As communities prioritize their highest-need people for permanent supportive housing (PSH), programs are finding that they need to have different staffing, different and more intensive services, and the involvement of outside service partners. Discuss ways to re-design services in PSH for higher-need participants; re-think how PSH units can be designed to allow for better monitoring and communal engagement for older adults and chronic substance users; and explore better service coordination and partnership across other systems.