No longer homeless; Program helps clients, saves money, advocates say

Seth Rosen / Charlottesville Daily Progress
Published: February 10, 2008

Two summers ago Lindsay Esterly was trapped in the morass of chronic homelessness, quietly and anonymously living in the shadows of society.

The 31-year-old former Ph.D. candidate was spending her nights in the Salvation Army's homeless shelter in downtown Charlottesville. During the days Esterly would read or wander the streets, struggling with a crippling bi-polar disorder that prevented her from holding down a job. For three desultory years - from the streets of Charlottesville to Virginia Beach to Morgantown, W.Va., to South Carolina - she had slept in myriad emergency shelters, on friends' couches, in her car and, occasionally, in jails.

Today, Esterly's life is marked by stability and security, free of the harsh uncertainty of vagrancy. Thanks to the Region Ten Community Services Board, she lives in a spacious one-bedroom apartment off Hydraulic Road and receives a bevy of intensive services.

"Once you are stabilized you can set goals," she said, sitting at her dining room table. "When you are living in a homeless shelter it's hard to want anything other than housing."

Because of the relatively small size of the area's habitually homeless population - estimated to be between 70 and 80 - Region Ten officials and shelter operators believe it is feasible to all but eradicate chronic homelessness in the area. With a minimum of hardship, they say, local governments and nonprofits could marshal their resources and provide enough funding to rent apartments and hire counselors for every resident who continually lives on the streets.

"We can end chronic homelessness in Charlottesville in short order," said Mayor Dave Norris, who heads an interfaith group of congregations that runs shelters. "It's not that large a population and there are the resources here to do it."

Yet as the economy dips into recession and local governments are forced to curtail some services, officials concede that there will likely be less money to spend on such initiatives. Just last week the Charlottesville City Council voted, 3-2, against establishing a dedicated stream of revenue for affordable housing programs that would have been an ideal funding source, according to supportive councilors and advocates.

To homeless advocates, the vote against dedicated revenue is shortsighted. The brilliance of supportive programs, proponents say, is that they don't just help the homeless, they save taxpayers money.

"The accumulation of evidence across the country shows that housing homeless people who are chronically ill is both humane and makes economic sense," said Dennis Culhane, a social policy professor at the University of Pennsylvania.

The demand

In December, the City Council gave Region Ten $238,000 to bolster its supportive housing program, allowing the organization to provide rent to 12 to 15 individuals who have lived on city streets for more than a year, and to pay the salaries of two new residential specialists. The organization already houses 27 homeless people, but had hoped to add 20 more to the program.

"This is not meeting the demand," said Reed Banks, director of Region Ten's Mental Health Services. "The numbers we are dealing with are well beyond 50 and Region Ten is strapped."

In fact, the Thomas Jefferson Area Coalition for the Homeless estimates that there are about 250 homeless people in the area at any given time, and about one-third of them fall into the category of habitually homeless with either mental illness or substance addiction.

Using the Region Ten numbers as a guideline, it could take between $1.2 million and $1.5 million per year to house and provide services for nearly the entire chronically homeless population. If area governments and an array of charities chipped in, that is an achievable goal, homeless advocates say.

"I think the resources are there, but the effort hasn't been there to take care of everyone right now," said Jeff Cornelius, the secretary of the coalition.

Smart investment

While it may take a lot of money to house this population, a slew of studies have shown that the investment would pay off in the long run.

Individuals living on the streets and in shelters are frequent visitors to area hospitals and emergency rooms. The University of Virginia Medical Center found that last year, 19 chronically homeless people each racked up an average of $10,750 in hospital bills. On average they made nine trips to the emergency room and required 6.6 days of inpatient service, said Noel Dianas-Hughes, a Medical Center manager.

Occasionally, the homeless would feign illness to get off the streets for a night and receive care. More often, though, they came to the emergency room for conditions that would not occur if they had permanent housing, Dianas-Hughes said.

"Many times the emergency room visits could be managed in physicians' offices," she said. "And it would be less expensive overall to the community."

Culhane, the University of Pennsylvania professor, found that placing homeless New York men into supportive housing programs decreased their hospital visits by 70 percent and dropped their total number of hospitalization days by 78 percent.

For each individual who moves from the streets into permanent supportive housing, taxpayers save thousands of dollars, Culhane discovered. Service costs, including hospitalization and incarceration expenses, dropped by more than 40 percent per individual - from $40,451 per year in New York to about $24,000.

"A community can deal with folks living in public spaces, rotating around hospitals and jails, or they can pay for a housing solution which is better for everyone," Culhane said.

"And the fact is, it's a break-even investment … and a net savings when you get out two years," he added.

A study of a supportive housing program in Seattle found that getting the homeless off the streets and into apartments reduced their jail bookings by 45 percent. And there is little doubt, Charlottesville police say, that they spend valuable time and resources on such people that could be better be used elsewhere.

"It's a help to us, to the community and to the folks themselves to get them off the streets and into stabilized living environment where they can get their lives on track," said Capt. Bryant Bibb of the Charlottesville Police Department.

Successful model

The supportive housing model employed by Region Ten, called "housing first," has proven to be vastly successful.

The traditional method for helping the chronically homeless was to first get them services, medication and counseling. Only then, the theory went, would they be ready to live on their own.

But often the homeless are reluctant to enter facilities or programs that set strict rules, said Joel Hamilton, of Region Ten's Dual Recovery Center.

"Treatment is irrelevant to people who have to worry about whether they will be alive in the morning," Hamilton added.

Under the "housing first" model, developed in New York City 15 years ago, homeless individuals are given apartments without any preconditions such as enrolling in treatment programs.

"People do better in treatment when they have some stability in their housing," said Nan Roman, president of the National Alliance to End Homelessness. "It's silly to expect someone who has a mental illness to get it together while they are thinking about where they are going to sleep every night."

For Esterly, this has proven to be true. A case manager ensures she is taking care of the apartment, while social workers stop by several times a week to provide counseling and drive her on errands. New medication prescribed by doctors has been so effective that she's now looking for volunteer work.

"The social workers are really helpful," Esterly said. "Since I don't know anyone or have any family here, they are always checking in on me."

Funding challenges

Though the benefits of supportive housing may be clear to many, finding additional money will not be easy.

In an economic downturn, less funding will likely be available for such programs. While Charlottesville is spending $2.1 million on affordable housing initiatives this year, including the $238,000 for Region Ten's program, it will likely only set aside $1.4 million in the fiscal 2009 budget.

A slowdown in the real estate market means the city and Albemarle County will have smaller increases in revenue next year and, therefore, may not be able to fully fund all of their priorities, let alone add new programs, officials said.

"Because of our assessments we will have less wiggle room for our budget, so for all of our initiatives we will have to be more targeted," said Ric Barrick, city spokesman. "It will be a year with some tougher choices and some longer debate."

Albemarle officials point out that they fully funded Region Ten's request this year for $566,000, and give money to nearly 50 community agencies.

Homeless advocates remain steadfast in their insistence that spending more on supportive housing programs is a wise investment for the community. And the new $238,000 program, they say, should be viewed as a springboard.

"Clearly the needs are so important and this is a step forward," Mayor Norris said. "But is it enough-"