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Homes for the Homeless

The new wave in getting people off the streets

Kate Silver

Paul Schafer sleeps under an A-frame sign that politicians use to show off their glamour shots or campaign slogans. He has a couple of pillows under there and usually some beer, and he survives. That's right—he doesn't live, he'll tell you; he survives. At this moment, on a Wednesday morning just before 8, the pudgy man with a reddish, innocent face has moved to a shadier spot on West Sahara near Jones, with his bronzed friend, suspicious-eyed Michael Earl. The two men sit behind a bus stop drinking tall cans of gut-rotting Steel Reserve beer. This is pretty much what they'll do for the rest of the day, save for Dumpster diving and maybe some panhandling. They're homeless alcoholics caught up in a cycle of destruction. They say they'd like to hold jobs. Judging by their condition, today would have been a good day to call in sick.


Passersby see them, but they don't really see them. They don't take in Paul's dirty blue jeans, his worn brown boots, his stubble, his longish brown hair or his lighthearted sense of humor. It's an uncomfortable portrait, these two sun-baked, dirty men who smell ripe and drink beer on a Wednesday morning. Most of society discarded them the moment they discarded themselves.











By the Numbers



From the study "The New York/New York Agreement Cost Study: The Impact of Supportive Housing on Services Use for Homeless Mentally Ill Individuals."


The study was conducted between July 1, 1989, and June 30, 1997, by Dennis P. Culhane, Stephen Metraux and Trevor Hadley at the Center for Mental Health Policy and Services Research, University of Pennsylvania. It tracked 4,679 homeless people with psychiatric disabilities who were placed in service-enriched affordable housing in New York. Researchers looked into use of emergency shelters, psychiatric hospitals, medical services, prisons and jails in the two years before and two years after being placed in housing.




FINDINGS



• A homeless mentally ill person in New York City uses an average of $40,449 of publicly funded services over the course of a year.


• Once placed into service-enriched housing, a homeless mentally ill individual reduces his or her use of publicly funded services by an average of $12,145 per year.


• Accounting for the natural turnover that occurs as some of the residents move out of service-enriched housing, these service reduction savings translate into $16,282 per year for each unit of housing constructed.


• The reduction in service use pays for 95 percent of the costs of building, operating and providing services in supportive housing and 90 percent of the costs of all types of service-enriched housing in NYC.


• The study also found that $14,413 of the service reduction savings resulted in a 33 percent decrease in use of medical and mental health services directly attributable to service-enriched housing.


• New York residents experienced fewer and shorter hospitalizations in state psychiatric centers with the average individual's hospital use declining 49 percent for every housing unit constructed.


• On average, shelter use decreased by over 60 percent, saving an additional $3,779 a year for each housing unit constructed.


• Data shows that over 70 percent of those placed remain in housing after a year, with an average stay of 17.9 months over two years.


• Use of emergency shelters dropped 85 percent from an average of 68.5 days per year per person to fewer than 10 days per year.


• Use of publicly funded acute hospitals, for both psychiatric and medical treatment dropped from 8.25 days to just 1.65 days per person per year.


• Use of Medicaid-reimbursed outpatient services almost doubled as a result of housing placement from an average of 31.1 days per person per year to 60.8 days annually


• Use of state prisons and city jails, while involving only a small portion of those placed in housing, both dropped precipitously by 74 percent and 40 percents respectively.




A white truck pulls up. They've been found. Noticed. Seen. The driver probably wants directions, Paul tells himself as he walks over to the vehicle. But no, it's Linda Lera-Randle El, a representative from that sliver of society that hasn't given up on them. She's discovered them while making her daily rounds through the city, searching for any of the area's homeless, who number almost 8,000, according to a recent count by UNLV and Clark County. The homeless advocate, who started her own nonprofit called Straight from the Streets, offers them water. "I know you're drinking beer, but do you want some water for later? Because that beer's going to tear your butt up." She's doubtful that they'll take it. She's wrong.


Linda, pudgy herself in green stretch pants and a stretchy green shirt, pulls her truck into a nearby lot while Paul puts down his beer and proclaims that, yes, it would be nice to talk to somebody. It's the first time in eight years of homelessness anyone's stopped by and given him anything. "Once you're out here you don't think anyone gives a rat's fanny," he says. He's friendly and has a soft, sweet nature. Linda calls a Nevada Health Centers team to come check the mens' blood pressure later and make sure their health is OK. She hands them food and juice, Chapstick, bus tokens and a phone card.


But when asked what he needs most right now to get him back on his feet and restore some stability to his life—which was upturned eight years ago when he found his mother dead and gave up on himself—he says he needs a place to live. "If somebody put a roof over my head, I'd be more than willing to work for it, do the job. Once you're out here it's a little difficult. It ain't no cakewalk, and it's not supposed to be. We do what we do to survive."


And right now, from the White House down to Las Vegas City Hall, the government's focusing on that very idea as the linchpin of an approach to ending homelessness in 10 years. The strategy's called "housing first" and will—ideally—place a key to an apartment in the hand of a chronically homeless person and then surround them with support services: doctors, therapists, food, clothing, job training and more. And, according to its proponents, it won't cost more than what's spent on homeless services, already. In fact, it will save money, they say, and can be funded simply by shifting existing funds. In some cities, it's already been effective, and it's worked on a small, private-sector scale here. "Housing first is not such a novel concept," says Randle El, who's been using a similar model for years, using private homes for people to stay in while they're getting back on their feet, or leading them to Clark County Social Services, where a voucher program can help them pay rent. "It is a concept that should have been incorporated years ago, but they kept building shelters, and those shelters were supposed to bring them in and probably stabilize people, and, much like a lot of programming and systems that were put in place, were probably supposed to be more temporary. Then they became more and more grandiose, and programming became more and more, and you end up supporting all the programming, and the people ... get lost in the shuffle."


What concerns her and others close to the matter is the government involvement, the funding shift and the idea that this is the newest focus to end homelessness—it's just not that simple, they say. Once the bureaucracy, red tape and ribbon-cutting ceremonies begin, some homeless advocates wonder, will people like Paul actually receive more shelter from real politicians than he does now, laying under their A-framed pearly whites?


It's mid-June, and Philip Mangano, the nation's homelessness czar, has come to Vegas. Part preacher, part carnival barker, part compassionate conservative, the suited man with a slick silver hairdo and sharp face, who once managed the group Peter, Paul and Mary, is speaking to locals during a state conference on homelessness. Mangano was appointed in 2002 by President Bush to head the United States Interagency Council on Homelessness, and he's decided that we're doing it all wrong. For 20 or 30 years, we've been managing homelessness, he says, and now it's time to end it. Mangano responds to the standard vocabulary of homelessness—phrases like "pandemic" and "national disgrace"—with the language of a business model. "Management agenda." "Performance-based investment that has direction." "Result-oriented." He spews them in evangelical style, gesturing wildly behind his podium in a ballroom at Fitzgerald's.


"Business as usual isn't working, is it? Is it? Can I get an amen here? This is the faith-based part of the program!" he testifies, before turning into Mr. Rogers: "Our mission and the mission of this conference is that every citizen of Nevada will be known by a single name: neighbor. And be treated as one."


The way to get these neighbors, he says, is through the housing-first strategy, and he has a bevy of numbers to support his solution. He recounts the study focusing on 15 chronically homeless people in San Diego. These men slept on the beach, ate in soup kitchens and, as far as anyone knew, led fairly inexpensive lives. Eighteen months later, the study showed the opposite: 299 visits to the emergency room, usually by ambulance, cost taxpayers $967,000. Add the cost of police, jail and emergency-shelter services and it amounted to $3 million, or an average of $200,000 per person. "That's pretty significant. That's tragic in its own right," Mangano says. "But the real tragedy was that these people were no better off."


The chronically homeless, those who have been without a home for more than a year or four times in three years, make up 10 percent of all homeless people but use 40 percent of the resources. The new focus would, in theory, surround them with all the services they need and a case worker to guide them. Mangano refers repeatedly to Einstein's definition of insanity—how, for decades, we've been repeating the same action and expecting different results. Now it's time to change the course of action. Forty-six governors have jumped at the thought of ending homelessness, forming councils or focus groups to study the issue, and 120 mayors have begun work on 10-year plans to end it—including Oscar Goodman, whose reputation with the homeless includes sweeps of encampments and a proposal to ship them off to a vacant prison in Jean. The mayor also speaks at the conference, emphasizing his desire to end homelessness and help those in need. But he also reiterates the statement he made years ago, regarding those of "sound mind, and sound body who don't want to work, want to panhandle, want to live a life where they affect the quality of life of us by urinating and defecating in our Downtown streets." Those he still wants to "get rid of—in a humane manner." But even with his attitude, and the fact that many of the homeless he's referring to are considered part of the chronically homeless population, the mayor showed interest in a 10-year plan to end homelessness, even making quips about how things move quickly here in Vegas, and that he'd like to focus on ending it in five.


It sounds so simple. You remove homelessness by handing out homes, or at least access to a home. Not shelter beds, not blankets and soup. Real dwellings. In an ideal scenario, that leads to stability, pride, a place to shower and an impetus to get and keep a job, to get clean, to rejoin society. Of course, nothing's that simple. This is a relatively new approach and a population of complex people, bringing with them endless variables. For many area homeless advocates, the housing-first initiative actually raises more questions than it answers. "The devil is in the details," said two people who work closely with the targeted population.


Those details still need a lot of hammering. Though the city and county have expressed interest in heading in this direction, questions remain as to whether it's the best solution for Las Vegas, and whether it's even feasible. Take the day-to-day practical issues that arise, like the housing market. Real estate is at a premium and low-cost housing is practically an oxymoron. While it's difficult to imagine area developers jumping at the opportunity to house the homeless, Darryl Martin, director of Clark County Social Services, says there has been some interest, but he's still concerned about finding the right fit.


"You know, that's another huge issue with housing we have here, because there really isn't a lot of inexpensive land that you can build any type of unit on," Martin says. "These things are costly, so we're talking probably moderate rehabs on some buildings and things of that nature. And it's an issue of finding the developers or finding a nonprofit if they want to take the risk and step out and do that."


And once they do? Not in my back yard. Look at the recent reaction to the psychiatric hospital at Jones and Oakey, and to adding more homeless services to the corridor. In both cases, residents vigorously objected. The Valley's NIMBYism isn't going to lay low at the prospect of bringing together the chronically homeless and housing them in a neighborhood. Martin knows that and prefers the idea of spreading out the housing, with two or three units in apartment complexes across town. That way they can get away from zoning issues and, hopefully, fearful neighbors.


Once the external problems are sorted out, there are pressing internal issues, like drug and alcohol testing. It's difficult to conceive of a federally funded program that will be lenient on addictions, or taxpayers who would be willing to see their money go toward someone who's openly using drugs. Daniele Dreitzer, director of Henderson Allied Community Advocates, or HACA, which provides food, clothing and other resources to the homeless, worries about funding shifting away from other homeless programs, places that help families and give transitional aid. Bush has already announced plans to cut Section 8 housing aid. She's also concerned about the rules that will be placed on a population that often bucks against such things.


"I think it's very difficult to house people with absolutely no strings attached and no rules. And if you have to have rules, somebody's going to break the rule, and then they're going to be on the street," Dreitzer says. "It's such a complicated issue, homelessness. I think a lot of times it's painted as this very homogeneous population, and it's so not. You've got people with severe mental illness who are paranoid delusional for whom the idea of being around anyone else, especially a government entity, is literally enough to push them over the edge."


Down the street, at St. Timothy's Episcopal Church in Henderson, the Rev. Lloyd Gary Rupp sits in his office, next to a sign that says "Working for the Lord doesn't pay, but the retirement plan is out of this world!" Lloyd spends time at the Poverello House, which allows homeless people to have a day's respite inside, showering, eating and relaxing off the streets. He explains that he's concerned about creating more cracks for these people, who've hit rock bottom already, to fall through. He's worried about property prices, about shifting funds and about bureaucracy.


"My take on [the conference] was it's another federal program, it's another way of trying to do something. Housing first as an initiative, you put them in housing then you provide services. We have traditionally provided services, and then one of the services is housing. So the emphAsis is on a different syllAble," he says, mispronouncing the words for effect. "That's all we're talking about here. And, you know, I hope it works. I hope it works for the country. But will it work in Southern Nevada? A number of us don't really think it's what we need here." The Rev. is more interested in the simple things: showers, Port-A-Potties, and making health care more available, than another program run by the government where much of the funding goes to administrative costs and not those in need.


Still, everyone interviewed for the story agrees that what we're doing now isn't working. "We all need to work together," says Brenda Dizon, executive director of Shade Tree. "The amount of money is not increasing, yet the demand for services is. If we accept funds to provide a certain service, then we need to be accountable [and provide those services]." Adds Regional Homeless Coordinator Paula Haynes-Green, "I suspect it's not a magic bullet. I suspect we will hear some downsides. But we know one thing: Having people live on the streets of the richest nation in the world has no upside."


Housing-first programs have been effective in cities like San Francisco, Columbus, Ohio, and New York. Janelle Simmons works as the director of development and communications for the Community Shelter Board in Columbus, an organization that in 1997 began working with the city and other nonprofits on a long-term plan to end homelessness. They came up with "Rebuilding Lives," a program to create 800 new units of permanent supportive housing for the chronically homeless. More than 370 units have been built to date.


One of residences, called The Commons at Grant, consists of 100 units, 50 of which are used for the chronically homeless; the others are low-income housing. Here, case managers help with issues like drugs and alcohol and mental illness. Health services are provided for them, on the premises. There's also a staffed resource center where residents use computers to find jobs, Alcoholics Anonymous classes are held onsite, as are literacy classes to help reintegrate this population into the community as they maintain a permanent place to live. Simmons says that in the year since the program started there, all units have remained full, with only two people leaving.


"In general, what the staff there tells us is that people do a complete 360 once they're in their apartment, because of the stability and the fact that people are taking an interest, and the resources are right there to help them instead of them having to go out and seek resources on their own. So there's a pride in where they live. People tend to clean up, whether it be alcohol, drugs; their appearance changes. There's a lot of different changes on the exterior that you can see, but also on the interior, to want to move in a different direction and to get their lives back on track."


On the streets with Linda Lera-Randle El, progress does happen, albeit slowly. And motivation can be washed easily away with a swig of Steel Reserve.


After talking with Paul and Michael for about an hour, Linda bought them fast-food burritos and hamburgers, gave them applications for food stamps, and just sat and listened.


Michael, who says he lives in a hole way out in the desert, is skeptical, suspicious of the whole housing-first idea. Wearing an American flag bandana, this veteran is smoking a cigarette while his friend Paul laughs at him. "Just another nail in your coffin. Ahhhh!" Paul yells. Michael shrugs off the criticism and demands to know what the housing agreement would be—something that's yet to formulate. "Well, as long as the government stayed off my ass," he says. "I've already been through the service. I had enough problems there. They'd have to give me some terms. There'd have to be some kind of terms on it." What Michael says he needs most right now is to sober up. He shakes when he stops drinking, can't sleep and needs help. Linda calls WestCare to see if they have any detox beds available. Though they don't, they set up an appointment for him that day. Less than excited by that display of promptness, Michael says he'll have to start tomorrow—he's already drunk. When Linda explains to him that being drunk is, essentially, a requirement, and certainly not unacceptable at a detox facility, he sits back to think about it.


Will he accept the help? Michael's just like anyone else out there, homeless or otherwise. You can surround him with services and support, but he has to decide whether to use them. That's the difficulty of things like free will, and the difficulty of succeeding in programs that help people who may or may not want to help themselves. Will he help himself today? Michael thinks about it; his eyes focus for an instant.


"Can I bring a six-pack?"

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