Housing First: Chronic Homeless or Homeless Families?

Posted: February 15, 2012 in homelessness
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In October of 2003, a cross-section of stakeholders from Nebraska attended a Federal Policy Academy in Denver, CO. The Policy Academy was one of several in which all States eventually participated. The purpose of the Academy was to assist States in developing “10-Year Plans to End Chronic Homelessness.” Nebraska’s resulting 10-Year Plan was titled “Nebraska’s 10-Year Plan for Increasing Access to Mainstream Services for Persons Experiencing Chronic Homelessness.”

Nebraska’s 10-Year Plan was unveiled in 2004 and was formally adopted by the governor-appointed Nebraska Commission on Housing and Homelessness. To ensured sustained and continued implementation of the 10-Year Plan, the Commission created a standing committee titled the “Ad Hoc Committee on Ending Chronic Homelessness.” The Ad Hoc Committee’s membership includes State inter-agency personnel, nonprofit housing and homelessness prevention service providers, and representatives of various consumer demographics. The Ad Hoc Committee serves as a State level version of the United States Inter-agency Council on Homelessness.

During 2010, the Nebraska Plan was revised to include five overall objectives. The Plan’s revised title is now “Completing the Journey: Nebraska’s Action Plan for People Experiencing Chronic Homelessness.” The Plan includes implementation objectives for the period beginning January 1, 2011 and ending June 30, 2012.

Chronic Homelessness

According to Homeless Emergency and Rapid Transition to Housing Act of 2009, the Federal definition of chronic homelessness is: “Individuals or families headed by an individual with any of the following: diagnosable substance use disorder; serious mental illness; developmental disability; post-traumatic stress disorder; chronic physical illness or disability; and/or co-occurrence of two or more disabilities.”

The Nebraska Ad Hoc Committee on Ending Chronic Homelessness believes that the path to ending chronic homelessness starts where people are at risk of being homeless and involves meeting people where they are with a place for supports and connections to occur.

http://dhhs.ne.gov/children_family_services/Pages/fia_nhap_nhapplan.aspx

From under a bridge to a home

Homeless for years, Mark Rettele lived in the most improbable places; His usual habitation was under the bridge near 36th and L. During that terrible winter of 2009-10 his friends had fled, leaving Rettele alone to survive on that concrete ledge through the snow and the cold. His way of life was getting old. And so was he.

Rettele is one of the “chronically homeless” — people who typically have a disability, an addiction or both and have been continuously homeless for more than a year.

Their needs and society’s cost have propelled a national push called “Housing First” that offers permanent supportive housing — apartments or assisted living with case management — to chronically homeless people without first requiring that they get sober, get healthy or have jobs. It reflects a thrust by the government to get chronically homeless people off the streets and, some skeptics point out, off homeless census counts.

Proponents say it can save lives and money. One recent study of formerly homeless alcoholics in Seattle reported a $30,000-per-person savings a year. Omaha’s Housing First was launched in October 2010. That’s when the city joined others in a campaign called 100,000 Homes, named after its goal of housing 100,000 people nationwide.

The campaign gives priority to the most medically fragile, and so an Omaha team works off a list built after a massive census of the homeless. Outreach workers canvass known hangouts or sleep spots for the homeless and try to find and keep up with those on their list. They try to persuade them to agree to housing, and then find a place for them to stay.

The team in 2010 surveyed 908 homeless people, identifying 520 as vulnerable under a measure that takes into account emergency room visits, presence of chronic disease, addiction, mental illness and occurrence of frostbite. Of those 520, 120 have been placed into housing in Omaha. Local advocates plan to analyze costs, but the Metro Area Continuum of Care for the Homeless couldn’t immediately say how much it had spent to get these 120 people housed.

They expect a savings, given national research shows that vulnerable people, once housed, are less likely to wind up in emergency room care or in jail. And their research indicates that reduced jail and ER time would save money. In 2008, the continuum looked at the costs of a one-night stay in an emergency shelter ($12.54), hospital emergency room ($2,156) and jail ($82 plus $179 for arrest costs).

Under the 100,000 Homes program, those housed get their own apartments; in some cases they go to assisted living with roommates. They also get caseworkers who visit regularly and offer support geared to make that housing stick.

What it takes to house the chronic homeless 

Heartland Family Service is paying Mark Rettele $500 monthly rent and utilities. It also has provided caseworker Lisa Rice, who estimates that she has spent more than 20 hours in the past three months on Rettele’s needs and about 20 hours before that trying to persuade Rettele to trade bridge life for an apartment. (And he’s one of her lowest-needs clients)

Rice met Rettele during that Housing First homeless census. At the time he wasn’t found vulnerable enough to immediately qualify for an apartment. But Rice kept her eye out for him during countless hours in South Omaha looking for other clients and trying to encourage more chronically homeless people to come inside.

For nearly a year he stayed off her radar — in part because of three hospital emergency room visits and five jail stints for misdemeanors ranging from having an open container to trespassing.

Then, in August she ran into him and updated his profile. He was back under the bridge. Turns out, that after his hospital stays, he qualified for housing. What surprised Rice was that he had registered for class at Metropolitan Community College.

Rettele trusted Rice and the two spent hours in her car driving around South Omaha looking for an apartment. The place had to comply with Heartland’s requirements of affordability — rent plus utilities couldn’t exceed $600 — and it had to have a landlord willing to take a chance on someone like Rettele with no job, no recent record of renting and a criminal record laden with misdemeanors.

They finally found a willing landlord and an affordable apartment in November and Rettele moved in with nothing more than some clothes. So a homeless resource team in Omaha provided a move-in kit that included trash cans, cleaning supplies, pots, pans and dishes and some other basics.

It’s a nice story, but there’s a tough reality of housing long-time homeless people with addictions, mental illnesses and other problems.

Mike Saklar runs the 340-bed Siena-Francis House in north downtown. Del Bomberger runs the Stephen Center in South Omaha.

Both shelters deal with really difficult cases that need the most support. Even when a chronically homeless person lives on the street, they tend to come back to the shelters for motivation, moral support, meals and pantries.

Homeless services here, as elsewhere, rely on government grants and private donations. One major federal grant has increased overall funding for Omaha from $209,000 in 2009 to $360,000 this fiscal year. But the emergency shelter portion is now capped at 60 percent. At least 40 percent of the formerly Emergency Shelter Grant, now called Emergency Solutions, must go to other long-term housing strategies.

Saklar and Bomberger have plans of their own to add “permanent housing” to their emergency shelter campuses. Siena-Francis House is building 48 efficiency-style apartments; Stephen Center has plans for a complex to house 14 families and 40 single people. The Open Door Mission in east Omaha opened 42 two- and three-bedroom apartments.

Saklar said his staff has had to retrieve formerly homeless people from off-site apartments because conditions became too unsafe. He said the apartments he’s building on campus will help his staff keep better tabs on their homeless clients.

Saklar said his shelter calls 911 at least once a day for what is often a seizure or heart problem.

“A lot of homeless people need 24-hour care,” Saklar said. “We see lots of people who have head trauma, heart problems, and they need medical care. You have to ensure they’re taking their meds daily. If someone like that is placed in off-site apartments, how do you do that?”

But proponents of Housing First say the alternative leaves some of society’s most vulnerable to street life, which is dangerous and expensive.

The 2009 Seattle study found that it was twice as costly to do nothing than to provide free housing to the homeless. Over the course of a year, participants in the Seattle Housing First program reduced their total costs by more than $4 million, compared with the year before they enrolled, according to results published in the April 2009 Journal of the American Medical Association. That amounted to a savings of nearly $30,000 a year per person when Housing First costs were considered.

In other words, it’s all about saving money. In the year they were on the streets, this population of homeless people with jail and hospital time racked up costs of about $43,000 apiece. But when fully paid apartments and on-site social services were factored in, costs dropped to about $13,000 per year per person.

What about families?

The U.S. Conference of Mayors 2010 Status Report on Hunger & Homelessness in American Cities in their annual assessment of 26 American cities tallied a 9 percent overall increase in the number of homeless families between September 1, 2009 and August 31, 2010. Fifty-eight percent of the cities analyzed showed an increase in family homelessness.

Based on this survey, on an average night, 1,105 family members are on the streets, 10,926 find refuge in an emergency shelter, and 15,255 stay in transitional homes. Trapped in this deteriorating economy, low-income families find themselves stuck in financial sinking sand and, although they have work, they must move out of their homes, and onto the streets because of low wages.

Of the 1.6 million children who are homeless each year in America, 42% are under age 6. Spending their critical early years in unstable housing, unhealthy environments, and chronic stress poses serious risks to a young child’s healthy development.

These are families that have lost their homes and don’t have the credit rating to get into another apartment and don’t have the savings to afford first- and last-month rent payments. Seventy-nine percent of the households with children accounted for in the U.S. Conference of Mayors Report claimed that the main cause was unemployment, and 72 percent declared lack of affordable housing. Homeless shelters will soon become overcrowded as more families are losing their homes. These are working families. They just don’t have the resources to put a roof over their head.

Families experiencing homelessness are under considerable stress. They move frequently and many are doubled-up in overcrowded apartments with relatives or friends. Others sleep in cars or send their children to stay with relatives to avoid shelter life. Once in shelter, families must quickly adjust to overcrowded, difficult, and uncomfortable circumstances. Despite the efforts of dedicated staff, many shelters are noisy, chaotic, and lack privacy. Homelessness increases the likelihood that families will separate or dissolve, which may compound the stress the family feels.

http://www.familyhomelessness.org/media/306.pdf

And yet so many the resources that are spent on the chronic homeless overlook families that are left to fend for themselves. On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, which includes $1.5 billion for a Homelessness Prevention Fund. Funding for this program included the Homelessness Prevention and Rapid Re-Housing Program (HPRP) that was designed to assist families facing homelessness.

HPRP ELIGIBILITY REQUIREMENTS

The first step in any HPRP program is determining if a household applying for HPRP assistance is eligible to receive assistance under HPRP. In order to receive HPRP-funded Financial Assistance and/or Housing Relocation and Stabilization Services, households must meet at least the following minimum criteria:

1. Initial Consultation & Eligibility Determination: the household must receive at least an initial consultation and eligibility assessment with a case manager or other authorized representative who can determine eligibility and the appropriate type of assistance needed;

2. Income: the household’s total income must be at or below 50 percent of Area Median Income.

3. Housing Status: the household must be either homeless (to receive rapid re-housing assistance) OR at risk of losing its housing. (to receive homelessness prevention assistance)

AND must meet the following circumstances:

a. No appropriate subsequent housing options have been identified;

b. The household lacks the financial resources to obtain immediate housing or remain in its existing housing; and

c. The household lacks support networks needed to obtain immediate housing or remain in its existing housing.

The criteria listed above are the minimum criteria set forth by HUD to determine eligibility for HPRP.  But HUD encourages grantees to examine local needs to determine if additional risk factors or other determinants should be used to determine eligibility.

Because HUD encourages grantees to use additional factors to determine eligibility, many families may not get assistance; even though they meet all of HUD’s requirements.

Living independently can be a lot harder for chronic homeless

Apartment life doesn’t last long for some accustomed to life on the street. A man similar to Mark Rettele was placed in an apartment that was a quick walk from a liquor store. The man resumed drinking and while taking a shower, he passed out in the tub. A building manager found him and called 911. So the caseworker came up with a different plan: an assisted-living center where drinking is not allowed. The man now has a roommate, eats community meals and is trying to stay sober. But just last month a reporter driving downtown on Leavenworth Street spotted him outside slumped on the sidewalk, and leaning against a building.

I have personally witnessed this same type of behavior in friends and family members who struggle with addiction. Some my wife and I have taken into our home when they were facing homelessness. Sadly, in most cases, the addict will return to the street rather than get sober.

Some of the chronic homeless helped by the 100,000 Homes program may try to change but it won’t be easy. In the three months that Mark Rettele has lived at his apartment on South 25th Street, he has endured a near-eviction and a break-in. Many longtime homeless people such as Rettele, who built friendships on the streets, want to help their friends and invite them in. But in Rettele’s case, Rice said, she had to tell him it was either keep your apartment to yourself or go join your friends on the street. Rettele is working on that problem. He told his friends, “You have to leave.” Rettele said.  “I’m not here to take care of everyone.”

I only wish that more families could get assistance from programs like HPRP and the 100,000 Homes program, but I guess it only proves that the squeaky wheel really does get the grease. Because while the chronic homeless may be the most visible and have the greatest impact on downtown businesses and services; the homeless families have become invisible – and yet you see them every day – in the grocery store; at the gas station; and at your children’s school.

For more information about homeless families visit http://www.familyhomelessness.org/

(Some of the information reprinted with permission from WORLD-HERALD STAFF WRITER Erin Grace) http://www.omaha.com/article/20120213/NEWS01/702139945

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