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Carol and Rebel, two homeless people living in Santa Cruz. Photo by Chip Scheuer.

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.”

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Megan Carlson

    For more information on Permanent Supportive Housing and the 180/180 Campaign, visit http://www.180santacruz.org

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Linda Lee

    Permanent Supportive housing is a great solution.  You can’t be against homelessness and against housing for the homeless.

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Rick R

    I imagine that this article will spark controversy, but I am all for it.  I am tired of seeing really sick homeless people in our town.  I would rather see these people get the help they need and get off the street.  If we don’t do something, the problem won’t just go away. It will probably get worse.

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Sibley

    Thank you for writing about this topic.  In my view, it is unfortunate that the article tries hard to stir up dissent and over-dramatize the details.  I note that the County Board of Supervisors was recently unanimous in encouraging the local housing authority to create the voucher preference mentioned in this article.  While there are many controversies – in some cases justifiably so – about the degree and details of homeless services in Santa Cruz, I do not believe that this program has been one of them. 

    On the housing authority topic, the fact is that the “first come first serve” model on the surface satisfies our desire for some degree of fairness, but adhering only to that model is not in the public’s best interest in all cases.  As noted in the article, public dollars would go much further (not only for social services programs, but for all uses) if some significance is placed on the cost savings created, as the 180/180 program does.  That is just smart business.  Even so, that shouldn’t be the criteria in a majority of cases either – I think the argument can be made much more clearly than it was herein that the 180/180 campaign represents an appropriate component in a suite of better practices for getting people successfully out of homelessness.

    At the end of the day, surely it makes sense to be doing what has been proven elsewhere to work more successfully than what Santa Cruz County is currently doing.  For one niche group of people within the homeless population, the 180/180 campaign is such an example – and it saves the community net $ along the way.  As the economics professor stated – how could we not do it?  I hope this article isn’t a set back for that process of implementing what works here in Santa Cruz.

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Christine Sippl

    I appreciate Georgia’s beginning efforts to learn about and write about Permanent Supportive Housing as a proven best practice for solving long-term homelessness. As someone who has observed first-hand the long and challenging path taken by people who have been homeless for years to find, enter and keep housing, I have to tell you, that it is nothing like what Georgia has described. No one “gets handed a key, no questions asked, and all the support they need for the rest of their lives.”

    Just like you and me, people who are homeless have to figure out how they are going to pay for housing. Even if they have successfully navigated the long process over months, and sometimes years, to apply and qualify for a housing subsidy, everyone needs to figure out how to come up with a deposit, and If they are lucky enough to have a subsidy, they will pay 1/3 of their monthly income for rent, others pay much more. For people with multiple health conditions and disabilities and unable to work, that means they have about $500 a month for all of their other needs – food, clothing, transportation, utilities, health care supplies, emergencies, etc. They do get help to apply and wait for openings at community substance abuse programs, County mental health treatment, and can access medical care. A busy case manager will do their best to help people navigate through these cumbersome systems, coordinate our dis-functional health care system and make sure basic needs and safety are met. They will plan together for the best way to make sure that nothing puts this new valuable housing at risk. No one takes it for granted.

    In every community across the country, the mission of HUD-funded Housing Authorities is “to provide housing assistance for the community’s low and moderate-income residents.” But the reality is that until recently, because of their rather rigid systems and structures, local housing authorities have had a very difficult time ensuring that housing assistance is actually reaching the very lowest income, long-term homeless population in their communities. People who need the assistance the most and qualify for it, end up sleeping on the streets for years because they don’t have an address, can’t navigate the system, have multiple health and mental health issues that get worse and worse over the years, and they and give up. One of the most successful strategies of the national 100,000 Homes Campaign is to partner local housing authorities with local housing support services and to target this population, in order to correct this historical problem. Clearly our community needs this partnership as much as the next, and fortunately our Housing Authority has been very engaged in looking what they can do. There is a lot of hope right now to make a lot of progress.

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness claudia brown

    Often the best solutions to big problems are simple and straightforward (I didn’t say ‘easy’). 180/180 is one of those cases; getting homeless people into housing saves money and saves lives.  This is a proven, data driven approach to solving a problem that has sometimes seemed insoluble. Good job to all involved.

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Phil Kramer

    This article touches on one of the most compelling aspects of Permanent Supportive Housing (PSH); it is a more effective use of community resources, and less of a drain on the public purse, to house a medically vulnerable homeless person than to leave them languishing on the streets requiring expensive, general relief, emergency services. And, we already have a track record of success with PSH here in Santa Cruz County – we know it works, but with only 199 units administered throughout the county it’s not enough. We need to expand this successful program. To make this a reality requires a community effort, with participation from committed volunteers, and good-working partnerships with business, government and public service agencies. Both the VA and Housing Authority have worked closely with 180/180 to identify how best to connect this medically vulnerable, homeless population with supportive services and housing – we are grateful for their support.

    Much of 180/180’s success and legacy will be in improved working methods and streamlined processes with these very agencies. Many 100k homes participating communities have cut in half the time it takes to identify, qualify and house a vulnerable homeless person. We can do the same here in Santa Cruz County, thus saving time and money, with the ultimate benefit of expediting the street-to-home process for chronically homeless, medically at-risk, men, women and families. To learn more and find out how you can get involved go to http://www.180santacruz.org. 

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Don Honda

    This seems like one of those moral conundrums given in a high school class:  “Who to save if you only had one choice, with you in the lifeboat?  Your mother, your wife, your son?”  Clearly it’s crass to apply this to a real-life situation, but we must.

    Does this program really become cost effective over time?  I ask this as this is one of the main pro arguments.  The article glosses over this point quickly.  Is it fair or moral to help this population before a well-deserving Housing Authority client, who is waiting in line, who may even die before they get their assistance?  Is it fair to give housing to this needy population without insisting that they must get rehab, attend counseling, take their medications?  Is it fair and moral to give a key to someone who doesn’t have the presence of mind on how to use it, while someone is waiting in the wings who needs just a little help to become more self-sufficient, and perhaps can be a benefit to society rather than a lifetime drain?

    We can talk about the concept of triage, who would benefit the most, with society also on the receiving end.  We can talk about who gets to decide this, and whether resources would be better used elsewhere.  We can talk about group homes or dormitory-style living for this special population.  We can talk about the tremendous support needed to maintain them and to supervise them.  We can talk about where can appropriate compassion be applied to do the most good for the most people.  We can talk about who receives this help, the truly hopeless, those who can’t even fish, or those who can learn to fish for themselves.  We can talk about helping only local people.  We can also talk about the power structure and bureaucracy already set up to make these decisions without any oversight.

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Michelle Spevy

    The SC Weekly should issue a caveat, if they plan on publishing any of these comments, that most of them are made by people involved with the local homeless service industry.

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness Xanthippe

    “Or are we providing free, no-strings-attached housing for the rest of their lives? (The answer is yes, we are providing that.)”

    So we’re getting these chronic hard cases off the streets, which extends their lives perhaps as much as 25 years.

    How does this save money again?

    Why should we save people who don’t care about themselves enough to provide even the most basic care for themselves?

  • http://www.santacruz.com/news/2012/07/02/doing_a_180_on_homelessness RealityCheck

    The problem with the studies that show a net savings is that they assume the average cost of incarceration, ER, etc. is a marginal cost.  Unless housing these people results in fewer jails built, fewer doctors, nurses, etc. being employed/paid, then there isn’t a real savings.  That may not be an issue for the advocates, but it is misleading.
    How will giving Walter an apartment stop him from crashing his bike while he’s drunk?  If they don’t clean up after themselves, does PSH pay someone to do it for them?
    As for Christine Sippl’s comments that “no one takes it for granted”, I find that hard to believe.  The law of large numbers says somebody will.