter).

Let us replace those lists with priority lists.

Waiting lists, with some exceptions, are not designed to serve those with the deepest needs. They are designed to serve those that have waited the longest. But here’s the thing – if I have really deep needs it is entirely possible that I will die before my time comes up on a waiting list.

Imagine if emergency rooms took the waiting list mentality. Last night, Sally stubbed her toe. She goes to the ER and is told by triage that there is nothing they really do for a stubbed toe and that she should go home. Sally insists on waiting. This morning, around 6am, Bernie sliced his finger while making breakfast. He goes to the ER. Triage tells him they aren’t sure if he is going to need stitches or not. They bandage him up. They tell him to take a seat until a doctor becomes available. They tell him that if anything changes or gets worse, to come back to the triage window. Fred had a heart attack at 9am.

Sally is still waiting.

Bernie is still waiting.

Who gets served next?

Fred.

But why? Haven’t Sally and Bernie been waiting longer? Yes they have. But Fred’s needs are more acute than Sally and Bernie. If you don’t serve Fred right away he may die. Bernie can wait a little bit. Sally, well, she may want to be served and be willing to wait all day, but she doesn’t really need the ER services.

In just about every scenario, a reasonable person would expect the person with the most urgent needs to be served next. Except that isn’t how we tend to operate affordable housing, supportive housing, or intensive support programs. Even when there is modified chronological access (a fancy term for being able to jump the queue a little bit), it is rarely based upon acuity in its totality, but rather preference for a priority population that may not be grounded in evidence.

In an era of better assessments of client needs and coordinated access, I want you to rip apart your waiting lists. Delete them from your computer. Replace them with a priority list. Triage access to housing based upon who has the highest priority for that housing and the supports that come with it. Don’t manage access by who has waited the longest. That has nothing to do with who needs it the most.

Iain De Jong

About Iain De Jong

2 Responses to “Priority Lists, Not Waiting Lists”

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  1. Anonymous says:

    Good Day Ian, I really get what you are saying and I agree totally. However, what I am experiencing is that I do have a priority list, but here is the kicker. REPUTATION!! Sometimes my top priority clients are not the first to be housed because of their reputation in the area and landlords won’t touch them with a ten foot pole no matter how hard I try to get the landlords to rent to them. This means that Fred would have to die and Sally or Bernie will get housed. I cannot give up a rental unit because I can’t put Fred in there. Thanks and keep the blog going. I read them all the time and find them very useful tools.Have a great day.

  2. I get what you are trying to say, but your analogy is very flawed. All people who are homeless are suffering from something extreme – there is no homelessness that is comparable to a stubbed toe.

    I became homeless at the age of 21. The service providers all but ignored me because I was a young white male in seemingly good health. Years went by as I struggled unsuccessfully on my own to overcome homelessness. Every time I asked for help, I was told that there were people in more dire circumstances. Finally, at the age of 50, service providers saw me as vulnerable enough to provide me with some assistance. Longevity in homelessness should account for something, should be a sign to service providers that help is needed. Just how long should a person remain homeless before receiving assistance? After a decade? two decades? three decades?