Carol and Rebel, two homeless people living in Santa Cruz. Photo by Chip Scheuer.
Monica Martinez, executive director of the Homeless Services Center, is not using her time efficiently. She’s committing an entire morning to Walter (not his real name), a very skinny homeless man with a bushy beard, leathery skin and a mumbly way of talking. She is taking him to the local Department of Veterans’ Affairs office to get him signed up for benefits, hopefully including a housing voucher.
“He’s entitled to veterans’ benefits but he’s not receiving a dollar from them. He’s never even gotten registered, because nobody’s walked him through the process. You know what?” Martinez lowers her voice, “I’m the executive director of this organization. The last thing I should be doing is taking a homeless guy to the VA. This is not a best practice.” And then she does something very odd for a person speaking about chronic, debilitating homelessness—she smiles. She smiles because she believes she knows how to end homelessness, once and for all. She smiles because, in the long run, she believes what she’s doing with Walter is very much a best practice.
Martinez cares deeply about homeless people, yes, but it becomes clear from talking to her that what she loves most is solving problems.
Martinez’s background is in something called Permanent Supportive Housing, which she describes breathlessly as “the ultimate solution.” It is a model for solving the problem of homelessness, and it is the backbone of a national grassroots effort called the 100,000 Homes Campaign. With this model, homeless individuals are put into housing—literally, “Here’s an apartment, here’s a key,” no questions asked—and wrapped in any and all supportive services they may need for the rest of their lives until they die, hopefully with dignity and indoors.
The national campaign aims to find permanent housing for 100,000 chronically homeless Americans—meaning people who have suffered long-term or repeated homelessness coupled with a disability—by July 2014. So far, the campaign has housed over 17,000 people. It has outposts in 130 communities, including Los Angeles, New York, Washington, D.C., Baltimore and San Jose. This May, Santa Cruz joined the campaign and committed to house 180 homeless individuals in our community.{pagebreak}
“We’re helping 180 individuals do a 180 in their lives,” explains campaign project manager Philip Kramer, a fit, affable man who got into this kind of work after over a decade spent in ad sales in New York City left him emotionally unfulfilled.
Last month about 100 volunteers kicked off the program by venturing out into homeless campsites at 4 in the morning and conducting a “vulnerability index.” They asked more than 300 homeless people what medical conditions they had, how long they had been homeless and other questions in order to determine who the 180 most vulnerable are.
To qualify as vulnerable, a person had to have been homeless for at least six months (though the average length of time homeless for the most vulnerable was eight years) and have at least one of the following conditions: liver disease, end-stage kidney disease, HIV/AIDS, over 60 years old, history of cold weather injuries, three or more Emergency Department visits in the past three months, three or more hospital visits in the past year, or tri-morbidity—a combination of mental health, substance abuse and chronic medical problems.
The team identified 155 people who met the criteria. “That means they’re vulnerable to dying on the streets,” says Kramer.
In a twisted way, these “most vulnerable” are also who the winners are—those who will potentially receive housing through the campaign.
Needy and Needier
Now that these people are identified, Project 180/180 has moved into its next phase—trying to get them into permanent housing. To do this, the campaign is asking for a very big favor from the Housing Authority of Santa Cruz County (or, as Kramer puts it, “We’re working really closely with the Housing Authority”). Project 180 is asking for the Housing Authority to set aside two Section 8 vouchers each month to this chronically homeless population.
Ken Cole, director of the Housing Authority, says there are currently 15,000 families on the waiting list for Section 8 housing. Fifteen thousand, he repeats.
Now take into account that only 40-50 vouchers are up for grabs each month. It’s so many families that Cole says the average wait time to get into a unit is four to five years. So many people are on the list that the Housing Authority had to stop accepting new applicants last year. Kramer, Martinez and company want not only to add 180 new names to the closed list, they want to bump them to the front of the list (at a rate of two per month) to guarantee these people housing above everyone else on the list who, by the way, is struggling too—that’s what Section 8 is.
This puts Cole and the Housing Authority in quite a situation. Martinez and Kramer, of course make sense. They cite relentlessly the homelessness census taken by Watsonville-based Applied Survey Research, which found that the average age of death on the streets is 49 years old. “If this was happening to any other population we’d stop dead in our tracks and go, ‘Wait a minute, something is wrong,’” says Kramer.
Still, to ask to have these people skip the five-years long line, that’s huge. The list in Santa Cruz County has always operated on a first-come, first-served basis. You’re dying of cancer? Sorry, you have to wait. No, really. Cole has literally had people die of cancer while waiting on that list. He has disabled people on his wait list, he has elderly people on his list, he has plenty of people on his list who are at-risk. So really, what’s extra-special, extra-needy about the 180? What’s different about a homeless guy like Walter and the guy on Cole’s list dying of cancer?
Well, there’s one really big difference: the guy with cancer is paying his own medical bills.
Doing the Math
Here’s the deal: this population, the chronically homeless—is really expensive to a community. They get arrested all the time because sleeping on the streets is illegal; they take ambulance rides to the emergency room (“An ambulance ride in Santa Cruz County is $1,000. Straight up,” says Kramer.); when they go to the hospital they stay for three or five days instead of the one day a person with a house stays, since the hospital has nowhere to release them while they recover. They don’t follow their prescriptions, so a couple months later they’re back at the hospital again with the same infection. Martinez says that out of the group of “vulnerable” homeless they have identified so far, 37 of those are “highly vulnerable,” and together that group of 37 has visited the ER almost 70 times in the last six months. The average cost of a hospital admission is $8,500. That’s almost $600,000.{pagebreak}
Housing this specific, chronically homeless population frees up money and time to devote to the rest of the homeless population, Martinez argues. There are about 2,700 homeless in the county, according to the homeless census, and a lot of them only needs things like meals, job training and a deposit check, and then they’re back on their feet. That’s the reasoning behind Project 180/180 and the Permanent Supportive Housing model—it’s this small population that’s sucking up most of the resources. Deal with them, and everyone else in the system can start getting the hand up that they need and be on their way.
Last month, a study came out of Los Angeles analyzing the Permanent Supportive Housing model as it was used on Project 50—an effort to house 50 of the most vulnerable, chronically homeless individuals living in the Skid Row section of Los Angeles. The study found that between 2008 and 2010, the housing program cost Los Angeles County $3.045 million but generated $3.284 million in estimated cost savings, mostly from fewer incarceration and medical costs.
This, the proponents of Permanent Supportive Housing argue, is proof that housing chronically homeless individuals and providing them with the supportive services they need is actually cheaper than leaving them on the streets.
UCSC economics professor David Kaun was gracious enough to look at these results for the Weekly, and had this to say: “These results are ridiculous. It’s so obvious it’s sad.”
More than 60 studies have been done nationwide on the Permanent Supportive Housing model, and they all come up with results like this L.A. study—no-brainer money savings.
“Even if we don’t care about these guys, we’re spending a lot of money keeping them outside, so we should care,” says Jennifer Loving, executive director of Destination Home, one of several organizations involved in the Santa Clara County arm of the 100,000 Homes campaign. “Housing 1000,” she says, has housed 27 people so far and is “rocking and rolling.”
Martinez says, “We have chronically homeless people in our community. That’s going to exist. We have two options. Option A is to apply a smart, evidence-based solution that saves money and saves lives. Option B is to say we’re not going to do anything. And by doing nothing we are saying by default that the hospital, the emergency room, the jails and our police officers are going to be the default social workers for these people. We’re investing the dollars either way.”
Cole says the Housing Authority will make a recommendation on whether or not to give Project 180/180 the two vouchers a month at their next meeting on July 25. Currently they’re in the thick of researching other communities who have housed people this way, such as Santa Barbara and Fresno. He says he is supportive of Project 180 in general but hesitant to open the can of worms that could, and likely would, come with changing the first-come first-served structure the Section 8 list operates with now.
“Other advocacy groups, community groups and special needs groups are going to come knocking on our door asking for a preference for their organization too. And we don’t want that to happen.”
Kramer says that the group of 180 alone deserves a preference because, until now, they’ve been overlooked, under represented.
“Look at Walter!” chimes in Martinez. “Walter’s not in line. Walter doesn’t have his paperwork all neatly filled out. And if we don’t do something Walter will be dead next year.”
“I know [Project 180 is] very eager,” says Cole. “We’re researching it.”{pagebreak}
Ounce of Prevention
In one YouTube video from the 100,000 Homes Campaign’s Phoenix chapter, balloons and a banner reading “Welcome Home Myron” adorn the door of a formerly homeless individual’s new apartment. Myron is trotted out wearing a starched shirt with an American flag lapel pin, but is unable to figure out how to put the key in the lock and turn it. A volunteer with a Coach purse gives a patronizing “Aww” and then, “Need some help? I’ll put it in, you turn it. How ‘bout that?” The crowd of about 10 breaks into applause and somebody yells “Woo!”
There are plenty of obvious questions a skeptic could ask about this program. Are we really going to move drug addicts who have been chronically homeless for 20 years into apartment buildings next to unsuspecting community members?
“But they’re not chronically homeless anymore!” Loving replies, and then laughs jovially.
Kramer says they didn’t ask about the criminal backgrounds of the homeless they surveyed, and he stumbles a bit over an explanation for why not: “We didn’t feel like it was—this really was meant to be a health survey.”
And then the ubiquitous jobs question: Will these individuals be expected to get jobs at some point? Or are we providing free, no-strings-attached housing for the rest of their lives? (The answer is yes, we are providing that.)
“The population we’re dealing with is so ill that if you listed the top 10 things that they needed today, a job would not be one of them,” says Martinez. “They need to get the infection in their foot figured out, they have a broken tooth, they have a warrant for their arrest for, like, not paying a citation from 1981, they haven’t slept in three days. We really need to rebuild these human beings before we can expect them to get a job.”
“There’s no stipulation that somebody move away from needing the housing. The idea behind Permanent Supportive Housing is that it’s permanent. This is very likely the place these people will stay for the rest of their lives,” says Kramer.
Martinez says Project 180/180 is relying on community volunteers to act as some sort of advocate (she hasn’t yet thought of a name for that role) for the individuals, visiting regularly and helping them figure out grocery shopping and basic grooming, maybe encourage them to go to substance abuse counseling. She’s confident community members will step up, as the project scored more than 100 volunteers for registry week in May. But registry week was a commitment of a few hours—now they’re asking volunteers to commit to the rest of a person’s life. It’s a tall order, especially if we’re talking about people who are so sick they can’t put a key in a lock and turn it.
There’s one more glaring question the studies—all of them over short-term periods and conducted in the last 10 years—fail to answer: Is this actually a cost savings in the long term? If the program is so successful that Walter lives to the ripe old age of 75, doesn’t that change the economic calculus here?
Maybe so. But economics professor Kaun says our country’s way of spending money is already so messed up, something needs to be done. “It’s always best to try and avoid the problem than to try and deal with it afterwards,” he says. “The way we deal with the homeless is the same idiotic way we deal with, quote, the prison population. Putting people in prison is so much more expensive than providing services and so forth, where a lot of these people could get help. The health system is the same. We pay 10 times as much to let people get sick and then cure them.” He sees Permanent Supportive Housing as a definite step in the right direction.
Deborah Elston, Founder of Santa Cruz Neighbors, says she thinks Project 180 is a “great, worthwhile program,” but isn’t sure it’s the be-all-end-all that Martinez and company think it is. “[The Project 180 team] is so involved in the program, that’s all they see. There are people that have been [homeless] for so long they really are going to have a hard time transitioning to be in housing,” she says.
Analicia Cube, founder of Take Back Santa Cruz, says she supports the program, and especially supports Martinez (“Isn’t she awesome?).
“We just have to put faith and hope that this is going to pan out correctly and it’s not going to be abused,” Cube says. “What other choice to we have? We can sit idle where we’ve been for fear of movement or we can go forward with some of these creative new ideas and hope for the best and give it our best effort.”
Martinez is confident that no hope is necessary—this program will work. “Permanent Supportive Housing works. It’s the national solution to homelessness. It’s in Obama’s plan to end homelessness.”
“If we don’t do something differently, Walter will be dead next year. He’s living a very hard life. He’s a chronic alcoholic. He’s been homeless for 23 years. He broke his shoulder last year because he crashed his bike while riding over the railroad tracks drunk. He’s just a mess. And we’ve created these systems he can’t navigate. So as a result he’s still living out there ready to die, and being very expensive, to be crass.”
